Abstract
Since the discovery of glucocorticoids (GCs), their important anti-inflammatory effect, rapid mechanism of action, low cost, and accessibility have made them one of the mainstays of treatment for Systemic lupus erythematosus (SLE). Although their use has allowed controlling the disease and reducing acute mortality in severe conditions, the implementation of a scheme based on high doses for long periods has inevitably been accompanied by an increase in adverse effects and infections, including long-term damage. The objective of this review is to answer some important questions that may arise from its use in daily clinical practice, and to propose a paradigm based on the use of methylprednisolone pulses followed by medium-low doses and a rapid decrease of prednisone.
Highlights
Systemic lupus erythematosus (SLE) is a complex disease characterized by autoimmunity, inflammation, and a variable degree of organ damage, which depends on the number and severity of flares and on the treatments received
Irreversible organ damage is very frequent in SLE, and relevant considering that most patients are young or middle-aged women
It is well assumed that MP pulses, due to their higher potency and faster mechanism of action compared to oral prednisone, are indicated in those patients with severe manifestations of SLE in whom a rapid effect is necessary [4,14]
Summary
Systemic lupus erythematosus (SLE) is a complex disease characterized by autoimmunity, inflammation, and a variable degree of organ damage, which depends on the number and severity of flares and on the treatments received. Most guidelines refer to “standard of care” as a combination of hydroxychloroquine, glucocorticoids (GCs), and, sometimes, an immunosuppressive agent. Such therapy often achieves disease remission, but too many times at the cost of a large degree of damage accrual. Irreversible organ damage is very frequent in SLE, and relevant considering that most patients are young or middle-aged women. The recently updated EULAR guidelines highlight the need to prevent organ damage and to optimize pharmacological strategies in order to improve health-related quality of life and to achieve long-term patient survival [4]. The purpose of this review is to answer ten daily clinical practice questions by updating the current evidence about the optimal doses of GCs in several scenarios, based on pharmacological and clinical evidence, as well as to offer our point of view regarding the “standard of care” of GC use
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