Towards treating lupus nephritis without oral steroids: A dream-come-true?

摘要

The discovery in the late 1940s of the very potent anti-inflammatory and imrnuno-suppressive properties of glucocorticoids (GC) has dramatically improved the prognosis of severe systemic lupus erythemato-sus (SEE), with survival rates increasing markedly from 50% at 3 years in 1953 to 92% at 10 years in recent series. In particular, intravenous pulse methylpred-nisolone (MP) therapy, introduced as treatment for severe lupus manifestations in the 1970s, displays remarkable and prompt beneficial effects in acutely ill SLE patients suffering from renal impairment, central nervous system disease, arthritis, pleuropericarditis, fever or severe thrombo-cytopenia. Unfortunately, many patients, especially those taking >7.5mg per day for long periods, experience the serious consequences of GC therapy, such as, increased risk of infection, avascular osteonecrosis, osteoporosis, myopathy, diabetes mellitus or Cushingoid features, as well as skin bruising and cataracts. Most of these side effects impact upon a patient's body image, being a huge source of emotional distress in young (sometimes teenaged) female patients, who are the principle victims of SLE.