Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA.
Handb Exp Pharmacol. 2022;272:181-208. doi: 10.1007/164_2021_551.
Many rheumatologic diseases are thought to originate in dysregulation of the immune system; lupus nephritis, for example, involves humoral immunity, while autoinflammatory diseases such as familial Mediterranean fever are caused by defects in innate immunity. Of note, this dysregulation may involve both upregulation of immune system components and aspects of immunodeficiency. Treatment of rheumatologic diseases thus requires a familiarity with a variety of immunosuppressive medications and their effects on immune system function.In many rheumatologic conditions, due to an incompletely elucidated mechanism of disease, immunosuppression is relatively broad in contrast to agents used, for example, in treatment of transplant rejection. Multiple immunosuppressive drugs may also be used in succession or in combination. As such, an understanding of the mechanisms and targets of immunosuppressive drugs is essential to appreciating their utility and potential adverse effects. Because of the overlap between therapies used in rheumatologic as well as other inflammatory disorders, some of these medications are discussed in other disease processes (e.g., Immunosuppression for inflammatory bowel disease) or in greater detail in other chapters of this textbook (corticosteroids, mTOR inhibitors, antiproliferative agents).
许多风湿性疾病被认为起源于免疫系统失调；例如狼疮性肾炎涉及体液免疫，而家族性地中海热等自身炎症性疾病则是由先天免疫缺陷引起的。值得注意的是，这种失调可能涉及免疫系统成分的上调和免疫缺陷的各个方面。因此，风湿性疾病的治疗需要熟悉各种免疫抑制药物及其对免疫系统功能的影响。在许多风湿性疾病中，由于疾病机制尚未完全阐明，与例如用于治疗移植排斥的药物相比，免疫抑制作用相对广泛。也可能连续或联合使用多种免疫抑制药物。因此，了解免疫抑制药物的机制和靶点对于理解其用途和潜在的不良反应至关重要。由于风湿性疾病以及其他炎症性疾病中使用的治疗方法有重叠，因此这些药物中的一些在其他疾病过程中进行了讨论（例如，炎症性肠病的免疫抑制治疗），或在本教科书的其他章节中进行了更详细的讨论（皮质类固醇、mTOR 抑制剂、抗增殖剂）。
