BRAIN and NERVE－神経研究の進歩71巻5号

2019年05月発行

特集 NPSLE

NPSLEの臨床—膠原病内科の立場から

著者： 田中良哉¹

所属機関： ¹産業医科大学医学部第1内科学講座

ページ範囲：P.445 - P.458

文献概要

全身性エリテマトーデス（SLE）は，妊娠可能年齢の女性に好発し，多臓器障害をもたらす代表的な全身性自己免疫疾患である。特に，中枢神経病変は予後を規定する要因である。障害部位は中枢神経，脊髄，末梢神経と幅広く，その症状は器質的なものから精神医学的所見まで非常に多様である。米国リウマチ学会では神経精神SLE（NPSLE）として精神・神経症状を19病型に細分類した。SLEの治療に関しては，寛解導入，臓器障害阻止，QOL改善，寛解維持後の副腎皮質ステロイド中止と目標が高くなってきた。NPSLEなどの重症臓器病変があれば，副腎皮質ステロイド大量と免疫抑制薬の併用療法で開始するが，免疫調整・抑制薬，可溶性BAFFに対する抗体ベリムマブなどと選択肢が増え，治療の有効性や安全性に進歩をもたらしつつある。

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