2019歐洲抗風濕病聯盟全身性紅斑狼瘡治療建議更新與比較

10.6666/ClinMed.202005_85(5).0054

李浩維；王愷君；廖顯宗

全身性紅斑狼瘡（systemic lupus erythematosus, SLE） ； 歐洲抗風濕病聯盟（European League Against Rheumatism, EULAR） ； 全身性紅斑狼瘡治療 ； 狼瘡腎炎（lupus nephritis）

臨床醫學月刊

85卷5期（2020 / 05 / 29）

292 - 298

繁體中文

歐洲抗風濕病聯盟根據近年來新的研究證據，於2019年更新了針對全身性紅斑狼瘡的治療建議。治療的主要目標在於達成疾病的緩解或達到低疾病活性。所有全身性紅斑狼瘡的病人均建議給予hydroxychloroquine，其最大劑量不超過每日每公斤體重5mg，以減少視網膜病變之風險，但考量到病人的服藥順從性，此建議劑量目前尚具爭議。當以類固醇作為維持治療時，其劑量不應超過每日7.5mg的prednisone等效劑量，並儘可能不使用類固醇。適當使用免疫抑制劑亦對減少類固醇的使用有所助益。當面對疾病持續活躍或復發的腎外表現，可考慮以belimumab作為附加治療；rituximab則可考慮用於頑固或危及器官的病況。針對皮膚、神經精神、血液和腎臟的表現亦分別有建議的更新。此篇文章亦統整比較了歐洲抗風濕病聯盟於2008年和2019針對全身性紅斑狼瘡所提出的治療建議，結合了實證和專家意見，提供醫師和病患全身性紅斑狼瘡治療上的更新和指引。

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