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Pharmacologic management of neuropsychiatric lupus

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Autores
Kivity, Shaye
Baker, Britain
Arango, Maria-Teresa
Chapman, Joab
Shoenfeld, Yehuda

Fecha
2016

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Taylor and Francis Ltd

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Abstract
Neuropsychiatric lupus affects above 50% of patients with systemic lupus erythematosus and may span from mild symptoms to acute devastating life-threatening ones. Owing to the clinical variability, most pharmacological data rely on small, uncontrolled trials and case reports. The mainstay of therapy relies on immune-suppression by glucocorticoids, in adjunction with cyclophosphamide or anti-B-cell therapy, in moderate to severe cases. In selected scenarios (e.g., chorea) intravenous immunoglobulin or plasmapheresis may be effective. Anticoagulation is warranted if anti-phospholipid antibodies are present. In parallel there may be a need for symptomatic treatment such as anti-epileptic or anti-depressive treatments, etc. In the future, more studies addressed to assess pathogenesis and preferred treatments of specific manifestations are needed in order to personalize treatments. © 2015 Taylor and Francis.
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Keywords
Antimalarial agent , central nervous system , Belimumab , Blood group b antibody , Chloroquine , Cyclophosphamide , Glucocorticoid , Hydroxychloroquine , Immunoglobulin , Methylprednisolone , Methylprednisolone sodium succinate , Mycophenolate mofetil , Prednisone , Rituximab , Anticonvulsive agent , Antidepressant agent , Cyclophosphamide , Glucocorticoid , Immunosuppressive agent , Anticoagulation , Computer assisted tomography , Human , Immunosuppressive treatment , Lupus erythematosus nephritis , Lupus vulgaris , Neuropsychiatric lupus , Nuclear magnetic resonance imaging , Nuclear magnetic resonance spectroscopy , Palliative therapy , Pharmaceutical care , Phase 3 clinical trial (topic) , Plasmapheresis , Positron emission tomography , Randomized controlled trial (topic) , Review , Single photon emission computer tomography , Systematic review (topic) , Systemic lupus erythematosus , Animal , B lymphocyte , Complication , Immunology , Lupus vasculitis , Pathophysiology , Procedures , Animals , Anticonvulsants , Antidepressive agents , B-lymphocytes , Cyclophosphamide , Glucocorticoids , Humans , Immunosuppressive agents , Lupus erythematosus , Lupus vasculitis , Plasmapheresis , Anti-ribosomal p antibodies , Cyclophosphamide , Depression , Neuropsychiatric lupus , Systemic lupus erythematosus
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