Lupus Eritematosa Sistemica

8/2/2019 Lupus Eritematosa Sistemica

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_IOEHFMF [H\XMJM FH H_VXFEMJVH_ FH HJGH\CH\M

\HWE_EIJ

MOMFHCEOMNX[X_ H\EVHCMVI_I _E_VHCEOI (NH_%

=8 fh cm|qi fh


2/14

_IOEHFMF [H\XMJM FH H_VXFEMJVH_ FH HJGH\CH\M NX[X_ H\EVHCMVI_I _E_VHCEOI

XJEWH\_EFMF JMOEIJMN _MJVEMBI MJVJHQ FH CMUINI

GMOXNVMF FH OEHJOEM_ CFEOM_

FH[M\VMCHJVI MOMFCEOI FH OEHJOEM_ FH NM _MNXF

H_OXHNM [\IGH_EIJMN FH HJGH\CH\M

_IOEHFMF [H\XMJM FH H_VXFEMJVH_ FH HJGH\CH\M

\HWE_EIJ MOMFHCEOM1

NX[X_ H\EVHCMVI_I _E_VHCEOI (NH_%

E)H Jhssdhjss [hf|i. O@EJO@MU [EJHFM*


3/14


NX[X_ H\EVHCMVI_I _E_VHCEOI (NH_%

E* OIJOH[VI*Hs xjm hjgh|chfmf fh jmvx|mnhqm ejcxjinbeom fh omxsm fhsoijioefm oij mghovmoej cxnvesesvceom u fh

fhsm||inni onjeoi oij {h|eifis fh movewefmf u |hcesej* M{m|hoh m oxmn}xeh| hfmf u {|hficejm hj hn shpi

ghchjeji 51=%*

Hj |hsxchj hs xjm hjgh|chfmf oic{nham fh i|ebhj cxnvegmovi|emn }xh sh {|ifxoh oici oijshoxhjoem fh nms

ejvh|mooeijhs hjv|h gmovi|hs bhjveois. `i|cijmnhs u mclehjvmnhs }xh movmj fh gi|cm oijaxjvm. {|iwiomjfi nm

movewmoej fh nms onxnms V oinmli|mfi|ms u fh nms onxnms L. oij sho|hoej fh wm|eis ve{is fh mjveoxh|{is* Hj hsvm

oic{nham |hf. omfm gmovi| {xhfh sh| jhohsm|ei. {h|i ji sxgeoehjvh. {m|m }xh nm hjgh|chfmf sh cmjegehsvh

onjeomchjvh4 nm ec{i|vmjoem |hnmvewm fh nis fewh|sis gmovi|hs {xhfhj wm|em| fh xjms {h|sijms m iv|ms*

EE* H[EFHCEINIBEM*Nm {|hwmnhjoem fhn NH_ hs nm m{|ipecmfmchjvh fh ?; omsis {i| omfm =;; ;;; `mlevmjvhs hj nis Hsvmfis Xjefis*

Hj nms cxah|hs sh {|hshjvm mn|hfhfi| fh 5 whohs cs }xh nis wm|ijhs u vehjh cmui| {|hwmnhjoem hj nm |mqm jhb|m*

Nm {|hwmnhjoem cxjfemn fh nm hjgh|chfmf wm|m hjv|h =8#8; omsis)=;;*;;; `mlevmjvhs*

EEE* HVEINIBM*Hn NH_ oijsesvh hj xjm hjgh|chfmf oic{nham fhlefm m nm ejvh||hnmoej fh sxsoh{velenefmfhs `h|hfevm|ems u

gmovi|hs mclehjvmnhs cmn fhgejefis. chfemjvh ejwhsvebmoeijhs sh `mj fhcisv|mfi }xh nm cmui|m fh nis

{moehjvhs {|hshjvmlmj fhgeoehjoems bhjveoms fh nis oic{ijhjvhs {|ipecmnhs fh nm wm onseom fhn oic{nhchjvi*

Mfhcs ji sh oic{|hjfhj nis chomjescis {i| nis oxmnhs nis gmovi|hs mclehjvmnhs g|cmois. ejghooeijhs

we|mnhs% gxjoeijmj {m|m ejeoem| i {|i{mbm| hn NH_*

EW* GE_EI[MVINIBEM*Hs ven fewefe| nm {mvibjhses fhn NH_ hj gmshs nms oxmnhs ji {xhfhj sh{m|m|sh hj nm onjeom*

Hj |hmnefmf. hs {|ilmlnh }xh nis hwhjvis mjvh|ei|hs m nm m{m|eoej fh nm hjgh|chfmf jhohsevhj nm mc{negeomoej

o|jeom hj nm gmsh fh {|i{mbmoej {m|m }xh shmj weselnhs onjeomchjvh*

Fewefe|hcis nms gmshs gesei{mvinbeoms fhn NH_ hj ? nms oxmnhs sij. Gmsh fh Ejeoei. [|i{mbmoej u Hpmoh|lmoej*

M* Gmsh fh Ejeoei*Nm |hs{xhsvm fh mxvimjveoxh|{is hj hn nx{xs vehjh oici lnmjoi xj b|x{i sxcmchjvh hs{hogeoi fh

mxvimjvebhjis* (Oxmf|i =*%.mxj}xh hsvh b|x{i fh mxvimjvbhjis ji oic{m|vh om|movh|sveoms oicxjhs {i| ha*.hsv|xovx|m. gxjoej. i fesv|elxoej% hj nms onxnms smnxfmlnhs. hsvms cinoxnms sh xjegeomj fx|mjvh nm cxh|vh

ohnxnm| m{i{viseom. oxmjfi sh mb|x{mj u cifegeomj hsv|xovx|mnchjvh hj nms whsoxnms sx{h|geoemnhs m{i{viseoms

(Gebx|m =%* Fh `ho`i nis hsvxfeis |hoehjvhs sxbeh|hj }xh hn hwhjvi }xh fhshjomfhjm hn nx{xs oijsesvh hj xjm

wm|ehfmf jeom fh cxh|vh m{i{viseom }xh vehjh nxbm| hj xj oijvhpvi {|iejcxjevm|ei {i| ha*. nm ejghooej we|mn%*


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Hj hn omsi fhn NH_. wm|eis ve{is fh ms{hovis mclehjvmnhs sh `mj wejoxnmfi oij hn ejeoei fh nm {mvinibm4 oici nm

sil|hhp{iseoej sinm| msioemfm vmjvi oij hn ejeoei oici oij nms hpmoh|lmoeijhs fh nm hjgh|chfmf%. hjgh|chfmf

we|mn nm hp{iseoej mn we|xs fh H{svhej #Lm|| vehjh xjm |hnmoej ec{i|vmjvh oij hn NH_ hj jeis% u oeh|vis

g|cmois* Hsvis gmovi|hs m nm oxmn sh hp{ijhj nms {h|sijms m chjxfi sxbeh|hj }xh nms {h|sijms }xh fhsm||innmj

NH_ vehjhj mnvh|moeijhs {isvh|ei|hs }xh nis wxhnwhj sxsoh{velnhs mn ejeoei fh nm hjgh|chfmf*

Gebx|m =* Nis mxvimjvebhjis. se lehj ji oic{m|vhj om|movh|sveoms hj nms onxnms smjms. sh xjegeomj hj nms onxnms

m{i{viseoms u hsvm hsv|xovx|m sh cifegeom*

Mn {m|hoh| hn fhvh|ei|i fh nm hnecejmoej ji|cmn fh nms onxnms m{i{viseoms hj nis vhaefis oijsvevxuh xj fhghovi

o|xoemn fh nms sxsoh{velenefmf {m|m hn fhsm||inni u {|i{mbmoej fhn NH_* Ms. hj nms {h|sijms smjms hn fhsveji fh

nm cmui| {m|vh fh nms onxnms m{i{viseoms hj nis vhaefis oijsesvh hj nm gmbioevises |{efm u hgeoehjvh m om|bi fh nis

cmo|gmbis. u nis mjvbhjis ejbh|efis hj hsvm wm sh fhb|mfmj |{efmchjvh* Mfhcs. nm gmbioevises fh nms onxnms

m{i{viseoms ej`elh nm sho|hoej fh oevioejms {|iejgnmcmvi|ems m {m|ve| fh nis cmo|gmbis h ejfxoh m nm sho|hoej

fh wm|ems oevioejms mjveejgnmcmvi|ems. ni oxmn oijv|elxuh mn fhvh|ei|i fh nm om{moefmf fh nms onxnms m{i{vseoms

{m|m ejeoem| xjm |hs{xhsvm ejcxjevm|em {|ecm|em*

(Oxmf|i =*% Nis mxvimjvebhjis hj hn Nx{xs H|evhcmvisi _esvceoi*

Jxonhm|hs Jxonhisicms (fsFJM u jonhi fh nm`esvi|em jxonhm|%

Oic{nhais |elijxonhi{|ivhejeois*

_c

j\J[

\i (7; dFM%

Nm

Oevi{nmscveois [|ivhejm [ |elisiceom

\i(8< dFM%

Msioemoej oij nm chcl|mjm Gisgin{efis mjeijeois i {|ivhjmsgeamfi|ms fh gisgin{efi*


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Gejmnchjvh. nm wefm gmbioevises fh nms onxnms m{i{viseoms {i| nis cmo|gmbis ji|cmnhs necevm hn moohsi fh

omjvefmfhs sebjegeomvewms oij onxnms fhjf|veoms. nms oxmnhs sij hgeoehjvhs ejeoemfi|hs fh nms |hs{xhsvms

ejcxjevm|ems {|ecm|ems*

Hj oijaxjvi. hsvis gmovi|hs mshbx|mj }xh nms {h|sijms ji|cmnhs ji sh ejcxjeohj m s cescms oij hn cmvh|emn

m{i{viseoi {|iwhjehjvh fh sxs {|i{eis vhaefis. m fegh|hjoem fhn fhvh|ei|i hj nm fh{x|moej fh nms onxnms

m{i{vseoms }xh sh {|hshjvm hj xj sxlb|x{i fh {moehjvhs oij NH_* Lmai hsvms oijfeoeijhs hj nm oxmnhs hn

cmvh|emn m{i{viseoi ji sh fh{x|m hgeoehjvhchjvh chfemjvh nis cmo|gmbis {* ha*. hj nm fhgeoehjoem fh On}%.

omjvefmfhs cxu {i| m||elm fhn xcl|mn {xhfhj nib|m| moohsi. hj oe|oxjsvmjoems {|iejcxjevm|ems. m nms

{ilnmoeijhs fh nms {ivhjvhs onxnms {|hshjvmfi|ms fh mjvbhji h ejeoem| xjm |hs{xhsvm m nms cinoxnms oxum

hsv|xovx|m sh `m cifegeomfi fx|mjvh nm cxh|vh ohnxnm| m{i{viseom |hv|msmfm*

L* Gmsh fh [|i{mbmoej*Hj hn nx{xs. nis mjveoxh|{is {xhfhj {|ifxoe| nhseijhs vesxnm|hs chfemjvh fewh|sis chomjescis1

=* Hn chomjesci {mvibjeoi cs g|hoxhjvh oijsesvh hj nm bhjh|moej u fh{sevi fh oic{nhais ejcxjevm|eis hj

nms oxmnhs hn mjvbhji fh|ewm fh nms onxnms nhseijmfms u ci|elxjfms*


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Gebx|m J


7/14


Iomseijmnchjvh sh {|ifxoh wmsoxneves chshjv|eom hj

hn NH_. u {xhfh shcham| fh oh|om m nm {inem|vh|eves

jxfism. ejonxsi oij mjhx|escms hj wmsis smjbxjhis

fh vmcmi chfemji* [xhfh {|ifxoe|sh oici

|hsxnvmfi fini| mlficejmn {m|veoxnm|chjvh fhs{xs

fh nms oicefms%. nhi. {h|evijeves. u {h|gi|moej*

Nms oic{neomoeijhs jhx|inbeoms fhn nhs sij nm

{seoises. sjf|ich i|bjeoi oh|hl|mn. oijwxnseijhs.

jhx|i{mvms {h|eg|eoms u o|mjhmnhs. cehneves

v|mjswh|sm u hjgh|chfmf wmsoxnm| oh|hl|mn* Nm

fh{|hsej u nm {seoises shwh|m m chjxfi sh hpmoh|lmj

oij nm mfcejesv|moej fh oi|veoisvh|iefhs hj b|mjfhs

fises* [xhfhj {|hshjvm|sh fewh|sms wm|ehfmfhs fh

bnich|xnijhg|eves hjv|h nms oxmnhs hsv nm chsmjbemn.

nm {|inegh|mjvh oe|oxjso|evm. nm {|inegh|mjvh fegxsm u nm

chcl|mjism. mxj}xh mnbxjis {moehjvhs {|hshjvmj

jhg|eves ejvh|sveoemn*

\homnomjfi }xh sh `mj ilsh|wmfi jxch|isms

oe|oxjsvmjoems hclm|mqi. hp{iseoej sinm|. vicm fh

hsv|bhjis. ejghooeijhs. ejvh|whjoeijhs }xe||beoms%

}xh fhshjomfhjmj nis l|ivhs fh nm hjgh|chfmf*

Jxch|isis g|cmois {xhfhj ejfxoe| hn nnmcmfi

nx{xs chfeomchjvisi i shxfinx{xs. hn oxmn |m|m whq

ig|hoh cmjeghsvmoeijhs onjeoms oic{nhvms u s sni

{isevewefmf fh nis mjveoxh|{is mjvejxonhm|hs MJM%*

Mn v|mvm|sh fh xjm hjgh|chfmf cxnvesesvceom. we|vxmnchjvh oxmn}xeh| |bmji {xhfh |hsxnvm|

mghovmfi (vmlnm =? vicmfi fhn Cmjxmn OVI%. fh

`ho`i g|hoxhjvhchjvh 58(% nis {moehjvhs {|hshjvmj

cmjeghsvmoeijhs bhjh|mnhs ejhs{hogeoms oici

ghl|oxnm. cmnhsvm|. msvhjem. mji|hpem u {|fefm fh

{hsi*

Vmlnm vicmfm fhn Cmjxmn OVI#\hxcmvinibm. 7 Hf*


8/14


Oxmf|i J


9/14


L* FMVI_ FH NMLI\MVI\EIHn NH_ sh om|movh|eqm {i| nm {|ifxooej fh cxo`is mjveoxh|{is fegh|hjvhs. mnbxjis fh nis oxmnhs fmj nxbm| m

mji|cmnefmfhs fh nmli|mvi|ei hs{hoegeoms {* ha*. mjhcem `hcinveom% wh| oxmf|i 6* Nms {|xhlms {m|m mjveoxh|{is

mjvejxonhm|hs |hsxnvmj shjselnhs. {h|i ejhs{hogeoms. {m|m hn NH_4 hs fhoe| |hsxnvmj {isevewms {|oveomchjvh hj

vifis nis {mfhoecehjvis ji n{efeois oici nm m|v|eves |hxcmviefh. fewh|sms wm|emjvhs fh `h{mveves u nm

hjgh|chfmf ejvh|sveoemn fhn {xncj*

_h {|hshjvmj ? ve{is fh mjveoxh|{is mjvegisgine{efis* Hn {|ech|i oijsvevxuh nm omxsm fh nms {|xhlms gmnsms

{isevewms {m|m sgenes4 hn shbxjfi

oi||hs{ijfh mn mjveoimbxnmjvh fh nx{xs.

hn oxmn. m {hsm| fh sx jicl|h. oijsvevxuh

xj gmovi| fh |ehsbi {m|m nm v|icli ses

whjism u m|vh|emn u mli|vi* Hsvh nveci sh

efhjvegeom oij cmui| g|hoxhjoem

chfemjvh nm {|inijbmoej fhn vehc{i fh

v|icli{nmsvejm {m|oemn movewmfm. xj

ghjchji ej wev|i |hnmoeijmfi oij nis

mjveoxh|{is }xh |hmooeijmj oij nis

gisgin{efis hj nis cmvh|emnhs fh {|xhlm*

Omse sehc{|h sh hjoxhjv|mj

mji|cmnefmfhs fhn shfechjvi x|ejm|ei |hnmoeijmfis oij nms nhseijhs |hjmnhs. fx|mjvh nm hpmoh|lmoej fh nm

hjgh|chfmf |hsxnvmj g|hoxhjvhs nms ilsh|wmoeijhs fh h|ev|ioevis. oij i sej oenejf|is. u nm {|ivhejx|em nhwh4 {i| ni

bhjh|mn mclms fhsm{m|hohj oij nm |hcesej*

_ij cxu om|movh|sveois hn mxchjvi fh nm W_B u nms mnvh|moeijhs `hcmvinbeoms. vmnhs oici nhxoi{hjem unejgi{hjem* M whohs sh ilsh|wm xjm mjhcem. }xh {xhfh sh| oici nms }xh moic{mmj m hjgh|chfmfhs o|jeoms.

i `hcinveom Oiicls {isevewm*

Ji hs hpoh{oeijmn nm v|iclioevi{hjem* Ni cs ec{i|vmjvh hs nm fhcisv|moej fh mxvimjveoxh|{is }xh hp{|hsmj

nis ghjchjis mxviejcxjhs*

Nis cs g|hoxhjvhchjvh {isevewis sij nis MJM. mxj}xh

svis {xhfhj ilsh|wm|sh vmclej hj iv|ms mghooeijhs*

_ij hs{hogeois fh nm hjgh|chfmf nis vvxnis hnhwmfis fh

mjveoxh|{is oijv|m hn FJM leomvhjm|ei i jmvewi* Hj nm vmlnm

2*8 (Vicmfi fhn Oic{hjfei fh Chfeoejm Ejvh|jm*% sh hsvmlnhoh

xjm oeh|vm |hnmoej hjv|h fewh|sis ve{is fh mjveoxh|{is u hnoxmf|i onjeoi {|hficejmjvh

Vmlnm 2*8 (Vicmfi fhn Oic{hjfei fh Chfeoejm Ejvh|jm*%

Oxmf|i J 6* Mji|cmnefmfhs fh nmli|mvi|ei hj hn NH_


10/14


L*= Hpchjhs oic{nhchjvm|eis

_h ejfeomj {m|m fhvhovm| mji|cmnefmfhs `hcmvinbeoms oici1

=* Mjhcem*


12/14


WEEE* V\CEJI_ CFEOI_*m* Mxvimjvebhji1c* Cinoxnm fhn {|i{ei i|bmjesci }xh. m oijshoxhjoem fh xjm |x{vx|m fh nis chomjescis fh vinh|mjoem. hs

|hoijioefm oici hpv|mm h ejfxoh nm m{m|eoej fh xjm |hs{xhsvm ejcxjevm|em. ni }xh {xhfh oijnnhwm| nm

m{m|eoej fh xjm hjgh|chfmf mxviejcxjevm|em*

l* Oxh|{is m{i{viveois1\hsvis ohnxnm|hs gi|cmfis hj nm hvm{m vm|fm fhn {|iohsi fh m{i{vises }xh sxg|hj fhvh|cejmfms onxnms fh xj

vhaefi u }xh sh gi|cmj oici oijshoxhjoem fh nm g|mbchjvmoej fh nm onxnm fx|mjvh hsvh {|iohsi* Nis mjneses

lei}xceois {ijhj fh cmjegehsvi }xh hsvis oxh|{is {|hshjvmj xj mnvi oijvhjefi hj {|ivhjms cxu

hc{m}xhvmfms u |hsesvhjvhs m nm {|ivhneses* Hj nm gmsh gejmn fh nm m{i{vises nms onxnms oe|oxjfmjvhs u nis

cmo|gmbis gmbioevmj nis oxh|{is m{i{vveois {m|m sx oic{nhvm fhb|mfmoej*

o* M{i{vises1[|iohsi fh cxh|vh ohnxnm| }xh hjwxhnwh omcleis ci|ginbeois om|movh|sveois. oici nm g|mbchjvmoej jxonhm|.

nm oijfhjsmoej fh nm o|icmvejm. nm |x{vx|m fh nm chcl|mjm {nmscveom u nm fhsejvhb|moej fh nm onxnm hj

{h}xhis g|mbchjvis fhjicejmfis oxh|{is m{i{vveois*

f* Hjgh|chfmf {i| H{svhej#Lm||1Ejghooej {|ifxoefm {i| hn we|xs fh H{svhej#Lm|| u }xh sh om|movh|eqm {i| gehl|h. gm|ejbeves chcl|mjism. jfxnis

nejgveois u hs{nhjichbmnem* Hpesvh {|inegh|moej nejgioveom u {|hshjoem fh nejgioevis mv{eois* Vmclej sh

fhjicejm cijijxonhises ejghooeism u sh msioem mn nejgicm fh Lx|devv u mn om|oejicm jmsigm|jbhi*

h* Gmbioevises1c* Ejbhsvej fh {m|voxnms fh vmcmi |hnmvewmchjvh b|mjfh {* ha*. lmovh|ems i |hsvis ohnxnm|hs% {i| onxnmsgmbioveoms* Hn {|iohsi sh ejeoem oij nm xjej fh nm {m|voxnm m nm chcl|mjm {nmscveom fhn gmbioevi* V|ms nm

xjej. nm chcl|mjm ohnxnm| sh hpvehjfh m ni nm|bi fh nm sx{h|geoeh fh nm {m|voxnm. hjbniljfinm4 sh oijsvevxuh

ms xjm wmoxinm fhjicejmfm gmbisicm* Hn gmbisicm sh gxseijm oij xj nesisicm. fmjfi nxbm| mn gmbinesisicm.

hj oxui ejvh|ei| hs febh|efm nm {m|voxnm {i| nms hjqecms èf|inveoms* Nms onxnms gmbioveoms {|ejoe{mnhs sij nis

cmo|gmbis. jhxv|genis u hisejgenis. u vifms hnnms fhshc{hmj xj {m{hn ec{i|vmjvh hj nm |hs{xhsvm

ejcxjevm|em mjveceo|ilemjm. {i| chfei fh nm hahoxoej fh hsvm gxjoej hghovi|m*

g* Cmo|gmbi1c* Onxnm gmbioevm|em fhn sesvhcm |hvoxni hjfivhnemn. }xh sh hjoxhjv|m {|hshjvh hj fegh|hjvhs |bmjis* ~~

Onxnm }xh {|iohsm u {|hshjvm hn mjvbhji mn sesvhcm ejcxjh* [|iohfh fh {|hox|si|hs fh nm cfxnm shm }xh{msmj m nm smjb|h cijioevis% u hceb|mj m seveis fh ejgnmcmoej i |hmooeijhs ejcxjhs* Fegeh|hj cxoì hj sx

vmcmi u hj sx gi|cm shbj sx niomneqmoej cfxnm shm. smjb|h. onxnms fh Dx{ggh|. onxnm chsmjbemn |hjmn.

{xncj. lmqi. hvo*%* _ij cwenhs. sh mfèh|hj m sx{h|geoehs u hcevhj shxf{ifis4 vehjhj om{moefmf fh

gmbioevises#{ejioevises i mncmohjmcehjvi fh oxh|{is hpv|mis. hvo* [h|vhjhohj mn sesvhcm cijioevi#cmo|igbeoi

i gmbioveoi#cijijxonhm| u {xhfhj {|hshjvm| mjvbhjis u hsvecxnm| nm {|inegh|moej u fegh|hjoemoej fh

nejgioevis L u V. sho|hvm| oevi}xejms u iv|ms cnve{nhs cinoxnms oici O?. hjqecms. hvo* Msecesci. {m|veoe{mj

hj nm |hmooej ejgnmcmvi|em. {|ifxooej fh ejvh|gh|j. hj nm nhsej chfemfm {i| hn oic{nhchjvi. v|iclneses.

gel|ejneses. hvo* _h efhjvegeomj {i| vojeoms fh vejoej i èsvi}xceoms*


13/14


14/14


EP* LELNEIB\MGEM

O* \iqcmj. Oic{hjfei fh Chfeoejm Ejvh|jm. win* E. E wins*. ? hf* Chpeoi1 Hnshweh|*.

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