Autoimmune Diseases Research Unit. Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain.
Autoimmune Diseases Research Unit. Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain; Universidad del País Vasco/Euskal Herriko Unibertsitatea, Bizkaia, Spain.
Best Pract Res Clin Rheumatol. 2023 Dec;37(4):101873. doi: 10.1016/j.berh.2023.101873. Epub 2023 Nov 11.
Glucocorticoids (GCs) continue to be essential agents for the management of systemic lupus erythematosus, since there are no other drugs able to active remission of active disease so rapidly. However, their potential for causing irreversible damage greatly limit their use. Fortunately, some strategies may help take advantage of their huge anti-inflammatory power while limiting GC-induced side effects. This article reviews the pharmacological basis of GC action and their translation into the clinical ground. We also offer the practical approach for the use of GC in induction and maintenance therapy as well as the strategies for GC withdrawal of the respective practice of the authors. The three main basic principles are a) using methyl-prednisolone pulses to induce remission not only in severe disease; b) limiting initial doses of prednisone to ≤30 mg/d, with rapid tapering to ≤5 mg/d, which should be the dose for maintenance therapy; and c) individualizing the decision and the strategy to withdraw GCs. Long-term therapy with HCQ and the early introduction of immunosuppressive treatment would help achieve these objectives.
糖皮质激素（GCs）仍然是治疗系统性红斑狼疮的重要药物，因为目前尚无其他药物能够如此迅速地使疾病活动得到缓解。然而，它们引起不可逆转损害的潜力极大地限制了它们的应用。幸运的是，一些策略可能有助于在限制 GC 诱导的副作用的同时，发挥其巨大的抗炎作用。本文综述了 GC 作用的药理学基础及其在临床中的转化。我们还提供了 GC 在诱导和维持治疗中的使用以及 GC 撤药策略的实用方法，这些策略是根据作者的实践经验提出的。三个主要的基本原则是：a）使用甲基泼尼松龙脉冲不仅在严重疾病中诱导缓解；b）将泼尼松的初始剂量限制在≤30mg/d，快速减量至≤5mg/d，这应该是维持治疗的剂量；c）个体化决定和撤药策略。长期应用 HCQ 和早期引入免疫抑制治疗将有助于实现这些目标。
