Aktuelle Rheumatologie 2017; 42(04): 285-290
DOI: 10.1055/s-0042-112363
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Systemischer Lupus erythematodes

Systemic Lupus Erythematosus
M. Aringer
1   Medicine III, University Clinical Center Carl Gustav Carus at the TU Dresden, Dresden
,
M. Schneider
2   Rheumatologie, Heinrich-Heine-Universität, Düsseldorf
› Author Affiliations
Further Information

Publication History

Publication Date:
06 September 2016 (online)

Zusammenfassung

Die heutigen Therapieoptionen und -konzepte haben die Chancen von SLE-Patientinnen und -Patienten auf ein langes und gutes Leben mit Lupus deutlich verbessert. Gerade deshalb stellt die Erkrankung weiter eine relevante ärztliche Herausforderung dar. Die Breite der möglichen Organbeteiligung fordert den „Vollblut“-Internisten in jedem Rheumatologen heraus. Schübe, Infektionen und vaskuläre Ereignisse können kaum je längerfristig ausgeschlossen werden und benötigen von Patienten wie Ärzten ein hohes Maß an Aufmerksamkeit. Zusätzlich haben psychische Faktoren oft deutlichen Einfluss auf das Gesamtbild. Dennoch lassen sich für die meisten häufigen Situationen ähnlich wie bei der rheumatoiden Arthritis (RA) klare, einfache Regeln aufstellen. Diese sollen in der vorliegenden Übersicht skizziert werden.

Abstract

Today’s therapeutic options and concepts have greatly improved the chances of SLE patients to live a long and good life with lupus erythematosus. However, this is the very reason why SLE continues to be a considerable challenge for physicians. The broad spectrum of possible organ involvement requires every rheumatologist to be a “full-blooded” internal medicine specialist. Flares, infections and vascular events usually cannot be ruled out in the long run and necessitate vigilance both on the patient’s and the physician’s side. In addition, psychological factors often have a significant impact on the overall picture. Nevertheless, simple and straightforward rules can be formulated for most situations, as was done for rheumatoid arthritis (RA). This review aims to outline these rules.

 
  • Literatur

  • 1 Tan EM, Cohen AS, Fries JF. et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982; 25: 1271-1277
  • 2 Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1997; 40: 1725
  • 3 Petri M, Orbai AM, Alarcon GS. et al. Derivation and validation of systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum 2012; 64: 2677-2686
  • 4 Leuchten N, Brinks R, Hoyer A et al. Anti-nuclear antibodies have high sensitivity for systemic lupus erythematosus: results of a systematic literature review and meta-regression of diagnostic data. Arthritis Rheumatol 2015; 67: (Suppl 10): (abstract 774). Ref Type: Abstract
  • 5 Agmon-Levin N, Damoiseaux J, Kallenberg C. et al. International recommendations for the assessment of autoantibodies to cellular antigens referred to as anti-nuclear antibodies. Ann Rheum Dis 2014; 73: 17-23
  • 6 Aringer M, Schneider M. Recipes systemic lupus erythematosus. Z Rheumatol 2014
  • 7 Touma Z, Gladman DD, Urowitz MB. Vaccination and auto-immune rheumatic diseases: lessons learnt from the 2009 H1N1 influenza virus vaccination campaign. Curr Opin Rheumatol 2013; 25: 164-170
  • 8 Mosca M, Tani C, Aringer M. et al. European League Against Rheumatism recommendations for monitoring patients with systemic lupus erythematosus in clinical practice and in observational studies. Ann Rheum Dis 2010; 69: 1269-1274
  • 9 Yurkovich M, Vostretsova K, Chen W. et al. Overall and cause-specific mortality in patients with systemic lupus erythematosus: a meta-analysis of observational studies. Arthritis Care Res (Hoboken) 2014; 66: 608-616
  • 10 Roman MJ, Shanker BA, Davis A. et al. Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus. N Engl J Med 2003; 349: 2399-2406
  • 11 Specker C. Antiphospholipid syndrome. Z Rheumatol 2015; 74: 191-198
  • 12 Fischer-Betz R, Spathling-Mestekemper S. Pregnancy and inflammatory rheumatic diseases. Z Rheumatol 2013; 72: 669-682
  • 13 Arnaud L, Mathian A, Ruffatti A. et al. Efficacy of aspirin for the primary prevention of thrombosis in patients with antiphospholipid antibodies: an international and collaborative meta-analysis. Autoimmun Rev 2014; 13: 281-291
  • 14 Kim HA, Jeon JY, An JM. et al. C-reactive protein is a more sensitive and specific marker for diagnosing bacterial infections in systemic lupus erythematosus compared to S100A8/A9 and procalcitonin. J Rheumatol 2012; 39: 728-734
  • 15 Listing J, Gerhold K, Zink A. The risk of infections associated with rheumatoid arthritis, with its comorbidity and treatment. Rheumatology (Oxford) 2013; 52: 53-61
  • 16 Ajeganova S, Svensson B, Hafstrom I. Low-dose prednisolone treatment of early rheumatoid arthritis and late cardiovascular outcome and survival: 10-year follow-up of a 2-year randomised trial. BMJ Open 2014; 4: e004259
  • 17 Roubille C, Richer V, Starnino T. et al. The effects of tumour necrosis factor inhibitors, methotrexate, non-steroidal anti-inflammatory drugs and corticosteroids on cardiovascular events in rheumatoid arthritis, psoriasis and psoriatic arthritis: a systematic review and meta-analysis. Ann Rheum Dis 2015; 74: 480-489
  • 18 Winzer M, Aringer M. Use of methotrexate in patients with systemic lupus erythematosus and primary Sjogren’s syndrome. Clin Exp Rheumatol 2010; 28 (Suppl. 61) S156-S159
  • 19 Bertsias G, Ioannidis JP, Boletis J. et al. EULAR recommendations for the management of systemic lupus erythematosus. Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics. Ann Rheum Dis 2008; 67: 195-205
  • 20 Furie R, Petri M, Zamani O. et al. A phase III, randomized, placebo-controlled study of belimumab, a monoclonal antibody that inhibits B lymphocyte stimulator, in patients with systemic lupus erythematosus. Arthritis Rheum 2011; 63: 3918-3930
  • 21 Navarra SV, Guzman RM, Gallacher AE. et al. Efficacy and safety of belimumab in patients with active systemic lupus erythematosus: a randomised, placebo-controlled, phase 3 trial. Lancet 2011; 377: 721-731
  • 22 Houssiau FA, Vasconcelos C, D’Cruz D. et al. The 10-year follow-up data of the Euro-Lupus Nephritis Trial comparing low-dose and high-dose intravenous cyclophosphamide. Ann Rheum Dis 2010; 69: 61-64
  • 23 Bertsias GK, Tektonidou M, Amoura Z. et al. Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis. Ann Rheum Dis 2012; 71: 1771-1782
  • 24 Ginzler EM, Dooley MA, Aranow C. et al. Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. N Engl J Med 2005; 353: 2219-2228
  • 25 Appel GB, Contreras G, Dooley MA. et al. Mycophenolate mofetil versus cyclophosphamide for induction treatment of lupus nephritis. J Am Soc Nephrol 2009; 20: 1103-1112
  • 26 Dooley MA, Jayne D, Ginzler EM. et al. Mycophenolate versus azathioprine as maintenance therapy for lupus nephritis. N Engl J Med 2011; 365: 1886-1895
  • 27 Houssiau FA, D’Cruz D, Sangle S. et al. Azathioprine versus mycophenolate mofetil for long-term immunosuppression in lupus nephritis: results from the MAINTAIN Nephritis Trial. Ann Rheum Dis 2010; 69: 2083-2089
  • 28 Aringer M, Fischer-Betz R, Hiepe F. Statement on the use of mycophenolate mofetil for systemic lupus erythematosus. Z Rheumatol 2013; 72: 575-580
  • 29 Jones RB, Walsh M, Chaudhry AN. et al. Randomized trial of enteric-coated mycophenolate sodium versus mycophenolate mofetil in multi-system autoimmune disease. Clin Kidney J 2014; 7: 562-568
  • 30 Bertsias GK, Ioannidis JP, Aringer M. et al. EULAR recommendations for the management of systemic lupus erythematosus with neuropsychiatric manifestations: report of a task force of the EULAR standing committee for clinical affairs. Ann Rheum Dis 2010; 69: 2074-2082
  • 31 Aringer M, Burkhardt H, Burmester GR. et al. Current state of evidence on „off-label“ therapeutic options for systemic lupus erythematosus, including biological immunosuppressive agents, in Germany, Austria and Switzerland – a consensus report. Lupus 2012; 21: 386-401
  • 32 Alexander T, Sarfert R, Klotsche J. et al. The proteasome inhibitior bortezomib depletes plasma cells and ameliorates clinical manifestations of refractory systemic lupus erythematosus. Ann Rheum Dis 2015; 74: 1474-1478
  • 33 Alexander T, Thiel A, Rosen O. et al. Depletion of autoreactive immunologic memory followed by autologous hematopoietic stem cell transplantation in patients with refractory SLE induces long-term remission through de novo generation of a juvenile and tolerant immune system. Blood 2009; 113: 214-223
  • 34 Illei GG, Shirota Y, Yarboro CH. et al. Tocilizumab in systemic lupus erythematosus: Data on safety, preliminary efficacy, and impact on circulating plasma cells from an open-label phase I dosage-escalation study. Arthritis Rheum 2010; 62: 542-552
  • 35 Merrill JT, Burgos-Vargas R, Westhovens R. et al. The efficacy and safety of abatacept in patients with non-life-threatening manifestations of systemic lupus erythematosus: results of a twelve-month, multicenter, exploratory, phase IIb, randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2010; 62: 3077-3087
  • 36 Cortes-Hernandez J, Egri N, Vilardell-Tarres M. et al. Etanercept in refractory lupus arthritis: An observational study. Semin Arthritis Rheum 2015; 44: 672-679
  • 37 Furie R, Merrill JT, Werth VP et al. Anifrolumab, an anti-interferon alpha receptor monoclonal antibody, in moderate to severe systemic lupus eyrthematosus (SLE). Arthritis Rheumatol 2015; 67 (Suppl 10): #3223 Ref Type: Abstract