糖皮质激素(GC)是系统性红斑狼疮(SLE)最有效的一线治疗方法之一。然而,GC负担与损坏有关。初始GC剂量和逐渐减少的时间表应根据临床情况的严重程度进行调整。由于狼疮治疗应促进缓解,同时尽量减少损害,最近的指南推荐了一种更准确的使用GC的方法,设定较低的起始剂量和快速减量计划,和鼓励维持泼尼松龙剂量<5毫克/天。甲基强的松龙脉冲(MP)有助于减少口服GCs的剂量,并改善严重和非严重表现的临床反应。没有明显的副作用。固定锥形GC方案提供了减少GC暴露的有用策略。长期抗疟治疗和早期开始使用免疫抑制药物可提高临床疗效,同时降低GC毒性。此外,在稳定治疗的长期缓解患者中,GCs的停药是可以实现的目标,最近的研究试图找出最合适的候选人。在这篇文章中,我们回顾了药理学基础,疗效的临床证据,剂量相关的危害,以及潜在的GCs退出。我们还回顾了指南建议,最后给出了一个个人和实用的方法来处理SLE患者使用GCs的问题。
Glucocorticoids (GCs) are one of the most effective first-line treatments for systemic lupus erythematosus (SLE). However, GC burden is associated with damage. The initial GC dose and tapering schedule should be tailored to the severity of the clinical scenario. As lupus therapy should prompt remission while minimising damage, recent guidelines recommend a more accurate approach to the use of GCs, setting lower starting doses and rapid tapering schemes, and encouraging maintenance prednisolone doses <5 mg/day. Methylprednisolone pulses (MP) help to reduce the dose of oral GCs and improve the clinical response in both severe and non-severe manifestations, without significant side effects. Fixed-tapering GC scheme provides a useful strategy to reduce GCs exposure. Long-term antimalarial treatment and early initiation of immunosuppressive drugs improve clinical efficacy while reducing GC toxicity. Besides, withdrawal of GCs is an achievable goal in patients in prolonged remission on stable treatment, and recent studies have attempted to identify the most suitable candidates. In this article, we review the pharmacological basis, clinical evidence of efficacy, dose-related harms, and potential withdrawal of GCs. We also review guidelines recommendations and finally give a personal and practical approach to dealing with the use of GCs in SLE patients.