Was ist neu?
Paradigmenwechsel in der Klassifikation des systemischen Lupus erythematodes Der Nachweis der antinukleären Antikörper oberhalb des Grenzwerts ist Eingangskriterium
für die Klassifikation des SLE. Diese Klassifikation beinhaltet 10 unterschiedliche
Domänen mit unterschiedlicher Wertigkeit, wobei 10 Punkte für die SLE-Klassifikation
erforderlich sind.
Antiphospholipidsyndrom Aktuelle Empfehlungen zum Antiphospholipidsyndrom differenzieren serologisch ein
Hochrisiko- (u. a. triple-positiv, Nachweis des Lupus-Antikoagulans) und Niedrigrisiko-Profil
(isolierte Anti-Cardiolipin- oder -beta-2-Glykoprotein-I-Antikörper) und begründen
damit z. T. Prophylaxe- und Therapieempfehlungen nach arteriellen und venösen Verschlüssen
sowie geburtshilflichen APS-Komplikationen.
Abstract
Recent advances in rheumatology indicate increased relevance of autoantibodies. In
this regard, positive ANA are now required as entrance criterium for the first EULAR/ACR
classification criteria of SLE. Importantly, ANA diagnostic with detection of isolated
anti-dense fine speckled antibodies (DSF-70) need consideration since their unique
detection has been identified to exclude largely an autoimmune disease. Thus, highly
qualified ANA diagnostic preferably on Hep-2 cell lines is a prerequisite of reliable
diagnostics.
Recent recommendations for the management of antiphospholipid syndrome define high
versus low risk seroprofiles which also guide primary and secondary prophylaxis. Importantly
triple positive APS patients (positive for anticradiolipin, anti-ß2 GP I positive
and carrying lupus anticoagulant) should be treated with vitamin K antagonists while
direct oral anticoagulants have been shown to be inferior in terms of risk/benefit.
Treatment of obstetric APS is mainly based on low dose aspirin and low molecular heparin.
Notably, this treatment should be maintained for 6 weeks after delivery. Thus, serologic
findings provide the basis for certain key clinical decisions and require their reliable
detection.
Schlüsselwörter systemischer Lupus erythematodes - Antiphospholipidsyndrom - Autoantikörper - Autoimmunität
- ANA - Lupus-Antikoagulans
Key words systemic lupus erythematosus - antiphospholipid syndrome - autoantibodies - autoimmunity
- ANA - lupus anticoagulant
