2023 Version Ntawm EULAR Lupus Kev Tswj Xyuas Cov Lus Pom Zoo Ceev Cov Txheej Txheem, Hormone Maintenance Dose Txo kom tsawg dua lossis sib npaug rau 5mg / d

Systemic lupus erythematosus (SLE) yog ib qho ntawm cov kab mob sib txuas ntau tshaj plaws hauv Department of Rheumatology thiab Immunology. Cov kev kho mob tshwm sim, chav kawm, thiab prognosis ntawm cov neeg mob sib txawv. Nyob rau xyoo 2008, European League Against Rheumatism (EULAR) thawj zaug tsim cov txheej txheem kev tswj hwm SLE thiab hloov kho cov lus pom zoo hauv 2019 nrog qhov tshwm sim ntawm cov kev xav tau tshiab thiab cov ntaub ntawv tshiab hauv SLE teb. Nyob rau ntawm 2023 EULAR lub rooj sib tham txhua xyoo, xibfwb Dimitrios Boumpas, tus lwm thawj editor-in-chief ntawm EULAR cov ntaub ntawv xov xwm "Annals ntawm Rheumatic Diseases", tau qhia txog qhov tseeb version ntawm SLE tswj cov lus pom zoo hauv 2023, suav nrog 5 cov ntsiab lus dav dav thiab 13 cov lus pom zoo. Kab lus no tau teeb tsa raws li hauv qab no.

Nyem rau cistanche tubulosa extract rau mob raum

Cov ntsiab lus tseem ceeb ntawm 2023 Lupus Cov Lus Pom Zoo

Kev kuaj mob ntxov thiab kev kho mob tseem ceeb heev.

Glucocorticoids tuaj yeem cawm txoj sia tab sis tib lub sijhawm ua rau muaj kev phiv ntau dhau.

Kev siv lub sijhawm luv luv ntawm glucocorticoids raws li kev kho mob bridging yog qhov zoo dua, tab sis qee tus neeg mob yuav xav tau kev siv mus ntev, thiab cov koob tshuaj pom zoo yog tsawg dua lossis sib npaug li 5 mg / kg / d (prednisone ua piv txwv) es tsawg dua lossis sib npaug li 7.5 mg / d.

Lub hom phiaj ntawm kev kho mob tuaj yeem yog kev tshem tawm lossis kev ua haujlwm ntawm cov kab mob lupus qis (LLDAS), tab sis cov koob tshuaj ntawm glucocorticoids yuav tsum tsawg dua lossis sib npaug li 5 mg / d (prednisone ua piv txwv).

Biologics tuaj yeem pab txo qhov koob tshuaj ntawm glucocorticoids thaum pab cov neeg mob ua tiav kev tshem tawm LLDAS thiab txo qis rov qab thiab qhov txhab.

Lub hauv paus ntsiab lus

A. SLE yuav tsum muaj ntau txoj kev qhuab qhia, kev tswj hwm tus kheej raws li tus neeg mob kev kawm thiab kev txiav txim siab sib koom, suav nrog tus nqi ntawm tus kheej thiab kev sib raug zoo.

B. Kev ua haujlwm ntawm tus kab mob SLE yuav tsum raug ntsuas ntawm txhua qhov kev mus ntsib (ntau zaus yog nyob ntawm tus kws kho mob txiav txim siab) thiab kev puas tsuaj visceral yuav tsum raug soj ntsuam (tsawg kawg ib xyoos ib zaug) siv cov kev kuaj pom tseeb.

C. Cov kev pabcuam uas tsis yog tshuaj khomob, suav nrog kev tiv thaiv lub hnub, kev haus luam yeeb, kev noj zaub mov kom zoo, kev tawm dag zog ib txwm, thiab kev ntsuas los txhawb cov pob txha noj qab haus huv, yog qhov tseem ceeb rau kev txhim kho cov neeg mob mus ntev.

D. Kev cuam tshuam tshuaj yeeb tshuaj yuav tsum tau coj los ntawm tus neeg mob tus yam ntxwv, hom thiab qhov hnyav ntawm kev koom tes hauv nruab nrog cev, kev kho mob ntsig txog kev puas tsuaj, comorbidities, kev pheej hmoo ntawm kev puas tsuaj ntawm lub cev, thiab cov neeg mob nyiam.

E. Kev kuaj mob ntxov ntxov ntawm SLE (xws li kev ntsuam xyuas serological), kev tshuaj ntsuam xyuas tsis tu ncua rau kev koom tes hauv visceral (tshwj xeeb tshaj yog nephritis), kev kho mob raws sij hawm kom ua tiav kev tshem tawm (lossis tsawg kawg txo cov kab mob ua haujlwm), thiab kev ua raws li kev kho mob nruj heev yog qhov tseem ceeb rau kev tiv thaiv kev rov tshwm sim thiab visceral kev koom tes. kev puas tsuaj, txhim kho kev cia siab, thiab txhim kho lub neej zoo yog qhov tseem ceeb.

13 cov lus qhia

➤ Cov Lus Qhia 1: Tshwj tsis yog tias muaj contraindications, hydroxychloroquine raug pom zoo rau txhua tus neeg mob SLE (1b/A), lub hom phiaj koob tshuaj yog 5mg / kg / d raws li qhov hnyav ntawm lub cev (2b / B), tab sis nws yuav tsum tau ua raws li cov lus pom zoo. Kev pheej hmoo rov tshwm sim (2b / B) thiab Retinal toxicity raug kho ib tus zuj zus.

➤ Cov Lus Qhia 2: Cov koob tshuaj ntawm glucocorticoid (GC) yuav tsum tau txiav txim siab raws li hom thiab qhov hnyav ntawm kev koom tes hauv lub cev (2b/C), thiab cov koob tshuaj yuav tsum txo qis rau 5 mg / d ( noj prednisone ua piv txwv) (2a / B), thiab txiav cov tshuaj yog tias ua tau; rau cov neeg mob uas muaj tus kab mob nruab nrab mus rau qhov hnyav, kev kho mob methylprednisolone pulse therapy (125-1000 mg ib hnub rau 1-3 hnub) yuav raug txiav txim siab (3b/C).

➤ Daim Ntawv Pom Zoo 3: Rau cov neeg mob uas tsis teb rau hydroxychloroquine (ib leeg lossis ua ke nrog GC), lossis leej twg tsis tuaj yeem txo GC qis dua qhov kev saib xyuas, ntxiv cov tshuaj immunomodulator/immunosuppressant (xws li methotrexate [1b/B], azathioprine [ 2b/C] los yog mycophenolate mofetil (2a/B)), thiab/los yog biologics (piv txwv li, belimumab [1a/A] los yog nivolumab [1a/A]).

➤ Daim Ntawv Pom Zoo 4: Intravenous cyclophosphamide (2b/C) yuav tsum raug txiav txim siab rau cov neeg mob uas muaj lub cev los yog muaj kev phom sij rau lub neej; Hauv cov xwm txheej refractory, rituximab (2b / C) tuaj yeem txiav txim siab.

➤ Daim Ntawv Pom Zoo 5: Cov kev kho mob rau cov kab mob ntawm daim tawv nqaij nquag hauv SLE yuav tsum muaj cov tshuaj tua kab mob (GC, calcineurin inhibitors) (2b/B), tshuaj tiv thaiv kab mob (hydroxychloroquine, chloroquine) (1a/A), thiab/lossis daim ntawv thov ntawm GC ( 4/C), methotrexate (1b/B), mycophenolate mofetil (4/C), anifrolumab (1a/A) los yog belimumab (1a/B) tuaj yeem siv los ua txoj kab thib ob.

➤ Daim Ntawv Pom Zoo 6: Kev kho mob ntawm cov kab mob neuropsychiatric lupus yuav tsum suav nrog GC thiab cov tshuaj tiv thaiv kab mob rau kev mob tshwm sim (1b/A) thiab cov tshuaj antiplatelet / anticoagulants rau atherothrombosis / antiphospholipid antibody-related manifestations Kev kho mob (2b/C).

➤ Pom zoo 7: Rau kev kho mob hnyav ntawm autoimmune thrombocytopenia: high-dose GC (xws li intravenous methylprednisolone pulse therapy) (4/C), nrog lossis tsis muaj intravenous immunoglobulin G (4/C), thiab/los yog rituximab (2/B) , thiab/los yog cov koob tshuaj ntau hauv cov hlab ntsha cyclophosphamide (4/C), rituximab (2b/B), azathioprine (2b/C), mycophenolate mofetil (2b/C), lossis cyclosporine (4/C).

➤ Daim Ntawv Pom Zoo 8: Cov neeg mob uas muaj tus mob lupus nephritis yuav tsum tau txais koob tshuaj tsawg (EuroLupus) cov tshuaj tua kab mob cyclophosphamide (1a/A) lossis mycophenolate mofetil (1a/A) ua ke nrog GC (intravenous methylprednisolone tom qab noj GC); kev sib xyaw ua ke ntawm belimumab (ua ke nrog cyclophosphamide lossis mycophenolate mofetil [1b/A]) lossis calcineurin inhibitor (tshwj xeeb yog voclosporin lossis tacromol ua ke nrog mycophenolate mofetil, 1b / A).

➤ Pom zoo 9: Tom qab lub raum teb, kev kho mob lupus nephritis yuav tsum tau txuas ntxiv mus ntev li 3 xyoos (2b/B); pib siv mycophenolate mofetil ib leeg lossis ua ke nrog belimumab lossis calcineurin inhibitor Cov neeg mob kho nrog lwm tus neeg ua haujlwm yuav tsum txuas ntxiv nrog cov neeg ua haujlwm no (1a / A), thaum cov neeg mob pib kho nrog cyclophosphamide ib leeg (1a / A) lossis ua ke nrog belimumab (1a / A) yuav tsum tau kho nrog mecomolecox Phenyl esters lossis azathioprine es tsis txhob siv cyclophosphamide.

➤ Daim Ntawv Pom Zoo 10: Rau cov neeg mob uas muaj kev pheej hmoo siab rau lub raum tsis ua haujlwm (txhais tias txo qis glomerular filtration rate, muaj fibrous crescents, fibrinous necrosis, glomerular atrophy / interstitial fibrosis), cov koob tshuaj ntau yuav raug txiav txim siab (NIH raws tu qauv) Intravenous cyclophosphamide (1a / A. ) ua ke nrog kev kho mob hauv cov hlab ntsha methylprednisolone pulse.

➤ Daim Ntawv Pom Zoo 11: Hauv cov neeg mob SLE uas ua tiav qhov kev tso tawm tsis tu ncua, kev kho mob yuav tsum tau txiav txim siab, nrog GC txiav ua ntej (2a / B).

➤ Daim Ntawv Pom Zoo 12: Rau cov neeg mob uas muaj thrombotic antiphospholipid syndrome (APS), tom qab thawj cov hlab ntsha lossis qhov tsis muaj qhov tshwm sim venous thrombotic (1b/B), vitamin K antagonists yuav tsum tau noj mus ntev; Cov tshuaj aspirin qis (75-100 mg/hnub) tuaj yeem siv los ua kev tiv thaiv thawj zaug hauv cov neeg mob SLE / non-APS uas muaj kev pheej hmoo siab antiphospholipid antibody profile (2a / B).

➤ Daim Ntawv Pom Zoo 13: Kev txhaj tshuaj tiv thaiv kab mob yuav tsum tau txhaj tshuaj tiv thaiv kab mob (HZV, HPV, mob khaub thuas, COVID-19, thiab pneumococcus), pob txha noj qab haus huv, tiv thaiv lub raum, thiab kev pheej hmoo ntawm cov hlab plawv yuav tsum tau tswj hwm, thiab yuav tsum tau kuaj mob malignancy (-/ D).