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Abordagens terapêuticas do Lúpus Eritematoso Sistémico e impacto na vida do doente
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Abstract(s)
O lúpus eritematoso sistémico é uma doença crónica e autoimune, que leva a uma desregulação do sistema imunitário e desenvolvimento de uma resposta inflamatória, mas mesmo desconhecendo-se a totalidade do mecanismo patogénico, sabe-se que este está relacionado com hiperreatividade dos linfócitos T e B, alterações no sistema complemento, produção de autoanticorpos e formação de complexos imunes. O que pode ser potencializado por fatores de risco genéticos, ambientais e hormonais.
Por ser uma doença muito heterogénea apresenta várias manifestações clínicas que podem ser cutâneas, musculosqueléticas, pulmonares, entre outras, e diversas complicações e comorbilidades como o desenvolvimento de nefrite lúpica ou de infertilidade e outros problemas aquando da gravidez.
Assim sendo, o impacto da doença no dia-a-dia do doente a nível físico, emocional e social é marcadamente relevante, diminuindo bastante a sua qualidade de vida e fazendo com que tenha de existir uma grande capacidade de adaptação e de gestão da patologia e das suas comorbilidades.
Para dar um maior conforto e melhorar a vida destes doentes torna-se fundamental o recurso a opções terapêuticas que consigam controlar ou diminuir a atividade da doença e impedir o aparecimento de novos danos, aliadas às quais devem ser aplicadas medidas não farmacológicas como a realização de consultas com um psicólogo.
De acordo com as diretrizes terapêuticas, a base do tratamento é a hidroxicloroquina e os glucocorticoides aos quais poderá haver a necessidade de adicionar determinados agentes imunossupressores, como o metotrexato, a azatioprina, o micofenolato de mofetil, o belimumab ou o anifrolumab, a ciclofosfamida, os inibidores da calcineurina e o rituximab.
Salienta-se deste modo, que o farmacêutico apresenta um papel fundamental no aumento da qualidade de vida do doente, e que ainda há um longo caminho a percorrer para o melhor entendimento da patologia e existência de melhores opções terapêuticas.
Systemic Lupus Erythematosus is a chronic autoimmune disease that leads to dysregulation of the immune system and the development of an inflammatory response. Although the complete pathogenic mechanism is not fully understood, it is known to be related to hyperreactivity of T and B lymphocytes, alterations in the complement system, production of autoantibodies, and formation of immune complexes. This process can be exacerbated by genetic, environmental, and hormonal risk factors. Being a highly heterogeneous disease, it presents various clinical manifestations, which can be cutaneous, musculoskeletal, pulmonary, among others, and can lead to different complications and comorbidities, such as the development of lupus nephritis or infertility and other pregnancy-related problems. Therefore, this disease significantly impacts patients' daily lives at physical, emotional, and social levels, substantially reducing their quality of life and requiring a high capacity for adaptation and management of the disease and its comorbidities. To provide greater comfort and improve the lives of these patients, it is essential to use therapeutic options that can control or reduce disease activity and prevent the occurrence of new damage. These should be combined with non-pharmacological measures, such as therapy. According to therapeutic guidelines, the basis of treatment is hydroxychloroquine and glucocorticoids, to which specific immunosuppressive agents may need to be added, such as methotrexate, azathioprine, mycophenolate mofetil, belimumab or anifrolumab, cyclophosphamide, calcineurin inhibitors, and rituximab. Thus, it is emphasized that pharmacists play a crucial role in improving patients' quality of life, and there is still a long way to go to better understand the disease and develop better therapeutic options.
Systemic Lupus Erythematosus is a chronic autoimmune disease that leads to dysregulation of the immune system and the development of an inflammatory response. Although the complete pathogenic mechanism is not fully understood, it is known to be related to hyperreactivity of T and B lymphocytes, alterations in the complement system, production of autoantibodies, and formation of immune complexes. This process can be exacerbated by genetic, environmental, and hormonal risk factors. Being a highly heterogeneous disease, it presents various clinical manifestations, which can be cutaneous, musculoskeletal, pulmonary, among others, and can lead to different complications and comorbidities, such as the development of lupus nephritis or infertility and other pregnancy-related problems. Therefore, this disease significantly impacts patients' daily lives at physical, emotional, and social levels, substantially reducing their quality of life and requiring a high capacity for adaptation and management of the disease and its comorbidities. To provide greater comfort and improve the lives of these patients, it is essential to use therapeutic options that can control or reduce disease activity and prevent the occurrence of new damage. These should be combined with non-pharmacological measures, such as therapy. According to therapeutic guidelines, the basis of treatment is hydroxychloroquine and glucocorticoids, to which specific immunosuppressive agents may need to be added, such as methotrexate, azathioprine, mycophenolate mofetil, belimumab or anifrolumab, cyclophosphamide, calcineurin inhibitors, and rituximab. Thus, it is emphasized that pharmacists play a crucial role in improving patients' quality of life, and there is still a long way to go to better understand the disease and develop better therapeutic options.
Description
Keywords
Lúpus eritematoso sistémico Doença autoimune Autoanticorpos Imunossupressores Farmacêutico