当前位置： SCI文献检索 > SEMINARS IN ARTHRITIS AND RHEUMATISM期刊下所有文献 > Management of inflammatory neurologic and psychiatric manifestations of systemic lupus erythematosus: A systematic review.

Management of inflammatory neurologic and psychiatric manifestations of systemic lupus erythematosus: A systematic review.

Abstract：

BACKGROUND:The neurological and psychiatric manifestations of systemic lupus erythematosus (NPSLE) are a heterogeneous group of conditions with variable clinical presentation and significant morbidity and mortality. OBJECTIVES:Our aim was to comprehensively assess and present the evidence for treatments used in the management of inflammatory NPSLE. METHODS:Medline, Embase, CINHAL and Cochrane CENTRAL were searched from 1990 to end of March 2019 using key words that related to NPSLE and treatment. Included studies comprised clinical trials, observational studies or case series with ≥5 patients and sufficient data related to treatment and outcome in NPSLE patients. RESULTS:There were 7222 studies identified in the search, of which 90 were included in the review. There was a notable paucity of clinical trials, with only two randomised controlled trials and one pilot study. Treatment categories included corticosteroids (14 studies), cyclophosphamide (18 studies), synthetic DMARDs (7 studies), biologic therapies (14 studies), therapeutic plasma exchange (6 studies), intravenous immunoglobulin (2 studies), autologous stem cell transplant (3 studies), other therapies (8 studies), combination therapies (6 studies), studies with grouped outcome data (5 studies) and observational studies with therapy-specific associations (7 studies). Corticosteroids are accepted as first line treatment in NPSLE and there is low-moderate evidence supporting their benefit. Moderate evidence, based on consistent data in numerous studies and some trial data, supports the use of cyclophosphamide in the treatment of NPSLE. Limited data support some synthetic DMARDs such as mycophenolate, azathioprine and intrathecal methotrexate. In refractory disease, low-moderate evidence supports rituximab therapy and limited evidence supports benefit following autologous stem cell transplant. Regarding adjuvant treatments, limited evidence favours addition of plasma exchange, intravenous immunoglobulin and hydroxychloroquine. There exists very limited data for other therapies. CONCLUSION:There are multiple therapeutic options for the management of inflammatory NPSLE including systemic, biologic and interventional therapies; however, currently there is a paucity of high-quality trial data to guide firm recommendations. In order to better understand the optimal treatment of NPSLE and its different subtypes, further well-designed clinical trials are needed.

journal_name

Semin Arthritis Rheum

journal_title

Seminars in arthritis and rheumatism

authors

Papachristos DA,Oon S,Hanly JG,Nikpour M

doi

10.1016/j.semarthrit.2020.12.004

subject

Has Abstract

pub_date

2020-12-17 00:00:00

pages

49-71

issue

eissn

0049-0172

issn

1532-866X

pii

S0049-0172(20)30285-7

journal_volume

pub_type

杂志文章,评审

在线工具

Management of inflammatory neurologic and psychiatric manifestations of systemic lupus erythematosus: A systematic review.