Zusammenfassung
Der systemische Lupus erythematodes stellt als chronisch verlaufende Multisystemerkrankung trotz optimierter Behandlungsregimes unverändert eine klinische Herausforderung dar. Langzeituntersuchungen konnten in der Vergangenheit eine Abnahme der Mortalität belegen. Dieser Trend setzt sich auch in den letzten beiden Jahrzehnten fort. Dennoch ist die Lebenserwartung im Vergleich zur Normalbevölkerung weiterhin deutlich eingeschränkt. Neben der Krankheitsaktivität sind Infektionen und kardiovaskuläre Erkrankungen die Haupttodesursachen. Während sowohl die durch die Erkrankung selbst als auch durch Infektionen bedingten Todesfälle aber über die Jahre rückläufig sind, imponiert eine Zunahme kardiovaskulärer Erkrankungen. Ersteres kann durch die individuell angepassten Therapiekonzepte und den vorsichtigeren Einsatz von Steroiden erklärbar sein; dagegen sind die kardiovaskulären Komplikationen auf das längere Überleben der Patienten und die beschleunigte Arteriosklerose zurückzuführen. Dieser Langzeitaspekt muss bereits in frühen Phasen der Erkrankung bei der Behandlung von Aktivität und Komorbiditäten berücksichtigt werden.
Abstract
Systemic lupus erythematosus (SLE) is a chronic multisystem disease and despite the improvements in treatment, long-term care still represents a clinical challenge. Previous long-running studies have demonstrated a continuous improvement in mortality and this trend has persisted over the last two decades. However, there still remains a significantly increased mortality in comparison to the normal population. Besides deaths caused by disease activity, cardiovascular and infectious diseases also play a major role. While deaths caused by SLE activity or infections have declined over the years, there has been a notable increase in cardiovascular diseases. As the improvement of SLE activity and infections can be traced back to individually optimized treatment regimes and the more cautious use of steroids, the cardiovascular complications are due to accelerated atherosclerosis and the improved survival with ageing of the patients. This long-term aspect needs to be taken into account in the early stages of disease when treating disease activity and comorbidities.
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Chehab, G., Fischer-Betz, R. & Schneider, M. Entwicklung von Mortalität und Morbidität beim systemischen Lupus erythematodes. Z. Rheumatol. 70, 480–485 (2011). https://doi.org/10.1007/s00393-011-0758-x
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DOI: https://doi.org/10.1007/s00393-011-0758-x