mrjСовременная ревматологияModern Rheumatology Journal1996-70122310-158XIMA-PRESS, LLC10.14412/1996-7012-2025-5-113-118mrj-1848Research ArticleОБЗОРЫREVIEWSКонцепция «Treat-to-Target» у пациентов с системной красной волчанкой и индексы активностиTreat-to-target concept in patients with systemic lupus erythematosus and activity indiceshttps://orcid.org/0009-0002-0634-5627ШолкинаП. А.SholkinaP. A.

Полина Андреевна Шолкина 

115522, Москва, Каширское шоссе, 34А 

Polina Andreevna Sholkina 

34A, Kashirskoe Shosse, Moscow 115522 

drpaulinasholkina@mail.ruhttps://orcid.org/0000-0003-1318-1894ШумиловаА. А.ShumilovaA. A.

115522, Москва, Каширское шоссе, 34А 

34A, Kashirskoe Shosse, Moscow 115522 

https://orcid.org/0000-0003-3552-2522РешетнякТ. М.ReshetnyakT. M.

115522, Москва, Каширское шоссе, 34А 

125993, Москва, ул. Баррикадная, 2/1, стр. 1 

34A, Kashirskoe Shosse, Moscow 115522 

2/1, Barrikadnaya Street, Build. 1, Moscow 125993 

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian FederationФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой» ; ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияV.A. Nasonova Research Institute of Rheumatology ; Russian Medical Academy of Continuing Professional Education, Ministry of Health of RussiaRussian Federation202518102025195113118Copyright © Шолкина П.А., Шумилова А.А., Решетняк Т.М., 20252025Шолкина П.А., Шумилова А.А., Решетняк Т.М.Sholkina P.A., Shumilova A.A., Reshetnyak T.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://mrj.ima-press.net/mrj/article/view/1848

В обзоре рассматриваются индексы, применяемые для оценки активности системной красной волчанки (СКВ). Основное внимание уделено понятиям низкой активности и ремиссии СКВ, впервые четко сформулированным в 2016 и 2021 гг. соответственно, и стратегии «Treat-to-Target» – Т2Т («Лечение до достижения цели»), направленной на снижение активности заболевания, предотвращение органных повреждений и минимизацию использования глюкокортикоидов.

This review discusses indices used to assess systemic lupus erythematosus (SLE) activity. Particular attention is given to the definitions of low disease activity and remission in SLE, first clearly formulated in 2016 and 2021, respectively, and to the treat-to-target (T2T) strategy aimed at reducing disease activity, preventing organ damage, and minimizing glucocorticoid use.

системная красная волчанканизкая активность заболеванияремиссиятерапия до достижения целиsystemic lupus erythematosuslow disease activityremissiontreat-to-target therapyСтатья подготовлена в рамках научной темы (регистрационный номер РК 125020501434-1).The article was prepared within the framework of the research project (registration № PK 125020501434-1).ReferencesРешетняк ТМ. Системная красная волчанка. В кн. Бадокин ВВ, редактор. Ревматология. Клинические лекции. Москва: Литтера; 2012. С.245-331. Reshetnyak TM. Systemic lupus erythematosus. In: Badokin VV, editor. Rheumatology. Clinical lectures. Moscow: Litera; 2012. P. 245-331.Reshetnyak TM. Systemic lupus erythematosus. In: Badokin VV, editor. Rheumatology. Clinical lectures. Moscow: Litera; 2012. P. 245-331.Maffi M, Tani C, Cascarano G, Scagnellato L, Elefante E, Stagnaro C et al. Which extra-renal flare is 'difficult to treat' in systemic lupus erythematosus? A one-year longitudinal study comparing traditional and machine learning approaches. Rheumatology (Oxford). 2024 Feb 1;63(2):376-384. doi: 10.1093/rheumatology/kead166.Maffi M, Tani C, Cascarano G, Scagnellato L, Elefante E, Stagnaro C et al. Which extra-renal flare is 'difficult to treat' in systemic lupus erythematosus? A one-year longitudinal study comparing traditional and machine learning approaches. Rheumatology (Oxford). 2024 Feb 1;63(2):376-384. doi: 10.1093/rheumatology/kead166.Barr SG, Zonana-Nacach A, Magder LS, Petri M. Patterns of disease activity in systemic lupus erythematosus. Arthritis Rheum. 1999 Dec;42(12):2682-8. doi: 10.1002/1529-0131(199912)42:12<2682.Barr SG, Zonana-Nacach A, Magder LS, Petri M. Patterns of disease activity in systemic lupus erythematosus. Arthritis Rheum. 1999 Dec;42(12):2682-8. doi: 10.1002/1529-0131(199912)42:12<2682.Соловьев СК, Асеева ЕА, Попкова ТВ и др. Стратегия лечения системной красной волчанки «до достижения цели» (Treat-to-Target SLE). Pекомендации международной рабочей группы и комментарии российских экспертов. Научно-практическая ревматология. 2015;53(1):9-16.Soloviev SK, Aseeva EA, Popkova TV, et al Treat-to-target SLE recommendations from the international task force and russian experts’ commentaries. Nauchno-prakticheskaya revmatologiya. 2015;53(1):9-16. (In Russ.).Van Vollenhoven RF, Bertsias G, Doria A, et al. 2021 DORIS definition of remission in SLE: final recommendations from an international task force. Lupus Sci Med. 2021 Nov: 8(1):e000538. doi: 10.1136/lupus-2021-000538.Van Vollenhoven RF, Bertsias G, Doria A, et al. 2021 DORIS definition of remission in SLE: final recommendations from an international task force. Lupus Sci Med. 2021 Nov: 8(1):e000538. doi: 10.1136/lupus-2021-000538.Franklyn K, Lau CS, Navarra SV, et al; Asia-Pacific Lupus Collaboration. Definition and initial validation of a Lupus Low Disease Activity State (LLDAS). Ann Rheum Dis. 2016 Sep;75(9):1615-21. doi: 10.1136/annrheumdis-2015-207726.Franklyn K, Lau CS, Navarra SV, et al; Asia-Pacific Lupus Collaboration. Definition and initial validation of a Lupus Low Disease Activity State (LLDAS). Ann Rheum Dis. 2016 Sep;75(9):1615-21. doi: 10.1136/annrheumdis-2015-207726.Hunnicutt J, Georgiou ME, Richards A, et al. Patients achieving low lupus disease activity state, systemic lupus erythematosus disease control or remission showed lower rates of organ damage during longitudinal follow-up: analysis of the Hopkins Lupus Cohort. Lupus Sci Med. 2024 Dec 11;11(2): e001206. doi: 10.1136/lupus-2024-001206.Hunnicutt J, Georgiou ME, Richards A, et al. Patients achieving low lupus disease activity state, systemic lupus erythematosus disease control or remission showed lower rates of organ damage during longitudinal follow-up: analysis of the Hopkins Lupus Cohort. Lupus Sci Med. 2024 Dec 11;11(2): e001206. doi: 10.1136/lupus-2024-001206.Kandane-Rathnayake R, Golder V, Louthrenoo W, et al. Development of the Asia Pacific Lupus Collaboration cohort. Int J Rheum Dis. 2019 Mar;22(3):425-433. doi: 10.1111/1756-185X.13431.Kandane-Rathnayake R, Golder V, Louthrenoo W, et al. Development of the Asia Pacific Lupus Collaboration cohort. Int J Rheum Dis. 2019 Mar;22(3):425-433. doi: 10.1111/1756-185X.13431.Tsang-A-Sjoe MWP, Bultink IEM, Heslinga M, et al. The relationship between remission and health-related quality of life in a cohort of SLE patients. Rheumatology (Oxford). 2019 Apr 1;58(4):628-635. doi: 10.1093/rheumatology/key349.Tsang-A-Sjoe MWP, Bultink IEM, Heslinga M, et al. The relationship between remission and health-related quality of life in a cohort of SLE patients. Rheumatology (Oxford). 2019 Apr 1;58(4):628-635. doi: 10.1093/rheumatology/key349.Jesus D, Rodrigues M, Matos A, et al. Performance of SLEDAI-2K to detect a clinically meaningful change in SLE disease activity: a 36-month prospective cohort study of 334 patients. Lupus. 2019 Apr;28(5):607-612. doi: 10.1177/0961203319836717.Jesus D, Rodrigues M, Matos A, et al. Performance of SLEDAI-2K to detect a clinically meaningful change in SLE disease activity: a 36-month prospective cohort study of 334 patients. Lupus. 2019 Apr;28(5):607-612. doi: 10.1177/0961203319836717.Chessa E, Piga M, Floris A, et al. Use of Physician Global Assessment in systemic lupus erythematosus: a systematic review of its psychometric properties. Rheumatology (Oxford). 2020; Dec 1;59(12):3622- 3632. doi: 10.1093/rheumatology/keaa383.Chessa E, Piga M, Floris A, et al. Use of Physician Global Assessment in systemic lupus erythematosus: a systematic review of its psychometric properties. Rheumatology (Oxford). 2020; Dec 1;59(12):3622- 3632. doi: 10.1093/rheumatology/keaa383.Ines LS, Fredi M, Jesus D, et al. What is the best instrument to measure disease activity in SLE? - SLE-DAS vs Easy BILAG. Autoimmun Rev. 2024 Jan;23(1):103428. doi: 10.1016/j.autrev.2023.103428.Ines LS, Fredi M, Jesus D, et al. What is the best instrument to measure disease activity in SLE? - SLE-DAS vs Easy BILAG. Autoimmun Rev. 2024 Jan;23(1):103428. doi: 10.1016/j.autrev.2023.103428.Nikolopoulos D, Lourenco MH, Depascale R, et al. Evolving Concepts in Treat-toTarget Strategies for Systemic Lupus Erythematosus. Mediterr J Rheumatol. 2024 Jun 30; 35(Suppl 2):328-341. doi: 10.31138/mjr.290424.eci.Nikolopoulos D, Lourenco MH, Depascale R, et al. Evolving Concepts in Treat-toTarget Strategies for Systemic Lupus Erythematosus. Mediterr J Rheumatol. 2024 Jun 30; 35(Suppl 2):328-341. doi: 10.31138/mjr.290424.eci.Fischer-Betz R, Chehab G, Sander O, et al. Renal outcome in patients with lupus nephritis using a steroid-free regimen of monthly intravenous cyclophosphamide: a prospective observational study. J Rheumatol. 2012 Nov;39(11):2111-7. doi: 10.3899/jrheum.120537.Fischer-Betz R, Chehab G, Sander O, et al. Renal outcome in patients with lupus nephritis using a steroid-free regimen of monthly intravenous cyclophosphamide: a prospective observational study. J Rheumatol. 2012 Nov;39(11):2111-7. doi: 10.3899/jrheum.120537.Ruiz-Irastorza G, Ugarte A, SaintPastou TC, et al. Repeated pulses of methylprednisolone with reduced doses of prednisone improve the outcome of class III, IV and V lupus nephritis: An observational comparative study of the Lupus-Cruces and lupusBordeaux cohorts. Autoimmun Rev. 2017 Aug;16(8):826-832. doi: 10.1016/j.autrev.2017.05.017.Ruiz-Irastorza G, Ugarte A, SaintPastou TC, et al. Repeated pulses of methylprednisolone with reduced doses of prednisone improve the outcome of class III, IV and V lupus nephritis: An observational comparative study of the Lupus-Cruces and lupusBordeaux cohorts. Autoimmun Rev. 2017 Aug;16(8):826-832. doi: 10.1016/j.autrev.2017.05.017.Kostopoulou M, Nikolopoulos D, Parodis I, Bertsias G. Cardiovascular Disease in Systemic Lupus Erythematosus: Recent Data on Epidemiology, Risk Factors and Prevention. Curr Vasc Pharmacol. 2020;18(6): 549-565. doi: 10.2174/1570161118666191227101636.Kostopoulou M, Nikolopoulos D, Parodis I, Bertsias G. Cardiovascular Disease in Systemic Lupus Erythematosus: Recent Data on Epidemiology, Risk Factors and Prevention. Curr Vasc Pharmacol. 2020;18(6): 549-565. doi: 10.2174/1570161118666191227101636.Nakai T, Fukui S, Ikeda Y, et al. Glucocorticoid discontinuation in patients with SLE with prior severe organ involvement: a singlecenter retrospective analysis. Lupus Sci Med. 2022 Jun;9(1):e000682. doi: 10.1136/lupus-2022-000682.Nakai T, Fukui S, Ikeda Y, et al. Glucocorticoid discontinuation in patients with SLE with prior severe organ involvement: a singlecenter retrospective analysis. Lupus Sci Med. 2022 Jun;9(1):e000682. doi: 10.1136/lupus-2022-000682.Асеева ЕА, Соловьев СК, Козловская НЛ и др. Волчаночный нефрит: современные представления о терапии. (Часть II). Научно-практическая ревматология. 2024; 62(4):377-384.Aseeva EA, Solovyev SK, Kozlovskaya NL, et al. Lupus nephritis. Part II, modern ideas about therapy. Nauchno-Prakticheskaya Revmatologia. 2024;62(4):377–384. (In Russ.).Fanouriakis A, Kostopoulou M, Andersen J, et al. EULAR recommendations for the management of systemic lupus erythematosus: 2023 update. Ann Rheum Dis. 2024 Jan 2; 83(1):15-29. doi: 10.1136/ard-2023-224762.Fanouriakis A, Kostopoulou M, Andersen J, et al. EULAR recommendations for the management of systemic lupus erythematosus: 2023 update. Ann Rheum Dis. 2024 Jan 2; 83(1):15-29. doi: 10.1136/ard-2023-224762.Dima A, Jurcut C, Chasset F, et al. Hydroxychloroquine in systemic lupus erythematosus: overview of current knowledge. Ther Adv Musculoskelet Dis. 2022 Jan 14;14:17597 20X2110730. doi: 10.1177/1759720X211073001.Dima A, Jurcut C, Chasset F, et al. Hydroxychloroquine in systemic lupus erythematosus: overview of current knowledge. Ther Adv Musculoskelet Dis. 2022 Jan 14;14:17597 20X2110730. doi: 10.1177/1759720X211073001.Аkhavan PS, Su J, Lou W, et al. The Early Protective Effect of Hydroxychloroquine on the Risk of Cumulative Damage in Patients with Systemic Lupus Erythematosus. J Rheumatol. 2013 Jun;40(6): 831-41. doi: 10.3899/jrheum.120572.Аkhavan PS, Su J, Lou W, et al. The Early Protective Effect of Hydroxychloroquine on the Risk of Cumulative Damage in Patients with Systemic Lupus Erythematosus. J Rheumatol. 2013 Jun;40(6): 831-41. doi: 10.3899/jrheum.120572.Petri M, Purvey S, Fang H, Magder LS. Predictors of organ damage in systemic lupus erythematosus: The Hopkins Lupus Cohort. Arthritis Rheum. 2012 Dec;64(12):4021-8. doi: 10.1002/art.34672.Petri M, Purvey S, Fang H, Magder LS. Predictors of organ damage in systemic lupus erythematosus: The Hopkins Lupus Cohort. Arthritis Rheum. 2012 Dec;64(12):4021-8. doi: 10.1002/art.34672.Almeida-Brasil CC, Hanly JG, Urowitz M, et al. Flares after hydroxychloroquine reduction or discontinuation: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort. Ann Rheum Dis. 2022 Mar;81(3):370-8. doi: 10.1136/annrheumdis-2021-221295.Almeida-Brasil CC, Hanly JG, Urowitz M, et al. Flares after hydroxychloroquine reduction or discontinuation: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort. Ann Rheum Dis. 2022 Mar;81(3):370-8. doi: 10.1136/annrheumdis-2021-221295.Nikolopoulos D, Fanouriakis A, Bertsias G. Treatment of neuropsychiatric systemic lupus erythematosus: clinical challenges and future perspectives. Expert Rev Clin Immunol. 2021 Apr 3;17(4):317-30. doi: 10.1080/1744666X.2021.1899810.Nikolopoulos D, Fanouriakis A, Bertsias G. Treatment of neuropsychiatric systemic lupus erythematosus: clinical challenges and future perspectives. Expert Rev Clin Immunol. 2021 Apr 3;17(4):317-30. doi: 10.1080/1744666X.2021.1899810.Gladman DD, Ibanez D, Urowitz MB. Systemic lupus erythematosus disease activity index 2000. J Rheumatol. 2002 Feb; 29(2):288-91.Gladman DD, Ibanez D, Urowitz MB. Systemic lupus erythematosus disease activity index 2000. J Rheumatol. 2002 Feb; 29(2):288-91.Асеева ЕА, Соловьев СК, Насонов ЕЛ. Современные методы оценки активности системной красной волчанки. Научно-практическая ревматология. 2013;51(2): 186-200.Aseeva EA, Solovyev SK, Nasonov EL. Current methods for evaluating the activity of systemic lupus erythematosus. Nauchno-prakticheskaya revmatologiya. 2013;51(2):186-200. (In Russ.).Isenberg DA, Rahman A, Allen E, et al. BILAG 2004. Development and initial validation of an updated version of the British Isles Lupus Assessment Group's disease activity index for patients with systemic lupus erythematosus. Rheumatology (Oxford). 2005 Jul; 44(7):902-6. doi: 10.1093/rheumatology/keh624.Isenberg DA, Rahman A, Allen E, et al. BILAG 2004. Development and initial validation of an updated version of the British Isles Lupus Assessment Group's disease activity index for patients with systemic lupus erythematosus. Rheumatology (Oxford). 2005 Jul; 44(7):902-6. doi: 10.1093/rheumatology/keh624.Carter LM, Gordon C, Yee CS, et al. Easy-BILAG: a new tool for simplified recording of SLE disease activity using BILAG-2004 index. Rheumatology (Oxford). 2022 Oct 6;61(10):4006-4015. doi: 10.1093/rheumatology/keab883.Carter LM, Gordon C, Yee CS, et al. Easy-BILAG: a new tool for simplified recording of SLE disease activity using BILAG-2004 index. Rheumatology (Oxford). 2022 Oct 6;61(10):4006-4015. doi: 10.1093/rheumatology/keab883.Шумилова АА, Чельдиева ФА, Нурбаева КС и др. Адаптация русскоязычной версии индекса активности системной красной волчанки EASY-BILAG. Современная ревматология. 2023;17(5):107-111. doi: 10.14412/1996-7012-2023-5-107-111Shumilova AA, Cheldieva FA, Nurbaeva KS, et al. Adaptation of the Russian version of the activity index of systemic lupus erythematosus EASY-BILAG. Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2023;17(5): 107-111. (In Russ.). doi: 10.14412/1996-7012-2023-5-107-111Jesus D, Matos A, Henriques C, et al. Derivation and validation of the SLE Disease Activity Score (SLE-DAS): a new SLE continuous measure with high sensitivity for changes in disease activity. Ann Rheum Dis. 2019 Mar;78(3):365-371. doi: 10.1136/annrheumdis-2018-214502.Jesus D, Matos A, Henriques C, et al. Derivation and validation of the SLE Disease Activity Score (SLE-DAS): a new SLE continuous measure with high sensitivity for changes in disease activity. Ann Rheum Dis. 2019 Mar;78(3):365-371. doi: 10.1136/annrheumdis-2018-214502.

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