DOI: https://doi.org/10.30841/2307-5112.2.2019.174634

Менеджмент пациентов с системной красной волчанкой на этапе первичной медицинской помощи: ответы на часто задаваемые вопросы

І. Ю. Головач, Є. Д. Єгудіна

Аннотация


Системная красная волчанка (СКВ) является аутоиммунным заболеванием, при котором поражаются многие системы и органы, в том числе кожа, опорно-двигательный аппарат, почки, кровь, легкие, сердечно-сосудистая, нервная и репродуктивная системы. Семейные врачи должны знать клинические манифестирующие проявления СКВ для ее ранней и своевременной диагностики, наблюдать за пациентами с легким течением заболевания, распознавать настораживающие признаки обострения, требующие направления к ревматологу, и помогать в мониторинге активности и лечения заболевания у пациентов с умеренным и тяжелым течением. Американский колледж ревматологов предлагает 11 классификационных критериев для диагностики СКВ. При наличии у пациента, по крайней мере, четырех из предложенных критериев, СКВ может быть диагностирована с 95% специфичностью и 85% чувствительностью. Все пациенты с СКВ должны получать информацию о заболевании, регулярные консультации и врачебную поддержку. Гидроксихлорохин является краеугольным камнем лечения, уменьшая частоту обострений болезни и другие общие симптомы. Низкие дозы глюкокортикоидов могут быть использованы для лечения большинства проявлений СКВ. Применение иммунодепрессантов и цитотоксических агентов зависит от того, какая система органов вовлечена в патологический процесс. Для оптимизации лечения, для улучшения медицинской помощи, профилактики и скрининга наличия коморбидностей важно тесное сотрудничество ревматолога, пациента и семейного врача. В настоящем обзоре обобщены практические рекомендации для семейных врачей и предоставлена обновленная информация относительно ранней диагностики и менеджмента пациента с СКВ, указаны основные сопутствующие заболевания, осложняющие течение заболевания.

Ключевые слова


системная красная волчанка; семейный врач; клинические проявления; коморбидные состояния; менеджмент; первичная медицинская помощь; диагностика

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Литература


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