Ibrahim Sara T, Edwards Christopher J, Ehrenstein Michael R, Griffiths Bridget, Gordon Caroline, Hewins Peter, Jayne David, Lightstone Liz, McLaren Zoe, Rhodes Benjamin, Vital Edward M, Reynolds John A
Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
Internal Medicine and Nephrology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Rheumatol Adv Pract. 2024 Feb 9;8(1):rkae017. doi: 10.1093/rap/rkae017. eCollection 2024.
Outcomes of therapy for LN are often suboptimal. Guidelines offer varied options for treatment of LN and treatment strategies may differ between clinicians and regions. We aimed to assess variations in the usual practice of UK physicians who treat LN.
We conducted an online survey of simulated LN cases for UK rheumatologists and nephrologists to identify treatment preferences for class IV and class V LN.
Of 77 respondents, 48 (62.3%) were rheumatologists and 29 (37.7%) were nephrologists. A total of 37 (48.0%) reported having a joint clinic between nephrologists and rheumatologists, 54 (70.0%) reported having a multidisciplinary team meeting for LN and 26 (33.7%) reported having a specialized lupus nurse. Of the respondents, 58 (75%) reported arranging a renal biopsy before starting the treatment. A total of 20 (69%) of the nephrologists, but only 13 (27%) rheumatologists, reported having a formal departmental protocol for treating patients with LN ( < 0.001). The first-choice treatment of class IV LN in pre-menopausal patients was MMF [41 (53.2%)], followed by CYC [15 (19.6%)], rituximab [RTX; 12 (12.5%)] or a combination of immunosuppressive drugs [9 (11.7%)] with differences between nephrologists' and rheumatologists' choices ( = 0.026). For class V LN, MMF was the preferred initial treatment, irrespective of whether proteinuria was in the nephrotic range or not. RTX was the preferred second-line therapy for non-responders.
There was variation in the use of protocols, specialist clinic service provision, biopsies and primary and secondary treatment choices for LN reported by nephrologists and rheumatologists in the UK.
狼疮性肾炎（LN）的治疗效果往往不尽人意。指南为LN的治疗提供了多种选择，不同临床医生和地区的治疗策略可能存在差异。我们旨在评估英国治疗LN的医生在常规治疗中的差异。
我们对英国风湿病学家和肾病学家进行了一项关于模拟LN病例的在线调查，以确定IV级和V级LN的治疗偏好。
77名受访者中，48名（62.3%）为风湿病学家，29名（37.7%）为肾病学家。共有37名（48.0%）报告称肾病学家和风湿病学家设有联合门诊，54名（70.0%）报告称针对LN召开了多学科团队会议，26名（33.7%）报告称设有专门的狼疮护士。在受访者中，58名（75%）报告在开始治疗前安排了肾活检。共有20名（69%）肾病学家报告有正式的科室治疗LN患者的方案，但只有13名（27%）风湿病学家有（P＜0.001）。绝经前IV级LN患者的首选治疗是霉酚酸酯（MMF）[41名（53.2%）]，其次是环磷酰胺（CYC）[15名（19.6%）]、利妥昔单抗[RTX；12名（12.5%）]或免疫抑制药物联合使用[9名（11.7%）]，肾病学家和风湿病学家的选择存在差异（P = 0.026）。对于V级LN，无论蛋白尿是否处于肾病范围，MMF都是首选的初始治疗。RTX是无反应者的首选二线治疗。
英国肾病学家和风湿病学家报告的LN治疗方案使用、专科门诊服务提供、活检以及一线和二线治疗选择存在差异。
