本文由小咖机器人翻译整理

期刊来源：Lancet

原文链接：https://doi.org/10.1016/S0140-6736(24)00398-2

摘要内容如下：

系统性红斑狼疮（SLE）是一种多系统自身免疫性疾病，其特征是针对核抗原的自身抗体、免疫复合物沉积和典型靶器官（如皮肤、关节和肾脏）的慢性炎症。尽管SLE的诊断和治疗取得了实质性进展，但疾病负担仍然很高。重要的是要了解典型的表现和诊断过程，以促进患者的早期转诊和诊断。在大多数患者中，体质性、皮肤粘膜和肌肉骨骼症状是最早的主诉；这些症状包括疲劳、狼疮特有的皮疹、口腔溃疡、脱发、关节痛和肌痛。在本次研讨会中，我们将根据最新的分类标准讨论症状的诊断方法，其中包括对临床表现（在每个领域内加权）和自身抗体谱（如抗双链DNA、抗SM、低补体血症或抗磷脂抗体）的系统评估。非药物治疗管理是为个人量身定制的，通过特定的生活方式干预和患者教育来改善生活质量和药物（如羟氯喹或免疫抑制剂）依从性。在过去的十年中，SLE和狼疮性肾炎的治疗取得了一些重大突破，如贝利木单抗（belimumab）、Anifrolumab和Voclosporin。然而，病程仍然多变，死亡率高得令人无法接受。在世界不同地区，获得这些昂贵药物的途径也受到限制。尽管如此，对治疗目标和策略的理解有所提高。我们认识到，治疗的主要目标是实现病情缓解或降低疾病活动度。由于疾病活动和治疗不良反应引起的合并症，特别是感染、骨质疏松症和心血管疾病，需要警惕预防和管理策略。调整治疗方案以达到缓解，同时平衡与治疗相关的合并症，是SLE管理的优先领域。

英文原文如下：

Abstracts

Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease characterised by the presence of autoantibodies towards nuclear antigens, immune complex deposition, and chronic inflammation at classic target organs such as skin, joints, and kidneys. Despite substantial advances in the diagnosis and management of SLE, the burden of disease remains high. It is important to appreciate the typical presentations and the diagnostic process to facilitate early referral and diagnosis for patients. In most patients, constitutional, mucocutaneous, and musculoskeletal symptoms represent the earliest complaints; these symptoms can include fatigue, lupus-specific rash, mouth ulcers, alopecia, joint pain, and myalgia. In this Seminar we will discuss a diagnostic approach to symptoms in light of the latest classification criteria, which include a systematic evaluation of clinical manifestations (weighted within each domain) and autoantibody profiles (such as anti-double-stranded DNA, anti-Sm, hypocomplementaemia, or antiphospholipid antibodies). Non-pharmacotherapy management is tailored to the individual, with specific lifestyle interventions and patient education to improve quality of life and medication (such as hydroxychloroquine or immunosuppressant) adherence. In the last decade, there have been a few major breakthroughs in approved treatments for SLE and lupus nephritis, such as belimumab, anifrolumab, and voclosporin. However the disease course remains variable and mortality unacceptably high. Access to these expensive medications has also been restricted across different regions of the world. Nonetheless, understanding of treatment goals and strategies has improved. We recognise that the main goal of treatment is the achievement of remission or low disease activity. Comorbidities due to both disease activity and treatment adverse effects, especially infections, osteoporosis, and cardiovascular disease, necessitate vigilant prevention and management strategies. Tailoring treatment options to achieve remission, while balancing treatment-related comorbidities, are priority areas of SLE management.

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