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Systemischer Lupus erythematodes: Aktivität und Outcome

Systemic lupus erythematosus — activity and outcome

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Zusammenfassung

Der systemische Lupus erythematodes (SLE) mit seinem vielfältigen Spektrum an Organmanifestationen stellt den Rheumatologen klinisch wie wissenschaftlich vor besondere Herausforderungen. Validierte Scores für die Aktivität (BILAG, ECLAM, SIS, SLAM, SLEDAI), den verursachten Organschaden oder „damage“ (SLICC) und die Lebensqualität (MOS SF-36) sind seit Jahren erfolgreich im Einsatz. Neue Therapien müssen ihre Wirksamkeit aber in erster Linie anhand von Outcome-Parametern konkreter Organe unter Beweis stellen — und die sind häufig schlecht definiert. Für die proliferative Lupusnephritis gibt es seit Jahren adäquate Studien, die aber mit sehr harten Parametern (Nierenversagen, Tod) arbeiten und bis zum endgültigen Beweis zumindest 5 Jahre benötigen. Keiner der Surrogatmarker kann dabei als gesichert gelten. Daher erscheinen überschaubare Studien zur Erarbeitung erfolgversprechende Strategien und Langzeitstudien zur endgültigen Sicherung derzeit als beste Lösung.

Abstract

Both clinically and scientifically, the variable organ manifestations of systemic lupus erythematosus (SLE) pose a particular challenge to rheumatologists. Validated scores for disease activity (BILAG, ECLAM, SIS, SLAM, SLEDAI), damage (SLICC/ACR damage index) and health-related quality of life (MOS SF-36) have been successfully used for years. New therapies, however, need to show improvement on outcome parameters for defined organ systems — and these are mostly ill-defined. For proliferative lupus nephritis, well designed studies have been available for years. However, these use very severe outcome parameters (renal failure, death), and therefore take at least 5 years for definitive results. Of the surrogate markers which were devised, none has proven reliable for determining outcome. The combination of shorter studies for defining hopeful strategies followed by long definitive studies, appears to be the best option at present.

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  1. Klinische Abt. für Rheumatologie, Universitätsklinik für Innere Medizin III, Wien

    M. Aringer & J. S. Smolen

  2. Klinische Abt. für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität, AKH, Währinger Gürtel 18–20, 1090, Wien

    M. Aringer

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Aringer, M., Smolen, J.S. Systemischer Lupus erythematodes: Aktivität und Outcome. Z Rheumatol 65, 103–109 (2006). https://doi.org/10.1007/s00393-006-0040-9

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