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Dtsch Med Wochenschr 2020; 145(16): 1179-1183
DOI: 10.1055/a-1037-5326
Klinischer Fortschritt
Rheumatologie

Lupus 2020

Lupus 2020
Johanna Mucke
  Poliklinik für Rheumatologie, Heinrich-Heine-Universität Düsseldorf
,
Matthias Schneider
  Poliklinik für Rheumatologie, Heinrich-Heine-Universität Düsseldorf
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Was ist neu?

Klassifikation 2020 Die neuen ACR/EULAR-Klassifikationskriterien für den systemischen Lupus erythematodes (SLE) stellen einen wichtigen Beitrag zur Optimierung klinischer Studien und eine Hilfestellung zur Diagnostik dar. So kann ein SLE erst als solcher klassifiziert werden, wenn antinukleäre Antikörper (ANA) ab einer Titerhöhe von 1:80 unabhängig vom Fluoreszenzmuster nachgewiesen werden. Sind ANA nachgewiesen, erhalten Lupus-spezifische Symptome und serologische Auffälligkeiten eine unterschiedliche Wichtung für die Klassifikation.

Therapie 2020 Mit der Überarbeitung der EULAR-Empfehlungen zum Management des SLE sowie der Lupusnephritis und des Antiphospholipid-Syndroms stehen nun wichtige neue Therapieprinzipien zur Verfügung. So sollte jede Lupus-Therapie ganz im Sinne eines Treat-to-Target-Ansatzes das Ziel der Remission verfolgen. Dies dient der Sicherung des Langzeitüberlebens, der Reduktion von Schaden sowie der Verbesserung von Lebensqualität. Erreicht werden diese Ziele durch konsequente Therapie auf Basis einer regelmäßigen Evaluation der Krankheitsaktivität. Alle Patienten sollen bei Abwesenheit von Kontraindikationen Antimalariamittel erhalten. Bei unzureichendem Ansprechen auf Antimalariamittel bzw. organgefährdende Manifestationen werden Steroidpulse (über wenige Tage) sowie der frühzeitige Einsatz von Immunsuppressiva (IM) und Biologika wie Belimumab und Rituximab (off-label) empfohlen.

Abstract

The publication of the new ACR/EULAR classification criteria for systemic lupus erythematosus (SLE) and the revision of the EULAR recommendations for the management of SLE last year include many important novelties that will change the classification and care of lupus patients. This refers to both general basic treatment principles and specific therapy recommendations. For example, SLE can only be classified as such if antinuclear antibodies (ANA) are present, independently of titer height and fluorescence pattern. If ANAs are detected, lupus-specific symptoms and serological abnormalities are assessed and separately scored. A score of 10 and more classifies an SLE patient as such. With regard to the care of SLE patients, every therapeutic decision should follow a treat-to-target approach with the aim of achieving remission. Aim is to ensure long-term survival, reduce damage and improve quality of life. These goals are achieved by early diagnosis, consistent therapy and regular evaluation of disease activity. All patients should receive antimalarials in the absence of contraindications. If the response is inadequate or in case of moderate to severe organ manifestations, steroid pulses over a few days and the early use of immunosuppressive drugs (IM) are recommended. With the inclusion of biologicals, especially belimumab and rituximab, new substance classes made their way into the recommendations.

Schlüsselwörter

systemischer Lupus erythematodes - Klassifikationskriterien - Treat-to-Target - EULAR-Empfehlungen

Key words

systemic lupus erythematosus - classification criteria - treat-to-target - EULAR recommendations


Publication History

Article published online:
07 July 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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