• Annegret Kuhn, Gisela Bonsmann, Hans-Joachim Anders, Peter Herzer, Klaus Tenbrock, and Matthias Schneider.
• Interdisciplinary Center for Clinical Studies (IZKS), University Medical Center, Mainz, Department of Dermatology, University Hospital of Münster, Nephrological Center, Department of Medicine IV, University Hospital, LMU München, Private practice in internal medicine and rheumatology, München, Department of Pediatric and Adolescent Medicine, University Hospital, RWTH Aachen, Department of Rheumatology, Düsseldorf University Hospital, Düsseldorf.
• Dtsch Arztebl Int. 2015 Jun 19; 112 (25): 423-32.

BackgroundSystemic lupus erythematosus (SLE) is an autoimmune disease with a prevalence of 36.7/100 000 in Germany and a female/male ratio of 4:1. The clinical course is variable, with a broad spectrum of organ manifestations; lupus nephritis develops in about half of all patients.MethodsThis review is based on a selective search of PubMed and the Cochrane Library, including current guidelines and expert recommendations.ResultsAssessment of clinical symptoms, laboratory findings, and optional biopsy results are the basis for early diagnosis of SLE. All patients should be treated with antimalarials as soon as the diagnosis is confirmed. In particular, hydroxychloroquine is associated with a higher rate of remission, fewer relapses, and reduced damage in the course of the disease, even in lupus nephritis. High-dose glucocorticoids should be given only when acutely indicated; immunosuppressives such as azathioprine, methotrexate, or mycophenolate mofetil may be administered to reduce glucocorticoids, according to the EULAR recommendations. Belimumab was recently approved as add-on therapy in autoantibody-positive SLE patients with high disease activity unresponsive to standard treatment. Short-term induction pulse therapy with low-dose intravenous cyclophosphamide, as well as continued mycophenolate mofetil treatment are advances in lupus nephritis.ConclusionThe long-term prognosis for SLE has improved markedly in recent decades because of earlier diagnosis and optimized treatment. Further research and randomized controlled trials are needed for the development of specifically targeted therapies.

18 keywords...

hide…