Systemic lupus erythematosus is an autoimmune disease. Many experts said in an online interview recently that in recent years, the overall disease control of lupus erythematosus has made great progress in clinical practice, but due to disease activity, repeated recurrence and drug toxicity, patients often have irreversible damage to multiple organ systems risk, it is necessary to take a multi-pronged approach to organ protection.
Systemic lupus erythematosus occurs in women of childbearing age aged 15 to 45, and is characterized by the involvement of multiple organs and systems, which can cause damage to multiple organs and tissues such as the kidneys, cardiovascular system, lungs, digestive system, and eyes, and significantly increase the patient’s risk of death.
“The 5-year survival rate of patients has increased from 50% to 60% in the 1950s to over 90% today,” said Zhang Zhuoli, vice chairman and secretary-general of the Rheumatology Branch of the Chinese Medical Association. With the improvement of doctors and patients’ awareness of diseases and the development of drug therapy, more and more patients can be diagnosed and treated in the early stage of the disease.
In June of this year, the deputy editor-in-chief of the official journal of the European League Against Rheumatism “Rheumatology Yearbook” shared the latest version of systemic lupus erythematosus management recommendations at the 2023 European League Against Rheumatism (EULAR) annual meeting and made an oral release. There are new recommendations on the dosage of hormones used by patients, the subsequent management of the disease, and the treatment of lupus kidneys.
Although the 10-year survival rate of patients has greatly improved, due to disease activity, repeated recurrence and drug toxicity, SLE patients often have the risk of irreversible damage to multiple organ systems, the severity and frequency of damage increase over time, and organ damage This in turn predicts more organ damage and an increased risk of death.
The above-mentioned EULAR guidelines, when issued orally, recommend that physicians assess systemic lupus erythematosus disease activity (frequency at the physician’s discretion) at each patient visit and assess organ damage at least annually using validated examination items.
“We can see clinically that although sometimes our disease may be at a relatively low disease activity, organ damage may still be quietly going on.” Xie Qibing, president of the Rheumatology and Immunology Branch of the Sichuan Medical Doctor Association of the Chinese Medical Doctor Association For example, even if patients do not feel abnormal, the underlying inflammation of lupus may still attack their kidneys, skin, and nervous system. The degree of damage to important organs such as the heart and liver, because it may cause an irreversible damage.”
Hormone is the first-line drug for systemic lupus erythematosus. The oral release of the EULAR guidelines suggested that drug intervention should be guided by patient characteristics, type and severity of organ involvement, treatment-related harms, comorbidities, risk of progressive organ damage, and patient preference.
“In the past, we thought it was a good state to maintain 7.5 mg, but now the hormone has been reduced, and it has been reduced to 5 mg under stable conditions.” Wu Lijun, standing member of the Rheumatology Branch of the Chinese Medical Association, said that with the development of immunosuppressants and biological agents After the combination therapy, the application of hormones is getting smaller and smaller, and now that biologics such as belimumab are on the market, on the basis of ensuring stable conditions in the past, hormone reduction will be faster.