{"id":151,"date":"2026-02-08T13:21:19","date_gmt":"2026-02-08T12:21:19","guid":{"rendered":"https:\/\/erlaxatu.fr\/?page_id=151"},"modified":"2026-03-15T21:16:05","modified_gmt":"2026-03-15T20:16:05","slug":"__trashed-2","status":"publish","type":"page","link":"https:\/\/erlaxatu.fr\/index.php\/__trashed-2\/","title":{"rendered":"Lupus \u00e9ryth\u00e9mateux syst\u00e9mique"},"content":{"rendered":"<p><strong>Lupus \u00e9ryth\u00e9mateux syst\u00e9mique <\/strong><\/p>\n<p><strong>I. Atteintes cutan\u00e9es et vasculaires (rep\u00e8res)<\/strong><\/p>\n<ul>\n<li>Lupus aigu : \u00e9ruption en \u201cvespertilio\u201d.<\/li>\n<li>Plaques \u00e9ryth\u00e9mato-squameuses des zones photo-expos\u00e9es ; sur le dos des mains, atteinte plut\u00f4t interarticulaire (\u00e0 l\u2019inverse de la dermatomyosite). <\/li>\n<li>Photosensibilit\u00e9.<\/li>\n<li>L\u00e9sions muqueuses \u00e9rosives (lupus actif), alop\u00e9cie, l\u00e9sions disco\u00efdes (formes souvent cutan\u00e9es, mais association \u00e0 un LES possible ~10%).<\/li>\n<li>Vascularite cutan\u00e9e : purpura (plus rarement n\u00e9crose\/urticaire infiltr\u00e9e). <\/li>\n<li>Acrosyndrome\/Raynaud (possible). <\/li>\n<li>Signes \u00e9vocateurs de SAPL : livedo racemosa, ulc\u00e8re veineux pseudophl\u00e9bitique, h\u00e9morragie sous-ungu\u00e9ale.<\/li>\n<\/ul>\n<p><strong>Biopsie cutan\u00e9e (si l\u00e9sions atypiques)<\/strong> : d\u00e9p\u00f4ts d\u2019IgG\/IgM et compl\u00e9ment (C1q, C3) \u00e0 la jonction dermo-\u00e9pidermique, en peau l\u00e9s\u00e9e ou saine (\u201cbande lupique\u201d).<\/p>\n<p><strong>II. Atteinte r\u00e9nale (n\u00e9phropathie lupique) : ce qu\u2019il faut ma\u00eetriser<\/strong><\/p>\n<p><strong>A. Fr\u00e9quence et profil<\/strong><\/p>\n<p>Atteinte r\u00e9nale classique, souvent glom\u00e9rulaire, parfois <strong>asymptomatique<\/strong>, justifiant un <strong>d\u00e9pistage syst\u00e9matique<\/strong> d\u00e8s le diagnostic et au suivi. <\/p>\n<p>led vascu ppr<\/p>\n<p><strong>B. D\u00e9pistage pratique<\/strong><\/p>\n<ul>\n<li>Outil propos\u00e9 : <strong>rapport prot\u00e9inurie\/cr\u00e9atininurie<\/strong> sur \u00e9chantillon (pathologique si \u2265 0,5 g\/g). <\/li>\n<li>Si positif : ECBU (confirmer h\u00e9maturie, leucocyturie, \u00e9liminer IU) + quantification. <\/li>\n<li>H\u00e9maturie isol\u00e9e : pas une indication \u00e0 biopsie en soi. <\/li>\n<\/ul>\n<p><strong>C. Indications de biopsie r\u00e9nale (rep\u00e8res)<\/strong><\/p>\n<ul>\n<li>Insuffisance r\u00e9nale au diagnostic : indication non discutable.<\/li>\n<li>Prot\u00e9inurie &gt; 500 mg\/24h (hors IU), et discussion selon cin\u00e9tique\/gravit\u00e9. <\/li>\n<\/ul>\n<p><strong>D. Classification OMS (grands rep\u00e8res)<\/strong><\/p>\n<p>Classes I \u00e0 VI (de minime \u00e0 scl\u00e9rose diffuse), <strong>classe IV<\/strong> = prolif\u00e9rative diffuse, la plus s\u00e9v\u00e8re. <\/p>\n<p><strong>III. Atteintes cardio-vasculaires et SAPL (\u00e0 conna\u00eetre)<\/strong><\/p>\n<p><strong>A. Valves \/ endocardite de Libman-Sacks<\/strong><\/p>\n<p>Prolapsus mitral possible, l\u00e9sions verruqueuses (Libman-Sacks) exposant \u00e0 fuite, emboles, etc., association avec anticorps anti-phospholipides ; d\u2019o\u00f9 ECG + \u00e9chographie syst\u00e9matiques dans ce contexte. <\/p>\n<p><strong>B. Ath\u00e9roscl\u00e9rose acc\u00e9l\u00e9r\u00e9e<\/strong><\/p>\n<p>Risque cardiovasculaire augment\u00e9, multifactoriel (inflammation + facteurs de risque + cortico\u00efdes). La pr\u00e9vention CV et l\u2019utilisation de la dose minimale efficace de cortico\u00efdes sont <\/p>\n<p><strong>C. Syndrome des anti-phospholipides (SAPL)<\/strong><\/p>\n<ul>\n<li>Thromboses veineuses\/art\u00e9rielles\/microvasculaires r\u00e9p\u00e9t\u00e9es ; peut \u00eatre primaire ou associ\u00e9 au LES.<\/li>\n<li>Crit\u00e8res : \u22651 crit\u00e8re clinique + \u22651 crit\u00e8re biologique. <\/li>\n<\/ul>\n<p><strong>Traitement (rep\u00e8res pratiques)<\/strong><\/p>\n<ul>\n<li>Aspirine faible dose (100 mg\/j) discut\u00e9e en pr\u00e9vention chez lupus avec biologie aPL (pas de consensus si totalement asymptomatique). <\/li>\n<li>Thrombose : anticoagulation au long cours (souvent \u00e0 vie), AVK recommand\u00e9s (INR cible 2\u20133, souvent 2,5). AOD d\u00e9conseill\u00e9s (risque thrombotique sup\u00e9rieur). <\/li>\n<li>Grossesse : AVK contre-indiqu\u00e9s \u00e0 partir de 6 SA \u2192 relais HBPM dose efficace + aspirine antiagr\u00e9gante, prise en charge pluridisciplinaire. <\/li>\n<\/ul>\n<p><strong>IV. Traitement du LES : socle + escalade (logique)<\/strong><\/p>\n<p><strong>A. Traitement de fond \u201csocle\u201d<\/strong><\/p>\n<p><strong>Hydroxychloroquine<\/strong> : recommand\u00e9e chez tous les patients (sauf contre-indication), dose ~5 mg\/kg\/j ; examen ophtalmologique initial puis suivi (toxicit\u00e9 r\u00e9tinienne rare mais \u00e0 d\u00e9pister pr\u00e9cocement).<\/p>\n<p><strong>B. Formes b\u00e9nignes cutan\u00e9o-articulaires<\/strong><\/p>\n<p>AINS \u00b1 faibles doses de cortico\u00efdes (non recommand\u00e9s si atteinte purement cutan\u00e9e), possibilit\u00e9 de m\u00e9thotrexate en association avec hydroxychloroquine si atteinte cutan\u00e9o-articulaire persistante.<\/p>\n<p><strong>C. Atteintes s\u00e9v\u00e8res (r\u00e9nale\/neurologique\/cardiaque\/h\u00e9mato)<\/strong><\/p>\n<ul>\n<li>Cortico\u00efdes fortes doses (parfois IV puis PO) + immunosuppresseurs (cyclophosphamide ou mycoph\u00e9nolate en induction ; entretien souvent par azathioprine ou mycoph\u00e9nolate pour n\u00e9phrites s\u00e9v\u00e8res).<\/li>\n<li>Bioth\u00e9rapies : b\u00e9limumab (AMM, mais efficacit\u00e9 non d\u00e9montr\u00e9e dans atteintes r\u00e9nales\/neurologiques s\u00e9v\u00e8res) ; rituximab sans AMM dans LES mais utilis\u00e9 en cas r\u00e9fractaire (n\u00e9phrite, thrombop\u00e9nie s\u00e9v\u00e8re, AHAI).<\/li>\n<li>Mesures de pr\u00e9vention : photoprotection, pr\u00e9vention ath\u00e9romateuse, vaccinations, pr\u00e9vention ost\u00e9oporose cortico-induite (densitom\u00e9trie, correction carence, activit\u00e9 physique, bisphosphonate selon terrain). <\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Lupus \u00e9ryth\u00e9mateux syst\u00e9mique I. Atteintes cutan\u00e9es et vasculaires (rep\u00e8res) Lupus aigu : \u00e9ruption en \u201cvespertilio\u201d. Plaques \u00e9ryth\u00e9mato-squameuses des zones photo-expos\u00e9es [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-151","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/erlaxatu.fr\/index.php\/wp-json\/wp\/v2\/pages\/151","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/erlaxatu.fr\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/erlaxatu.fr\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/erlaxatu.fr\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/erlaxatu.fr\/index.php\/wp-json\/wp\/v2\/comments?post=151"}],"version-history":[{"count":2,"href":"https:\/\/erlaxatu.fr\/index.php\/wp-json\/wp\/v2\/pages\/151\/revisions"}],"predecessor-version":[{"id":213,"href":"https:\/\/erlaxatu.fr\/index.php\/wp-json\/wp\/v2\/pages\/151\/revisions\/213"}],"wp:attachment":[{"href":"https:\/\/erlaxatu.fr\/index.php\/wp-json\/wp\/v2\/media?parent=151"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}