The treatment of systemic lupus erythematosus.
Because no two SLE patients are identical, the treatment of this disease should be individualized. SLE patients, however, can be grouped by subsets, either throughout the course of the disease or at certain episodes. A number of syndromes, such as antiphospholipid or Sjögren's, also occur within SLE and may require distinct forms of treatment. The intensity of treatment in each circumstance depends on its severity and its life threatening potential. When two manifestations coexist the level of treatment usually required is determined by the most serious one. At present, the ultimate goal of treatment is achieving remission, which we define as a period of at least a year without disease activity and thus requiring no treatment. About one fourth of SLE patients achieve remission lasting a median of over 5 years, with more than half of them remaining in remission indefinitely. Current treatment of SLE is based mostly on some form of generalized immune suppression and takes little into account what is known about immune regulation in SLE. Future treatment of SLE should be tailor-made and could include use of various monoclonal antibodies, gene therapy, the administration of biological response modifiers, or the use of various hormones that may influence immune system reactivity. Also, the use of anti-idiotypic antibodies, affinity columns or injectable anionic compounds to elute or distract autoantibodies are being considered. Some of these forms of therapy are at hand but require in their application the judicious collaboration of clinicians and investigators.
Alarcón-Segovia
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Department of Rheumatology, Universidad Nacional Autónoma de México, Mexico City.
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy*
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents