French protocol for the diagnosis and management of systemic lupus erythematosus.

Autor: Amoura Z; Department of Internal Medicine, Institute E3M, CIMI-Paris, Faculty of medicine, National Reference Centre of Systemic Lupus, Antiphospholipid Syndrome, and Other Autoimmune Diseases, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, boulevard de l'Hôpital, 75013 Paris, France. Electronic address: zahir.amoura@aphp.fr., Bader-Meunier B; Paediatric Immunology and Rhumatologie, Hospital Necker for Sick Children, AP-HP, Paris, France. Electronic address: brigitte.bader-meunier@aphp.fr., Antignac M; Department of Pharmacy, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France., Bardin N; Department of Immunology, Biogénopôle, Timone Hospital, AP-HM, Marseille, France., Belizna C; Department of Internal Medicine, Department Clinique of L'Anjou, Angers, France., Belot A; Department of Paediatric Nephrology, Rheumatology, Dermatology, Reference Centre for Rheumatic, Autoimmune and Systemic Diseases in Children (RAISE), Femme Mère Enfant Hospital, Lyon University Hospital, Bron, France., Bonnotte B; Department of Internal Medicine, Dijon University Hospital, Dijon, France., Bouaziz JD; Department of Dermatology, Saint-Louis Hospital, AP-HP, Paris, France., Chasset F; Department of Dermatology and Allergology, Faculty of Medicine, Tenon Hospital, Sorbonne University, Paris, France., Chiche L; Department of Internal Medicine, Marseille Public University Hospital System, Marseille, France., Cohen F; Department of Internal Medicine, Institute E3M, CIMI-Paris, Faculty of medicine, National Reference Centre of Systemic Lupus, Antiphospholipid Syndrome, and Other Autoimmune Diseases, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, boulevard de l'Hôpital, 75013 Paris, France., Costedoat-Chalumeau N; Department of Internal Medicine, Referral Centre for Rare Autoimmune and Systemic Diseases of Île-de-France, Centre for Epidemiology and Statistics, institut national de la santé et de la recherche médicale, French National Institute for Agricultural Research, Cochin Hospital, AP-HP, University Paris Cité, Paris, France., Daugas E; Department of Nephrology, Bichat-Claude Hospital, AP-HP, Nord University of Paris, Paris, France., Devilliers H; Department of Internal Medicine, Dijon University Hospital, Dijon, France., Diot E; Department of Internal Medicine, Tours University Hospital, Tours, France., Elefant E; Department of Public Health, Teratogens Reference Centre (CRAT), Trousseau Hospital, Sorbonne University, Paris, France., Faguer S; Department of Nephrology and Organ Transplantation, Transplantation, Immunity and Environment (TImE) Research Group, Reference Centre of Rare Renal Diseases, University Hospital of Toulouse, Toulouse, France., Ferreira N; Department of Internal Medicine, Tours University Hospital, Tours, France., Hachulla E; Department of Internal Medicine and Clinical immunology, Reference Centre of Autoimmune Systemic Rare Diseases of North and North-West of France (CeRAINO), Lille University, Inserm, University Hospital of Lille, Lille, France., Hanslik T; Department of Internal Medicine, Ambroise-Paré Hospital, AP-HP, Paris, France., Hie M; Department of Internal Medicine, Institute E3M, CIMI-Paris, Faculty of medicine, National Reference Centre of Systemic Lupus, Antiphospholipid Syndrome, and Other Autoimmune Diseases, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, boulevard de l'Hôpital, 75013 Paris, France., Jourde-Chiche N; Nephrology and Renal Transplant Centre, Conception Hospital, Marseille, France., Le Guern V; Department of Internal Medicine, Referral Centre for Rare Autoimmune and Systemic Diseases of Île-de-France, Centre for Epidemiology and Statistics, institut national de la santé et de la recherche médicale, French National Institute for Agricultural Research, Cochin Hospital, AP-HP, University Paris Cité, Paris, France., Martin T; Department of Internal Medicine and Clinical Immunology, Strasbourg University Hospital, Strasbourg, France., Mathian A; Department of Internal Medicine, Institute E3M, CIMI-Paris, Faculty of medicine, National Reference Centre of Systemic Lupus, Antiphospholipid Syndrome, and Other Autoimmune Diseases, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, boulevard de l'Hôpital, 75013 Paris, France., Michel M; Department of Internal Medicine, National Referral Centre for Autoimmune Cytopenias, Créteil University Hospital, Créteil, France., Miyara M; Department of Immunology, Pitié-Salpêtrière Hospital, AP-HP, University of Sorbonne, Paris, France., Papo T; Department of Internal Medicine, Bichat Hospital, AP-HP, Paris, France., Richez C; Department of Rhumatologie, Bordeaux University Hospital, Bordeaux, France., Scherlinger M; Department of Rhumatologie, Strasbourg University Hospital of Hautepierre, Strasbourg, France., Sibilia J; Department of Rhumatologie, Strasbourg University Hospital of Hautepierre, Strasbourg, France., Uzunhan Y; Department of Pneumology, Centre of Reference for Rare Lung Diseases, Avicenne Hospital, Sorbonne Paris North University, Bobigny, France., Wahl D; Department of Vascular Medicine and National Referral Centre for Rare Vascular and Systemic Autoimmune Diseases, University Hospital of Nancy, Nancy, France., Wojtasik G; Department of Internal Medicine and Clinical immunology, Reference Centre of Autoimmune Systemic Rare Diseases of North and North-West of France (CeRAINO), Lille University, Inserm, University Hospital of Lille, Lille, France., Yelnik C; Department of Internal Medicine and Clinical immunology, Reference Centre of Autoimmune Systemic Rare Diseases of North and North-West of France (CeRAINO), Lille University, Inserm, University Hospital of Lille, Lille, France.
Jazyk: angličtina
Zdroj: La Revue de medecine interne [Rev Med Interne] 2024 Sep; Vol. 45 (9), pp. 559-599. Date of Electronic Publication: 2024 Aug 26.
DOI: 10.1016/j.revmed.2024.07.006
Abstrakt: Because Systemic Lupus Erythematosus (SLE) is a rare disease, and due to the significant prognostic impact of early management, a diagnosis confirmed by a physician with experience in SLE is recommended, for example from an expert center. Once the diagnosis is confirmed, existing manifestations should be identified in particular, renal involvement by an assessment of proteinuria, disease activity and severity should be determined, potential complications anticipated, associated diseases searched for, and the patient's socioprofessional and family context noted. Therapeutic management of SLE includes patient education on recognizing symptoms, understanding disease progression as well as when they should seek medical advice. Patients are informed about routine checkups, treatment side effects, and the need for regular vaccinations, especially if they are receiving immunosuppressive treatment. They are also advised on lifestyle factors such as the risks of smoking, sun exposure, and dietary adjustments, especially when they are receiving corticosteroids. The importance of contraception, particularly when teratogenic medications are being used, and regular cancer screening are emphasized. Support networks can help relieve a patient's isolation. The first-line medical treatment of SLE is hydroxychloroquine (HCQ), possibly combined with an immunosuppressant and/or low-dose corticosteroid therapy. The treatment of flares depends on their severity, and typically involves HCQ and NSAIDs, but may be escalated to corticosteroid therapy with immunosuppressants or biologic therapies in moderate to severe cases. Because there is no curative treatment, the goals of therapy are patient comfort, preventing progression and flares, and preserving overall long-term health and fertility. The frequency of follow-up visits depends on disease severity and any new symptoms. Regular specialized assessments are necessary, especially when treatment changes, but a frequency of every 3 to 6 months is recommended during periods of remission and monthly during active or severe disease, especially in children. These assessments include both clinical and laboratory tests to monitor complications and disease activity, with specific attention to proteinuria.
(Copyright © 2024. Published by Elsevier Masson SAS.)
Databáze: MEDLINE
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