Refractory disease in Systemic Lupus Erythematosus

被引:18
作者
Campar, Ana [1 ]
Farinha, Fatima [1 ]
Vasconcelos, Carlos [1 ]
机构
[1] Santo Antonio Hosp, Dept Internal Med, P-4099001 Oporto, Portugal
关键词
CUTANEOUS LUPUS; INNOVATIVE USES; RITUXIMAB; ANTI-CD20; EFFICACY; THROMBOCYTOPENIA; PREVALENCE; MANAGEMENT; SAFETY;
D O I
10.1016/j.autrev.2011.04.027
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
There is no definition or guidelines for refractory disease (RD) in Systemic Lupus Erythematosus (SLE). However, new therapies have been tested mainly in refractory patients. The concept, like the disease, is complex and implies deeper knowledge on the disease pathogenesis and patients' subsets. RD is not included in current activity indices of the disease, what raises the question of how are we monitoring its response to new drugs. In this paper, we analyse some concepts considered important for the global definition of RD in SLE and in some specific organ involvements, excluding lupus nephritis. Management issues will be addressed also. Finally, we review therapeutic options in particular subsets of the disease, namely, cutaneous, articular, haematological and neuropsychiatric lupus. Crucial to the management of a patient suspected to be refractory is an accurate diagnosis, assuring that the persistent clinical manifestations are derived primarily from SLE and not from a concomitant or alternative process. Likewise, certainty about the patient compliance with the therapy prescribed is a frequent unrecognized problem that erroneously might lead to a classification of RD. Therapy of RD for SLE, in general and in most particular involvements, is currently based mainly on the clinician's own experience and judgement, with few randomized trials effectively addressing the issue. In such a heterogeneous disease, consideration of approval of drugs for single-organ indications may pave the way for new therapies. Better biomarkers are needed to add accuracy to the currently used activity indices in order to monitor RD and consolidate its definition. Prospective studies directed to RD in the main SLE involvements are needed to improve our understanding on the management of the disease and foster the development of targeted new drugs. (C) 2011 Elsevier B.V. All rights reserved.
引用
收藏
页码:685 / 692
页数:8
相关论文
共 34 条
[1]   The role of tumor necrosis factor-alpha in systemic lupus erythematosus [J].
Aringer, Martin ;
Smolen, Josef S. .
ARTHRITIS RESEARCH & THERAPY, 2008, 10 (01)
[2]   EULAR recommendations for the management of systemic lupus erythematosus. Report of a task force of the EULAR standing committee for international clinical studies including therapeutics [J].
Bertsias, G. ;
Ioannidis, J. P. A. ;
Boletis, J. ;
Bombardieri, S. ;
Cervera, R. ;
Dostal, C. ;
Font, J. ;
Gilboe, I. M. ;
Houssiau, F. ;
Huizinga, T. ;
Isenberg, D. ;
Kallenberg, C. G. M. ;
Khamashta, M. ;
Piette, J. C. ;
Schneider, M. ;
Smolen, J. ;
Sturfelt, G. ;
Tincani, A. ;
van Vollenhoven, R. ;
Gordon, C. ;
Boumpas, D. T. .
ANNALS OF THE RHEUMATIC DISEASES, 2008, 67 (02) :195-205
[3]   EULAR recommendations for the management of systemic lupus erythematosus with neuropsychiatric manifestations: report of a task force of the EULAR standing committee for clinical affairs [J].
Bertsias, G. K. ;
Ioannidis, J. P. A. ;
Aringer, M. ;
Bollen, E. ;
Bombardieri, S. ;
Bruce, I. N. ;
Cervera, R. ;
Dalakas, M. ;
Doria, A. ;
Hanly, J. G. ;
Huizinga, T. W. J. ;
Isenberg, D. ;
Kallenberg, C. ;
Piette, J. C. ;
Schneider, M. ;
Scolding, N. ;
Smolen, J. ;
Stara, A. ;
Tassiulas, I. ;
Tektonidou, M. ;
Tincani, A. ;
van Buchem, M. A. ;
van Vollenhoven, R. ;
Ward, M. ;
Gordon, C. ;
Boumpas, D. T. .
ANNALS OF THE RHEUMATIC DISEASES, 2010, 69 (12) :2074-2082
[4]   Innovative Uses of Rituximab in Dermatology [J].
Carr, David R. ;
Heffernan, Michael P. .
DERMATOLOGIC CLINICS, 2010, 28 (03) :547-+
[5]   Long-term efficacy and safety of rituximab in refractory and relapsing systemic lupus erythematosus [J].
Catapano, Fausta ;
Chaudhry, Afzal N. ;
Jones, Rachel B. ;
Smith, Kenneth G. C. ;
Jayne, David W. .
NEPHROLOGY DIALYSIS TRANSPLANTATION, 2010, 25 (11) :3586-3592
[6]   Innovative Uses of Thalidomide [J].
Chen, Meng ;
Doherty, Sean D. ;
Hsu, Sylvia .
DERMATOLOGIC CLINICS, 2010, 28 (03) :577-+
[7]   Antithrombotic treatment failures in antiphospholipid syndrome: the new anticoagulants? [J].
Cohen, H. ;
Machin, S. J. .
LUPUS, 2010, 19 (04) :486-491
[8]   Low blood concentration of hydroxychloroquine is a marker for and predictor of disease exacerbations in patients with systemic lupus erythematosus [J].
Costedoat-Chalumeau, Nathalie ;
Amoura, Zahir ;
Hulot, Jean-Sebastien ;
Abou Hammoud, Hala ;
Aymard, Guy ;
Cacoub, Patrice ;
Frances, Camille ;
Wechsler, Bertrand ;
Huong, Du Le Thi ;
Ghillani, Pascale ;
Musset, Lucile ;
Lechat, Philippe ;
Piette, Jean-Charles .
ARTHRITIS AND RHEUMATISM, 2006, 54 (10) :3284-3290
[9]  
Delgado Alves Jose, 2004, Eur J Intern Med, V15, P162
[10]   Lupus: improving long-term prognosis [J].
Doria, A. ;
Briani, C. .
LUPUS, 2008, 17 (03) :166-170