10 factors + 4 questions, you can also predict organ damage in SLE patients after understanding!

*Only for medical professionals to read and refer to the explanation of the big coffee, take a small book and write it down! The 23rd Asia-Pacific Alliance for Rheumatology (APLAR) Annual Conference ended in Kyoto, Japan.
During the 4-day online conference, rheumatology experts from the Asia-Pacific region gathered through a virtual meeting to focus on the diagnosis and treatment of rheumatism in the Asia-Pacific region.
The progress carried out wonderful academic sharing
.

Director Li Mengtao, Department of Rheumatology and Immunology, Peking Union Medical College Hospital, systematically summarized the related factors of systemic lupus erythematosus (SLE) organ damage
.

Professor Li Mengtao’s 14 clinical problems, SLE organ damage aspects SLE is a complex and highly heterogeneous autoimmune disease, the main body is multi-system multi-organ involvement, repeated relapse and remission, and the presence of a large number of autoantibodies in the body.
Clinical characteristics, if the treatment is not timely, it will cause irreversible damage to the involved organs and eventually lead to the death of the patient [1]
.

In the speech, Professor Li Mengtao expressed his views on the five basic problems of SLE organ damage
.

1.
As the disease progresses, the influencing factors of organ damage are also changing.
Professor Li Mengtao pointed out that in the early stage of the disease, system damage is mainly related to disease activity, and patients with high disease activity are more likely to develop organ damage
.

However, as the disease progresses, the use of drugs, especially the use of glucocorticoids (CS), has become increasingly associated with organ damage
.

In the later stage of the disease, the use of CS and immunosuppressive agents (IS) and the accumulated disease activity have become the main predictors of organ damage
.

Figure 1: The related factors of organ damage in different disease stages are different.
2.
Can patients with low disease activity also experience organ damage? A 5-year follow-up survey of the disease burden of SLE patients in a multi-center study pointed out that even if the patient has maintained a low disease activity, the risk of organ damage will accumulate as the duration of the disease increases [2]
.

Figure 2: The risk of organ damage in patients with low disease activity continues to increase over time 3.
What is the relationship between the use of CS and the risk of organ damage? CS is the basic medicine for the management of SLE.
However, some studies have confirmed that the use of CS may increase the risk of organ damage in patients
.

Professor Li Mengtao pointed out that the use of CS is related to most of the adverse events of SLE, including organ damage (cataracts, glaucoma, osteoporosis and osteonecrosis, heart failure), high blood pressure, infections, etc.
, the use of CS ≥7.
5mg/day The risk of cataract, bone destruction and cardiovascular damage were 2.
41 times, 2.
16 times and 1.
54 times that of other patients, respectively
.

Figure 3: The relationship between the use of CS and organ damage 4.
What is the relationship between the use of IS and the risk of organ damage? The status of IS in the treatment of SLE is not inferior to glucocorticoids.
Unfortunately, the use of IS is also related to organ damage
.

Professor Li Mengtao said that the use of IS is associated with an increased risk of organ damage (HR=1.
56, P=0.
044).
At the same time, a 40-year follow-up study also showed that early use of IS (within 2 years after diagnosis) is more likely to increase Organ damage risk—especially the risk of organ damage in the early stages of the disease
.

Figure 4: The risk of organ damage in patients with early use of IS increases.
There are more 210 related factors that rheumatologists should memorize! The Asia-Pacific Lupus Cohort Study (APLC) [3] showed that 14.
9% of SLE patients suffered irreversible organ damage within 2.
2 years after the diagnosis of the disease
.

Reducing organ damage, ensuring the long-term survival of patients, and improving the quality of life have become one of the important goals of SLE treatment.
It has been written into the authoritative guide [1,4], which means to grasp the influencing factors of SLE organ damage and carry out the treatment of SLE patients.
Pre-assessment of organ damage is one of the trends in SLE diagnosis and treatment in the future
.

Professor Li Mengtao used a picture to summarize 10 factors related to organ damage in SLE patients: age, organ damage at diagnosis, race/living area, gender, use of CS/IS, high blood pressure, high disease activity, Active kidney damage, use of antimalarial drugs, and access to medical resources
.

Figure 5: The 10 major influencing factors of SLE organ damage.
Professor Li Mengtao divided the 10 major influencing factors into invariable factors (age, gender, race, organ damage at diagnosis) and variable factors
.

Among the variable factors, CS/IS use, high blood pressure, high disease activity, and active kidney damage are all associated with an increased risk of organ damage, while the use of antimalarial drugs and more accessible medical resources are associated with the risk of organ damage in SLE Reduce correlation
.

Professor Li Mengtao pointed out that the identification of variable factors and individualized intervention can control the risk of organ damage in patients
.

References: [1] Zeng Xiaofeng, Chen Yaolong.
2020 Chinese Systemic Lupus Erythematosus Diagnosis and Treatment Guidelines [J].
Chinese Journal of Internal Medicine, 2020(3): 172-185.
[2] Urowitz MB, Gladman DD, Ibañez D, et al .
Evolution of disease burden over five years in a multicenter inception systemic lupus erythematosus cohort.
Arthritis Care Res(Hoboken).
2012 Jan;64(1):132-7.
doi:10.
1002/acr.
20648.
PMID:21954226.
[3 ]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 .
Epub 2018 Nov 5.
PMID:30398013.
[4]Oku K,Hamijoyo L,Kasitanon N,et al.
Prevention of infective complications in systemic lupus erythematosus:A systematic literature review for the APLAR consensus statements.
Int J Rheum Dis.
2021 Jul;24(7):880-895.
doi:10.
1111/1756-185X.
14125.
Epub 2021 May 17.
PMID:33999518.