Via practica 2/2012

Systemic lupus erythematosus – an overview of new knowledge in pathogenesis, clinical picture and treatment

Systemic lupus erythematosus (SLE) is a serious autoimmune disease characterized by multiple organ involvement (skin, joints, kidneys, blood cells and nervous system). It occurs most often in women then in men in 1:10, especially in the second and third decade of age. Although the therapy of disease has improved dramatically during the past 30 years, the risk of death is higher than in the general population. The cause of SLE is related to a complex disorder of the immune system (abnormality of the regulatory function and interactions of immune cells, T lymphocytes, B lymphocytes, macrophages and dendritic cells), resulting in storing of immune complexes and subsequent tissue damage organs. During developing of the disease probably occur abnormal immunological interactions between structures (hyperactive B cells) and systems, such as complement, which then culminate in affecting of tissue and clinical manifestation. The clinical signs for diagnosis are known those described in the revised criteria for SLE (ARA / ACR), this is a set of 11 criteria (8 clinical and 3 laboratory); for the diagnosis of SLE demonstrate the presence of 4 out of 11 criteria with a sensitivity and specificity of 96%. The traditional treatment of SLE includes NSAIDs, antimalarias, corticosteroids, cyclophosphamide and cyclosporin, as well as high-dose intravenous immunoglobulin. Recently, the target therapy enters into options of treatment, which consists in the inhibition by fully human monoclonal antibody that binds to solublBLyS and inhibits its feedback on TACI, BCMA and BAFF-R. The above mentioned treatment represents a new way in the management of this serious disease.

Keywords: systemic lupus erythematosus, new insights in pathogenesis, clinical presentation, diagnostic criteria for therapeutic approaches.