rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2025-421-431rsp-3802Research ArticleПЕРЕДОВАЯLEADING ARTICLEЭволюция взглядов на использование глюкокортикоидов при системной красной волчанкеNew strategy for glucocorticoid use in systemic lupus erythematosushttps://orcid.org/0000-0002-1663-7810АсееваЕ. А.AseevaE. A.

Асеева Елена Александровна 

115522, Москва, Каширское шоссе, 34а

Elena A. Aseeva 

115522, Moscow, Kashirskoye Highway, 34A

eaasseeva@mail.ruhttps://orcid.org/0000-0002-5206-1732СоловьевС. К.SolovievS. K.

115522, Москва, Каширское шоссе, 34а

Sergey K. Soloviev 

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-1598-8360НасоновЕ. Л.NasonovE. L.

115522, Москва, Каширское шоссе, 34а

Evgeny L. Nasonov 

115522, Moscow, Kashirskoye Highway, 34A

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation202501112025635421431Copyright © Асеева Е.А., Соловьев С.К., Насонов Е.Л., 20252025Асеева Е.А., Соловьев С.К., Насонов Е.Л.Aseeva E.A., Soloviev S.K., Nasonov E.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/3802

Глюкокортикоиды (ГК) остаются незаменимыми препаратами для лечения системной красной волчанки (СКВ), поскольку не существует других альтернатив, способных так быстро купировать активность заболевания. Тем не менее накопление необратимых повреждений органов (катаракта, остеопороз, сахарный диабет и т. д.) значительно ограничивает их использование. В данной статье рассматриваются современные взгляды ведущих ревматологов на лечение ГК пациентов с СКВ, а именно три основных принципа: а) использование пульс-терапии 6-метилпреднизолоном для индукции ремиссии не только при тяжелом течении заболевания; б) ограничение начальной дозы преднизолона до ≤30 мг/сут. с быстрым снижением до поддерживающей дозы ≤5 мг/сут.; в) персонифицированный подход к стратегии отмены ГК. Долгосрочная терапия гидроксихлорохином и раннее назначение иммуносупрессивной терапии помогут достичь этих целей.

Glucocorticoids (GC) continue to be indispensable drugs for the treatment of systemic lupus erythematosus, since there are no other alternatives that can so quickly stop the activity of the disease. However, the accumulation of irreversible damage to organs (cataracts, osteoporosis, diabetes mellitus, etc.) significantly limits their use. This article examines the current views of leading rheumatologists on the treatment with GC in patients with SLE, namely three main principles: a) the use of pulse therapy with 6-methyl prednisone to induce remission not only in severe cases of the disease; b) limiting the initial doses of prednisone to <30 mg/day, with a rapid decrease to maintenance dose <5 mg/day; c) a personalized approach to the GC withdrawal strategy. Long-term hydroxychloroquine therapy and early implementation of immunosuppressive therapy will help achieve these goals.

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The authors declare that there are no conflicts of interest present.