Lúpus Eritematoso Sistêmico: o que o clínico precisa saber
Palavras-chave:
Lúpus eritematoso sistêmico, critérios de classificação, desfechos, autoanticorposResumo
Lúpus eritematoso sistêmico (lúpus) é uma doença crônica, autoimune, sistêmica, caracterizada pela sua heterogeneidade clínica, curso imprevisível e períodos de agudização. Novos critérios de classificação elaborados pela associação entre a Liga Europeia Contra o Reumatismo (EULAR) e o Colégio Americano de Reumatologia (ACR) foram publicados em 2019 e permitem a sua detecção precoce e mais precisa. Vários endótipos da doença têm sido reconhecidos ao longo dos anos. Há progressiva identificação de casos leves na sua apresentação, mas quase 50% destes progride para formas mais graves. As metas de tratamento incluem a sobrevivência do paciente a longo prazo, prevenção de agudização e da instalação de danos crônicos irreversíveis, além de otimização de qualidade de vida relacionada à saúde. O tratamento se caracteriza pela terapia imunossupressora de alta intensidade para controlar a atividade da doença, seguido por um período mais longo de terapia menos intensiva para consolidar a resposta e evitar recaídas. O manejo das morbidades associadas, especialmente infecções e aterosclerose, é de suma importância. Novos agentes imunossupressores sintéticos ou biológicos – utilizados isoladamente ou em combinação, ou sequencialmente, melhoraram as chances de se alcançar as metas terapêuticas tanto a curto prazo quanto a longo prazo, incluindo minimização de uso de glicocorticoide.
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