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Systemischer Lupus erythematodes

Eine problemorientierte Annäherung

Systemic lupus erythematosus

A problem based approach

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Zusammenfassung

Der systemische Lupus erythematodes (SLE) ist eine chronische Autoimmunerkrankung unbekannter Ätiologie, die nahezu alle Organsysteme betreffen kann. Jüngere Frauen sind häufiger betroffen als Männer. Für die Diagnose sind klinische Kriterien in Kombination mit immunologischen Kriterien, insbesondere dem Nachweis von Autoantikörpern, notwendig. Der klinische Verlauf ist sehr variabel. Remissionen können im Wechsel mit chronischen oder akuten Schüben auftreten. Neu aufgetretene Symptome stellen oft eine differenzialdiagnostische Herausforderung dar und werden in der vorliegenden Arbeit problemorientiert diskutiert. Aktivitätsparameter des SLE können die Differenzierung zwischen Krankheitsaktivität und anderen Problematiken wie Infektionen erleichtern. Die gegenüber der Normalbevölkerung 5-fach erhöhte Mortalität resultiert weniger aus schweren Organmanifestationen des SLE selbst, viel häufiger sind infektiöse Komplikationen und das deutlich erhöhte kardiovaskuläre Risiko dafür verantwortlich. Neben dem zielgerichteten und raschen Einsatz von Immunsuppressiva gewinnt im weiteren Krankheitsverlauf daher die konsequente Therapie der Komorbiditäten an Bedeutung. Die Kontrolle kardiovaskulärer Risikofaktoren, Modifikationen des Lebensstils oder Osteoporosediagnostik und -therapie sind wichtige Bestandteile der Betreuung dieser Patienten.

Abstract

Systemic lupus erythematosus (SLE) is a chronic autoinflammatory disease of unknown etiology with predominance of the female sex. Clinical criteria as well as immunological characteristics, e. g. autoantibodies, are necessary for diagnosis. The clinical course of SLE is variable and may be characterized by periods of remissions and chronic or acute relapses. New symptoms are often challenging regarding differential diagnosis. This review will discuss symptoms with a problem based approach. Parameters of activity are helpful to differentiate between disease activity and associated problems, e. g. infections. Lupus patients have a 5 times increased mortality compared to the normal population. The main reasons for mortality are infections and cardiovascular events, rather than disease manifestations. Therefore, besides the fast and precise use of immunosuppressants the consequent therapy of co-morbidities is a major issue in dealing with these patients. Cardiovascular risk factors need to be controlled, life style modifications should be started early, and diagnosis and therapy of osteoporosis should not be neglected.

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Authors and Affiliations

  1. Rheumatologie/Klinische Immunologie, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg , Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland

    S. Kleinert, M. Feuchtenberger & H.-P. Tony

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  1. S. Kleinert
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  2. M. Feuchtenberger
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  3. H.-P. Tony
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Correspondence to S. Kleinert.

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Kleinert, S., Feuchtenberger, M. & Tony, HP. Systemischer Lupus erythematodes. Internist 51, 1013–1028 (2010). https://doi.org/10.1007/s00108-010-2682-6

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