3
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Felten R, Sagez F, Gavand PE, Martin T, Korganow AS, Sordet C, Javier RM, Soulas-Sprauel P, Rivière M, Scher F, Poindron V, Guffroy A, Arnaud L. 10 most important contemporary challenges in the management of SLE. Lupus Sci Med 2019; 6:e000303. [PMID: 30729019 PMCID: PMC6340557 DOI: 10.1136/lupus-2018-000303] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/12/2018] [Accepted: 12/16/2018] [Indexed: 01/05/2023]
Abstract
From a 1-year survival of less than 50% before the discovery of glucocorticoids to over 90% at 10 years in most dedicated centres, the spectrum of SLE has profoundly evolved. Despite this improvement, several major challenges currently remain. The aim of this review is to analyse what are, according to us, the 10 most important contemporary challenges in the management of SLE. Among those are the need to treat to target to favour disease remission (or low disease activity), limit the use of glucocorticoids, derive more comprehensive tools for the evaluation of disease activity, develop more effective drugs (yielding successful trials), dissect the heterogeneity of the disease both at the molecular and genetic levels, identify relevant biomarkers for individualised treatment, manage fertility and pregnancy, tackle comorbidities such as cardiovascular risk, the prevention of infections and osteoporosis, improve the network of care (from the patients’ perspective), and favour a holistic approach (integrating fatigue, adherence to treatment, physical activity). Altogether, these 10 contemporary challenges in SLE may be considered as a roadmap for those involved in the daily care of patients with SLE, as well as for researchers who may wish to contribute to an improved management of this rare and complex disease.
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Affiliation(s)
- Renaud Felten
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.,Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO)-LUPUS, Strasbourg, France
| | - Flora Sagez
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.,Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO)-LUPUS, Strasbourg, France
| | - Pierre-Edouard Gavand
- Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO)-LUPUS, Strasbourg, France.,Service d'immunologie clinique, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Thierry Martin
- Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO)-LUPUS, Strasbourg, France.,Service d'immunologie clinique, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Anne-Sophie Korganow
- Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO)-LUPUS, Strasbourg, France.,Service d'immunologie clinique, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Christelle Sordet
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.,Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO)-LUPUS, Strasbourg, France
| | - Rose-Marie Javier
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.,Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO)-LUPUS, Strasbourg, France
| | - Pauline Soulas-Sprauel
- Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO)-LUPUS, Strasbourg, France.,Service d'immunologie clinique, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Marianne Rivière
- Association Française du Lupus et autres Maladies Auto-Immunes (AFL+), France
| | - Florence Scher
- Service de Pharmacie-Stérilisation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Vincent Poindron
- Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO)-LUPUS, Strasbourg, France.,Service d'immunologie clinique, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Aurélien Guffroy
- Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO)-LUPUS, Strasbourg, France.,Service d'immunologie clinique, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Laurent Arnaud
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.,Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO)-LUPUS, Strasbourg, France
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4
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Tamirou F, Arnaud L, Talarico R, Scirè CA, Alexander T, Amoura Z, Avcin T, Bortoluzzi A, Cervera R, Conti F, Cornet A, Devilliers H, Doria A, Frassi M, Fredi M, Govoni M, Houssiau F, Lladò A, Macieira C, Martin T, Massaro L, Moraes-Fontes MF, Pamfil C, Paolino S, Tani C, Tas SW, Tektonidou M, Tincani A, Van Vollenhoven RF, Bombardieri S, Burmester G, Eurico FJ, Galetti I, Hachulla E, Mueller-Ladner U, Schneider M, Smith V, Cutolo M, Mosca M, Costedoat-Chalumeau N. Systemic lupus erythematosus: state of the art on clinical practice guidelines. RMD Open 2018; 4:e000793. [PMID: 30564454 PMCID: PMC6269635 DOI: 10.1136/rmdopen-2018-000793] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/05/2018] [Accepted: 10/08/2018] [Indexed: 12/16/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is the paradigm of systemic autoimmune diseases characterised by a wide spectrum of clinical manifestations with an unpredictable relapsing-remitting course. The aim of the present work was to identify current available clinical practice guidelines (CPGs) for SLE, to provide their review and to identify physicians’ and patients’ unmet needs. Twenty-three original guidelines published between 2004 and 2017 were identified. Many aspects of disease management are covered, including global disease management, lupus nephritis and neuropsychiatric involvement, management of pregnancies, vaccinations and comorbidities monitoring. Unmet needs relate with disease management of some clinical manifestations and adherence to treatment. Many patient’s unmet needs have been identified starting with faster diagnosis, need for more therapeutic options, guidelines on lifestyle issues, attention to quality of life and adequate education.
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Affiliation(s)
- Farah Tamirou
- Rheumatology Department, Cliniques universitaires Saint-Luc, Université catholique deLouvain, Bruxelles, Belgium
| | - Laurent Arnaud
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Centre National de Referencedes Maladies Auto-immunes et Systémiques Rares RESO, Strasbourg, France
| | | | - Carlo Alberto Scirè
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Tobias Alexander
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Berlin, Germany
| | - Zahir Amoura
- Department of Internal Medicine, Hospital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children'sHospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Alessandra Bortoluzzi
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
| | - Fabrizio Conti
- Rheumatology Unit, Dipartimento di Medicina Interna e Specialità Mediche, Università degliStudi di Roma La Sapienza, Rome, Italy
| | | | - Hervé Devilliers
- Department of Internal Medicine and Systemic Diseases, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, Dijon, France
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, AO Padova and University of Padua, Padua, Italy
| | - Micol Frassi
- Rheumatology and Clinical Immunology Unit, Civil Hospital, Brescia, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology Unit, Civil Hospital, Brescia, Italy
| | - Marcello Govoni
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Frederic Houssiau
- Rheumatology Department, Cliniques universitaires Saint-Luc, Université catholique deLouvain, Bruxelles, Belgium
| | - Ana Lladò
- Unidade de Doenças Auto-imunes/Medicina 7.2, Hospital de Curry Cabral, Centro Hospitalarde Lisboa Central, Lisbon, Portugal
| | - Carla Macieira
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Thierry Martin
- Department of Rheumatology, Emergency County Teaching Hospital, Cluj-Napoca, Romania
| | - Laura Massaro
- Rheumatology Unit, Dipartimento di Medicina Interna e Specialità Mediche, Università degliStudi di Roma La Sapienza, Rome, Italy
| | - Maria Francisca Moraes-Fontes
- Unidade de Doenças Auto-imunes/Medicina 7.2, Hospital de Curry Cabral, Centro Hospitalarde Lisboa Central, Lisbon, Portugal
| | - Cristina Pamfil
- Department of Rheumatology, Emergency County Teaching Hospital, Cluj-Napoca, Romania
| | - Sabrina Paolino
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS Polyclinic Hospital San Martino, University of Genoa, Genoa, Italy
| | | | - Sander W Tas
- Amsterdam UMC, Department of Clinical Immunology & Rheumatology and Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, Meibergdreef 9, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Rheumatology & immunology Center (ARC), Academic Medical Center, Amsterdam, The Netherlands
| | - Maria Tektonidou
- Joint Rheumatology Academic Program, First Department of Propaedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Civil Hospital, Brescia, Italy
| | - Ronald F Van Vollenhoven
- Clinical Immunology & Rheumatology, Amsterdam Rheumatology & Immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | | | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Berlin, Germany
| | - Fonseca João Eurico
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Ilaria Galetti
- FESCA - Federation of European Scleroderma Association, Milan, Italy
| | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), LIRIC, INSERM, Univ. Lille, CHU Lille, Lille, France
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Matthias Schneider
- Department of Rheumatology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Vanessa Smith
- Department of Rheumatology, Department of Internal Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS Polyclinic Hospital San Martino, University of Genoa, Genoa, Italy
| | - Marta Mosca
- Rheumatology Unit, AOU Pisana, Pisa, Italy.,Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Nathalie Costedoat-Chalumeau
- Assistance Publique-Hôpitaux de Paris (AP-HP), Internal Medicine Department, Cochin Hospital, Referral center for rare autoimmune and systemic diseases, Paris, France.,Paris Descartes Sorbonne, Paris Cité University, Paris, France.,INSERM U 1153, Center for Epidemiology andStatistics Sorbonne Paris Cité (CRESS), Paris, France
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6
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Ünlü O, Zuily S, Erkan D. The clinical significance of antiphospholipid antibodies in systemic lupus erythematosus. Eur J Rheumatol 2016; 3:75-84. [PMID: 27708976 PMCID: PMC5042235 DOI: 10.5152/eurjrheum.2015.0085] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/20/2015] [Indexed: 12/22/2022] Open
Abstract
Antiphospholipid syndrome (APS) is the association of thrombosis and/or pregnancy morbidity with antiphospholipid antibodies (aPL). Thirty to forty percent of systemic lupus erythematosus (SLE) patients are tested positive for aPL, which may have an impact on the SLE presentation, management, and prognosis. Compared with SLE patients without aPL, those with aPL have a higher prevalence of thrombosis, pregnancy morbidity, valve disease, pulmonary hypertension, livedo reticularis, thrombocytopenia, hemolytic anemia, acute/chronic renal vascular lesions, and moderate/severe cognitive impairment; worse quality of life; and higher risk of organ damage. The use of low-dose aspirin (LDA) is controversial for primary thrombosis and pregnancy morbidity prevention because of the lack of strong prospective controlled data. Similarly, the use of anticoagulation is controversial for patients with an aPL-related nephropathy. Until further studies are available, physicians should discuss the risk/benefits of LDA or anticoagulation as well as the available literature with patients.
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Affiliation(s)
- Ozan Ünlü
- Division of Rheumatology, Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
| | - Stephane Zuily
- Division of Vascular Medicine, Centre Hospitalier Universitaire de Nancy, Regional Competence Centre For RareVascular and Systemic Autoimmune Diseases, Nancy, France
| | - Doruk Erkan
- Division of Rheumatology, Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
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7
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Mathian A, Arnaud L, Adoue D, Agard C, Bader-Meunier B, Baudouin V, Belizna C, Bonnotte B, Boumedine F, Chaib A, Chauchard M, Chiche L, Daugas E, Ghali A, Gobert P, Gondran G, Guettrot-Imbert G, Hachulla E, Hamidou M, Haroche J, Hervier B, Hummel A, Jourde-Chiche N, Korganow AS, Kwon T, Le Guern V, Le Quellec A, Limal N, Magy-Bertrand N, Marianetti-Guingel P, Martin T, Martin Silva N, Meyer O, Miyara M, Morell-Dubois S, Ninet J, Pennaforte JL, Polomat K, Pourrat J, Queyrel V, Raymond I, Remy P, Sacre K, Sibilia J, Viallard JF, Viau Brabant A, Hanslik T, Amoura Z. Prévention des infections au cours du lupus systémique chez l’adulte et l’adolescent : élaboration de recommandations pour la pratique clinique, à partir d’une analyse de la littérature et de l’avis d’experts. Rev Med Interne 2016; 37:307-20. [DOI: 10.1016/j.revmed.2016.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 01/03/2016] [Accepted: 01/05/2016] [Indexed: 12/21/2022]
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