Glucocorticoids in Systemic Lupus Erythematosus. Ten Questions and Some Issues

Porta, Sabrina; Danza, Ãlvaro; Saavedra, Maira Arias; Carlomagno, Adriana; Goizueta, María Cecilia; Vivero, Florencia; Ruiz‐Irastorza, Guillermo

doi:10.3390/jcm9092709

Cited by 72 publications

(68 citation statements)

References 56 publications

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“…GCs use, immunosuppressive therapy and lupus nephritis are the most important risk factor for infections in SLE patients. GCs related risk of infection increases by 12% for each mg/day of prednisone, thus is already high at 7.5 mg/day which is considered relatively safe for damage accrual [ 68 ]. In a recent meta-analysis, GCs were associated with an increased risk of COVID-19 in patients with autoimmune diseases including SLE [ 69 ].…”

Section: Preventing Comorbiditiesmentioning

confidence: 99%

The Main Challenges in Systemic Lupus Erythematosus: Where Do We Stand?

Piga

Arnaud

2021

JCM

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Systemic lupus erythematosus (SLE) is an immune-mediated multi-systemic disease characterized by a wide variability of clinical manifestations and a course frequently subject to unpredictable flares. Despite significant advances in the understanding of the pathophysiology and optimization of medical care, patients with SLE still have significant mortality and carry a risk of progressive organ damage accrual and reduced health-related quality of life. New tools allow earlier classification of SLE, whereas tailored early intervention and treatment strategies targeted to clinical remission or low disease activity could offer the opportunity to reduce damage, thus improving long-term outcomes. Nevertheless, the early diagnosis of SLE is still an unmet need for many patients. Further disentangling the SLE susceptibility and complex pathogenesis will allow to identify more accurate biomarkers and implement new ways to measure disease activity. This could represent a major step forward to find new trials modalities for developing new drugs, optimizing the use of currently available therapeutics and minimizing glucocorticoids. Preventing and treating comorbidities in SLE, improving the management of hard-to-treat manifestations including management of SLE during pregnancy are among the remaining major unmet needs. This review provides insights and a research agenda for the main challenges in SLE.

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Section: Preventing Comorbiditiesmentioning

confidence: 99%

The Main Challenges in Systemic Lupus Erythematosus: Where Do We Stand?

Piga

Arnaud

2021

JCM

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“…Although it crosses the placenta after the 2nd trimester and in a more significant way after the 3rd trimester, no fetal malformations have been reported. Hence, it is considered a drug compatible with pregnancy [62].…”

Section: Intravenous Immunoglobulinmentioning

confidence: 99%

Systemic Lupus Erythematosus Pregnancy

Fernandes¹,

Bernardino²,

Taulaigo³

et al. 2021

Lupus - Need to Know

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Systemic Lupus Erythematosus (SLE) is an autoimmune disease of unknown etiology that often affects women during childbearing age. Pregnant women with SLE are considered high-risk patients, with pregnancy outcomes being complicated by high maternal and fetal mortality and morbidity. Obstetric morbidity includes preterm birth, fetal growth restriction (FGR), and neonatal lupus syndromes. Active SLE during conception is a strong predictor of adverse pregnancy outcomes and exacerbations of disease can occur more frequently during gestation. Therefore, management of maternal SLE should include preventive strategies to minimize disease activity and to reduce adverse pregnancy outcomes. Patients with active disease at time of conception have increased risk of flares, like lupus nephritis, imposing a careful differential diagnosis of pre-eclampsia, keeping in mind that physiological changes of pregnancy may mimic a lupus flare. Major complications arise when anti-phospholipid antibodies are present, like recurrent pregnancy loss, stillbirth, FGR, and thrombosis in the mother. A multidisciplinary approach is hence crucial and should be initiated to all women with SLE at childbearing age with an adequate preconception counseling with assessment of risk factors for adverse maternal and fetal outcomes with a tight pregnancy monitoring plan. Although treatment choices are limited during pregnancy, prophylactic anti-aggregation and anticoagulation agents have proven beneficial in reducing thrombotic events and pre-eclampsia related morbidity. Pharmacological therapy should be tailored, allowing better outcomes for both the mother and the baby. Immunosuppressive and immunomodulators, must be effective in controlling disease activity and safe during pregnancy. Hydroxychloroquine is the main therapy for SLE due to its anti-inflammatory and immunomodulatory effects recommended before and during pregnancy and other immunosuppressive drugs (e.g. azathioprine and calcineurin inhibitors) are used to control disease activity in order to improve obstetrical outcomes. Managing a maternal SLE is a challenging task, but an early approach with multidisciplinary team with close monitoring is essential and can improve maternal and fetal outcomes.

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“…El uso disminuido de hidroxicloroquina y micofenolato de mofetilo se debe a costos. De los pacientes tratados con glucocorticorticoides orales, el 64.6% recibían dosis bajas (< 7.5 mg de prednisona o su equivalente), el 21.8% dosis moderadas (7.5 a 30 mg) y el 4% dosis altas (> 30 mg) (23,25).…”

Section: Manejounclassified

Descripción clínica de pacientes con Lupus Eritematoso Sistémico evaluados en un Centro Especializado en Enfermedades Reumáticas de la Ciudad de Guatemala (AGAR)

López¹,

Bustamante²,

Kramer³

et al. 2021

Global Rheumatology

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LES es una enfermedad autoinmune inflamatoria crónica, caracterizada por el incremento de autoanticuerpos que genera inflamación sistémica y afectación multiorgánica. En la etiopatogenia intervienen factores genéticos, hormonales, y ambientales, y se presenta como un conjunto de manifestaciones clínicas muy variables, por lo que su diagnóstico es un reto para el médico tratante. Esta enfermedad es de dominancia mundial y se presenta en todos los grupos étnicos, con una mayor prevalencia en los afroamericanos. Según The Lupus Foundation of America, 1,5 millones de estadounidenses y al menos 5 millones de personas en todo el mundo tienen alguna forma de lupus.

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Glucocorticoids in Systemic Lupus Erythematosus. Ten Questions and Some Issues

Cited by 72 publications

References 56 publications

The Main Challenges in Systemic Lupus Erythematosus: Where Do We Stand?

The Main Challenges in Systemic Lupus Erythematosus: Where Do We Stand?

Systemic Lupus Erythematosus Pregnancy

Descripción clínica de pacientes con Lupus Eritematoso Sistémico evaluados en un Centro Especializado en Enfermedades Reumáticas de la Ciudad de Guatemala (AGAR)

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