The ClinicianThe ClinicianКлиницист1818-83382412-8775Publishing House ABV Press610.17650/1818-8338-2013-3-4-14-26REVIEWОБЗОРGLUCOCORTICOIDS IN THE THERAPY OF SYSTEMIC LUPUS ERYTHEMATOSUSГЛЮКОКОРТИКОИДЫ В ТЕРАПИИ СИСТЕМНОЙ КРАСНОЙ ВОЛЧАНКИReshetnyakT. M.РешетнякТ. М.
Russian Federation
t_reshetnyak@yahoo.comSeredavkinaN. V.СередавкинаН. В.
Russian Federation
DydykinaI. S.ДыдыкинаИ. С.
Russian Federation
NasonovE. I.НасоновЕ. Л.
Russian Federation
V.A. Nasonova Research Institute of Rheumatology, Russian Academy of Medical SciencesФГБУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой» РАМН1510201373-414261407201414072014Copyright ©; 2013, Reshetnyak T.M., Seredavkina N.V., Dydykina I.S., Nasonov E.I.Copyright ©; 2013, Решетняк Т.М., Середавкина Н.В., Дыдыкина И.С., Насонов Е.Л.2013Reshetnyak T.M., Seredavkina N.V., Dydykina I.S., Nasonov E.I.Решетняк Т.М., Середавкина Н.В., Дыдыкина И.С., Насонов Е.Л.https://creativecommons.org/licenses/by/4.0https://klinitsist.abvpress.ru/Klin/article/view/6

Despite a more than fifty-year period after the introduction of glucocorticoids (GCs) into therapeutic practice; they have headed the list of anti-inflammatory drugs so far. The paper analyzes current views on the terminology of GCs, mechanism of action, standardization of indications for their use in systemic lupus erythematosus, choice of a dose and a regimes of the drugs, as well as the rates of their decrease; the authors also review Russian and foreign literature on this problem and their own data.

Несмотря на более чем полувековой период после внедрения глюкокортикоидов (ГК) в терапевтическую практику, они до сих пор занимают одно из первых мест в противовоспалительной терапии. В статье проанализированы современные представления о терминологии ГК, механизме действия, стандартизации показаний к их назначению при системной красной волчанке, выбор дозы и режима приема препаратов, а также варианты темпов снижения дозы; приводится обзор отечественной и зарубежной литературы по этой проблеме, а также собственные данные.

glucocorticoidssystemic lupus erythematosusглюкокортикоидысистемная красная волчанка1. Насонов Е.Л., Чичасова Н.В., Ковалев В.Ю. Глюкокортикоиды в ревматологии (системная и локальная терапия). М., 1998.Насонов Е.Л., Чичасова Н.В., Ковалев В.Ю. Глюкокортикоиды в ревматологии (системная и локальная терапия). М., 1998.2. Соловьев С.К., Асеева Е.А., Чикликчи А.С., Насонова В.А. Синхронная программная интенсивная терапия у больных с тяжелым течением ревматоидного артрита. Тер архив 2002;74(5):112–8.Соловьев С.К., Асеева Е.А., Чикликчи А.С., Насонова В.А. Синхронная программная интенсивная терапия у больных с тяжелым течением ревматоидного артрита. Тер архив 2002;74(5):112–8.3. Харкевич Д.А. Фармакология: Учебник. 8-е изд., перераб., доп. и испр. М.: ГЭОТАР-Медиа, 2005.Харкевич Д.А. Фармакология: Учебник. 8-е изд., перераб., доп. и испр. М.: ГЭОТАР-Медиа, 2005.4. Monneaux F., Muller S. Molecular therapies for systemic lupus erythematosus: clinical trials and future prospects. Arthritis Res Ther 2009;11(3):234.Monneaux F., Muller S. Molecular therapies for systemic lupus erythematosus: clinical trials and future prospects. Arthritis Res Ther 2009;11(3):234.5. Иванова М.М., Соловьев С.К., Сперанский А.И., Насонов Е.Л. Внутривенное введение ударных доз метилпреднизолона (пульс-терапия) при люпуснефрите. Тер архив 1983;55(7):114–6.Иванова М.М., Соловьев С.К., Сперанский А.И., Насонов Е.Л. Внутривенное введение ударных доз метилпреднизолона (пульс-терапия) при люпуснефрите. Тер архив 1983;55(7):114–6.6. Buttgereit F., da Silva J.A. Boers M. et al. Standardised nomenclature for glucocorticoid dosages and glucocorticoid treatment regimens: current questions and tentative answers in rheumatology. Ann Rheum Dis 2002;61(8):718–22.Buttgereit F., da Silva J.A. Boers M. et al. Standardised nomenclature for glucocorticoid dosages and glucocorticoid treatment regimens: current questions and tentative answers in rheumatology. Ann Rheum Dis 2002;61(8):718–22.7. Ad Hoc Working Group on Steroid-Sparing Criteria in Lupus. Criteria for steroid-sparing ability of interventions in systemic lupus erythematosus: report of a consensus meeting. Arthritis Rheum 2004;50(11):3427–31.Ad Hoc Working Group on Steroid-Sparing Criteria in Lupus. Criteria for steroid-sparing ability of interventions in systemic lupus erythematosus: report of a consensus meeting. Arthritis Rheum 2004;50(11):3427–31.8. Hoes J.N., Jacobs J.W.G., Boers M. et al. EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis 2007;66(12):1560–7.Hoes J.N., Jacobs J.W.G., Boers M. et al. EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis 2007;66(12):1560–7.9. Белоусов Ю.Б., Моисеев В.С., Лепахин В.К. Клиническая фармакология и фармакотерапия. Руководство для врачей. М.: Универсум Паблишинг, 2000.Белоусов Ю.Б., Моисеев В.С., Лепахин В.К. Клиническая фармакология и фармакотерапия. Руководство для врачей. М.: Универсум Паблишинг, 2000.10. Современные аспекты глюкокортикоидной терапии ревматических заболеваний. Пособие для врачей под ред. акад. РАМН, проф. В.А. Насоновой. M., 2009.Современные аспекты глюкокортикоидной терапии ревматических заболеваний. Пособие для врачей под ред. акад. РАМН, проф. В.А. Насоновой. M., 2009.11. Насонова В.А., Насонов Е.Л., Алекперов Р.Т. и др. Рациональная фармакотерапия ревматических заболеваний: Рук-во для практикующих врачей. Под общ. ред. В.А. Насоновой, Е.Л. Насонова. М.: Литтерра, 2003.Насонова В.А., Насонов Е.Л., Алекперов Р.Т. и др. Рациональная фармакотерапия ревматических заболеваний: Рук-во для практикующих врачей. Под общ. ред. В.А. Насоновой, Е.Л. Насонова. М.: Литтерра, 2003.12. Насонова В.А., Васильев В.И., Сейсенбаев А.Ш. и др. Лечение ревматических заболеваний ударными дозами метилпреднизолона. Пульс-терапия. Пособие для врачей. Киев, 2006.Насонова В.А., Васильев В.И., Сейсенбаев А.Ш. и др. Лечение ревматических заболеваний ударными дозами метилпреднизолона. Пульс-терапия. Пособие для врачей. Киев, 2006.13. Al-Maini M., Urowitz M. Systemic steroids. In: Tsokos G.C., Gordon C., Smolen J. (eds.). Systemic lupus erythematosus. А companion to Rheumatology. 1st ed. MOSBY, Elsevier, 2007:487–97.Al-Maini M., Urowitz M. Systemic steroids. In: Tsokos G.C., Gordon C., Smolen J. (eds.). Systemic lupus erythematosus. А companion to Rheumatology. 1st ed. MOSBY, Elsevier, 2007:487–97.14. Машковский М.Д. Лекарственные средства: В 2 т. Т. 2. 14-е изд., перераб., испр. и доп. М.: ООО «Издательство Новая Волна», 2000.Машковский М.Д. Лекарственные средства: В 2 т. Т. 2. 14-е изд., перераб., испр. и доп. М.: ООО «Издательство Новая Волна», 2000.15. Барскова В.Г., Решетняк Т.М., Соловьев С.К., Насонов Е.Л. Комментарии к рекомендации Европейской антиревматической лиги по применению системной глюкокортикоидной терапии при ревматических болезнях. Совр ревматол 2008;(2):9–12.Барскова В.Г., Решетняк Т.М., Соловьев С.К., Насонов Е.Л. Комментарии к рекомендации Европейской антиревматической лиги по применению системной глюкокортикоидной терапии при ревматических болезнях. Совр ревматол 2008;(2):9–12.16. Strand V., Gladman D., Isenberg D. et al. Outcome measures to be used in clinical trials in systemic lupus erythematosus. J Rheumatol 1999;26(2):490–7.Strand V., Gladman D., Isenberg D. et al. Outcome measures to be used in clinical trials in systemic lupus erythematosus. J Rheumatol 1999;26(2):490–7.17. Smolen J.S., Strand V., Cardiel M. et al. Randomized clinical trials and longitudinal observational studies in systemic lupus erythematosus: consensus on a preliminary core set of outcome domains. J Rheumatol 1999;26(2):504–7.Smolen J.S., Strand V., Cardiel M. et al. Randomized clinical trials and longitudinal observational studies in systemic lupus erythematosus: consensus on a preliminary core set of outcome domains. J Rheumatol 1999;26(2):504–7.18. Burlingme M.B., Delafuente J.C. Treatment of systemic lupus erythematosus. Drug Intell Clin Pharm 1998;22(4):283–9.Burlingme M.B., Delafuente J.C. Treatment of systemic lupus erythematosus. Drug Intell Clin Pharm 1998;22(4):283–9.19. Al-Maini M.H., Mountz J.D., Al-Mohri H.A. et al. Serum levels of soluble Fas correlate with indices of organ damage in systemic lupus erythemetosus. Lupus 2009;9(2):132–9.Al-Maini M.H., Mountz J.D., Al-Mohri H.A. et al. Serum levels of soluble Fas correlate with indices of organ damage in systemic lupus erythemetosus. Lupus 2009;9(2):132–9.20. Решетняк Т.М. Лечение системной красной волчанки. В кн.: Клинические лекции по ревматологии. Под ред. В.В. Бадокина. M.: Литтерра, 2012.Решетняк Т.М. Лечение системной красной волчанки. В кн.: Клинические лекции по ревматологии. Под ред. В.В. Бадокина. M.: Литтерра, 2012.21. Schiffenbauer J., Simon L.S. Randomized сontrolled trials in systemic lupus erythematosus: what has been done and what do we have to do? Lupus 2004;13(5):398–405.Schiffenbauer J., Simon L.S. Randomized сontrolled trials in systemic lupus erythematosus: what has been done and what do we have to do? Lupus 2004;13(5):398–405.22. Oinuma K., Harada Y., Nawata Y. et al. Osteonecrosis in patients with systemic lupus erythematosus develops very early after starting high dose corticosteroid treatment. Ann Rheum Disease 2001;60(12):1145–8.Oinuma K., Harada Y., Nawata Y. et al. Osteonecrosis in patients with systemic lupus erythematosus develops very early after starting high dose corticosteroid treatment. Ann Rheum Disease 2001;60(12):1145–8.23. McEvoy G.K., Litvak K., Welsh O.H. AHFS drug information. Bethеsda, MD: American Society of Health-Systems Pharmacists, 1996.McEvoy G.K., Litvak K., Welsh O.H. AHFS drug information. Bethеsda, MD: American Society of Health-Systems Pharmacists, 1996.24. Badsha H., Kong K.O., Lian T.Y. et al. Low-dose pulse methylprednisolone for systemic lupus erythematosus flares is efficacious and has a decreased risk of infectious complications. LupusBadsha H., Kong K.O., Lian T.Y. et al. Low-dose pulse methylprednisolone for systemic lupus erythematosus flares is efficacious and has a decreased risk of infectious complications. Lupus2002;11(8):508–13.;11(8):508–13.25. Badsha H., Edwards C.J. Intravenous pulses of methylprednisolone for systemic lupus erythematosus. Semin Arthritis Rheum 2003;32(6):370–7.Badsha H., Edwards C.J. Intravenous pulses of methylprednisolone for systemic lupus erythematosus. Semin Arthritis Rheum 2003;32(6):370–7.26. Howe H.S., Boey M.L., Feng P.H. Methylprednisolone in systemic lupus erythematosus. Singapore Med J 1990;31(1):18–21.Howe H.S., Boey M.L., Feng P.H. Methylprednisolone in systemic lupus erythematosus. Singapore Med J 1990;31(1):18–21.27. Edwards J.C., Snaith M.L., Isenberg D.A. A double blind controlled trial of methylprednisolone in systenic lupus erythematosus using individualised outcome assessment. Ann Rheum Dis 1987;46(10):773–6.Edwards J.C., Snaith M.L., Isenberg D.A. A double blind controlled trial of methylprednisolone in systenic lupus erythematosus using individualised outcome assessment. Ann Rheum Dis 1987;46(10):773–6.28. Fan P.T., Yu D.T., Clements P.J. et al. Effect of corticosteroids on the human immune response: comparison of one and three daily 1 gm intravenous pulses of methylprednisolone. J Lab Clin Med 1978;91(4):625–34.Fan P.T., Yu D.T., Clements P.J. et al. Effect of corticosteroids on the human immune response: comparison of one and three daily 1 gm intravenous pulses of methylprednisolone. J Lab Clin Med 1978;91(4):625–34.29. Sakemi T., Yamaguchi M., Fujimi S. et al. Effect of methylprednisolone pulse therapy on renal function. Am J Nephrol 1991;11(1):48–53.Sakemi T., Yamaguchi M., Fujimi S. et al. Effect of methylprednisolone pulse therapy on renal function. Am J Nephrol 1991;11(1):48–53.30. Boumpas D.T., Austin H.A. 3rd, Vaughn E.M. et al. Controlled trial of pulse methylprednisolone versus two regimens of pulse cyclophosphamide in severe lupus nephritis. Lancet 1992;340(8822):741–5.Boumpas D.T., Austin H.A. 3rd, Vaughn E.M. et al. Controlled trial of pulse methylprednisolone versus two regimens of pulse cyclophosphamide in severe lupus nephritis. Lancet 1992;340(8822):741–5.31. Corzillius M., Bae S.C., Lew R. et al. Criteria for steroid sparing agents in SLE [abstract]. Lupus 2001;10:S77.Corzillius M., Bae S.C., Lew R. et al. Criteria for steroid sparing agents in SLE [abstract]. Lupus 2001;10:S77.32. Corzillius M., Bae S.C. Methodological issues of corticosteroid use in SLE clinical trials. Lupus 1999;8(8):692–7.Corzillius M., Bae S.C. Methodological issues of corticosteroid use in SLE clinical trials. Lupus 1999;8(8):692–7.33. Hay E.M., Bacon P.A., Gordon C. et al. The BILAG index: a reliable and valid instrument for measuring clinical disease activity in systemic lupus erythematosus. Q J Med 1993;86(7):447–58.Hay E.M., Bacon P.A., Gordon C. et al. The BILAG index: a reliable and valid instrument for measuring clinical disease activity in systemic lupus erythematosus. Q J Med 1993;86(7):447–58.34. Liang M.H., Socher S.A., Larson M.G., Schur P.H. Reliability and validity of six systems for the clinical assessment of disease activity in systemic lupus erythematosus. Arthritis Rheum1989;32(9):1107–18.Liang M.H., Socher S.A., Larson M.G., Schur P.H. Reliability and validity of six systems for the clinical assessment of disease activity in systemic lupus erythematosus. Arthritis Rheum1989;32(9):1107–18.35. Bae S.C., Koh H.K., Chang D.K. et al. Reliability and validity of systemic lupus activity measure-revised (SLAM-R) for measuring clinical disease activity in systemic lupus erythematosus. Lupus 2001;10(6):405–9.Bae S.C., Koh H.K., Chang D.K. et al. Reliability and validity of systemic lupus activity measure-revised (SLAM-R) for measuring clinical disease activity in systemic lupus erythematosus. Lupus 2001;10(6):405–9.36. Bencivelli W., Vitali C., Isenberg D.A. et al. Disease activity in systemic lupus erythematosus: report of the Consensus Study Group of the European Workshop for Rheumatology Research. III. Development of a computerised clinical chart and its application to the comparison of different indices of disease activity. The European Consensus Study Group for Disease Activity in SLE. Clin Exp Rheumatol 1992;10(5):549–54.Bencivelli W., Vitali C., Isenberg D.A. et al. Disease activity in systemic lupus erythematosus: report of the Consensus Study Group of the European Workshop for Rheumatology Research. III. Development of a computerised clinical chart and its application to the comparison of different indices of disease activity. The European Consensus Study Group for Disease Activity in SLE. Clin Exp Rheumatol 1992;10(5):549–54.37. American College of Rheumatology Ad Hoc Committee on Systemic Lupus Erythematosus Response Criteria. The American College of Rheumatology response criteria for systemic lupus erythematosus clinical trials: measures of overall disease activity. Arthritis Rheum 2004;50(11):3418–26.American College of Rheumatology Ad Hoc Committee on Systemic Lupus Erythematosus Response Criteria. The American College of Rheumatology response criteria for systemic lupus erythematosus clinical trials: measures of overall disease activity. Arthritis Rheum 2004;50(11):3418–26.38. Petri M., Buyon J., Kim M. Classification and definition of major flares in SLE clinical trials. Lupus 1999;8(8):685–91.Petri M., Buyon J., Kim M. Classification and definition of major flares in SLE clinical trials. Lupus 1999;8(8):685–91.39. Petri M., Barr S.G., Buyon J. et al. RIFLE: Responder Index for Lupus Erythematosus [abstract]. Arthritis Rheum 2000;43 Suppl 9:S244.Petri M., Barr S.G., Buyon J. et al. RIFLE: Responder Index for Lupus Erythematosus [abstract]. Arthritis Rheum 2000;43 Suppl 9:S244.40. van Vollenhoven R.F. Corticosteroids in rheumatic disease. Understanding their effects is key to their use. Postgrad Med 1998;103(2):137–42.van Vollenhoven R.F. Corticosteroids in rheumatic disease. Understanding their effects is key to their use. Postgrad Med 1998;103(2):137–42.41. Di Munno O., Imbimbo B., Mazzantini M. et al. Deflazocort versus methylprednisolone in polymyalgia rheumatic: clinical equivalence and relative anti-inflammatory potency of different treatment regimsens. J Rheumatol 1995;22(8):1492–8.Di Munno O., Imbimbo B., Mazzantini M. et al. Deflazocort versus methylprednisolone in polymyalgia rheumatic: clinical equivalence and relative anti-inflammatory potency of different treatment regimsens. J Rheumatol 1995;22(8):1492–8.42. Scudeletti M., Puppo F., Lanza L. et al. Comparison of two glucocorticoid preparations (deflazocort and prednisone) in the treatment of immune-mediated disease. Eur J Clin Pharmocol 1993;45 Suppl 1:S29–34.Scudeletti M., Puppo F., Lanza L. et al. Comparison of two glucocorticoid preparations (deflazocort and prednisone) in the treatment of immune-mediated disease. Eur J Clin Pharmocol 1993;45 Suppl 1:S29–34.43. Messina O.D., Barreira J.C., Zancheta J.R. et al. Effect of low doses deflazacort vs prednisone on bone mineral content in premenopausal rheumatoid arthritis. J Rheumatol 1992;19(10):1520–6.Messina O.D., Barreira J.C., Zancheta J.R. et al. Effect of low doses deflazacort vs prednisone on bone mineral content in premenopausal rheumatoid arthritis. J Rheumatol 1992;19(10):1520–6.