Decoding Rheumatism Live Room ⑤ Rheumatism can also cause acute and critical illness?

The annual meeting of the Rheumatology Branch of the Chinese Medical Association was held in Shenzhen, and scholars in the field of rheumatism conducted academic exchanges on the theme of "targeted therapy, early intervention for critical illness, and rare diseases"
.

During the period, the "Physician" decoded the rheumatism live broadcast room at the annual meeting, and many big names gathered in the live broadcast room to bring in-depth and simple interpretations on the hot topics in the field of rheumatism
.

This article reports on the sharing of experts in critical illness, including rheumatism, interstitial pneumonia, lupus critical illness, and how to achieve SLE system evaluation to avoid the development of lupus critical illness
.

01 Yang Chengde: The diagnosis of critical illness caused by rheumatism requires multidisciplinary cooperation.
The field of rheumatism is a hot topic.
What are the difficulties in this field and what are the solutions? Professor Yang Chengde, deputy chairman of the Chinese Medical Association Rheumatology Branch, brought answers
.

Rheumatic immune diseases are caused by disorders of the immune system, which affect all organs of the body 1
.

Professor Yang said that acute and critical illness in rheumatology is a complex concept, and the involvement of each system varies from degree to degree
.

Skin, blood, brain, and kidney involvement can all have manifestations that affect the life of the patient.
These are critical and critical illnesses in the field of rheumatism
.

The critical illness of rheumatism involves multiple organs, and because of its atypical performance, it is often difficult to diagnose the critical illness of rheumatism early, so multidisciplinary cooperation is required
.

In addition, in terms of treatment, due to the lack of evidence-based medicine research, a unified plan has not yet been formed
.

Based on these characteristics, this China Rheumatology Annual Conference has set up a special critical illness special session, which mainly focuses on several clinical critical illnesses: first, rapidly progressing pulmonary interstitial lesions
.

The differential diagnosis of whether the disease is caused by rheumatism is very important, and the means of identification include: clinical manifestations, laboratory examinations, and diagnosis with a rheumatologist 2
.

Second, dermatomyositis is also a critically ill-affected area, which can be identified clinically based on early warning models, and early treatment of MDA5-positive and rapidly progressing dermatomyositis3
.

Third, the bloodthirsty syndrome secondary to rheumatism is also an acute and critical illness that is easy to appear.
The clinical manifestations are high fever, reduced blood picture, and organ dysfunction
.

First, determine whether the patient has triggers and treat it according to international guidelines after early identification4
.

Fourth, patients with acute abdomen should also be tested for autoantibodies to rule out rheumatism, such as vasculitis, and be diagnosed and treated in time5
.

In terms of early warning of critical illness, the risk warning model has great clinical value for early warning of critical illness
.

02 Zhao Jiuliang: Patients with pneumonia in the Department of Infectious Diseases and Respiratory Medicine should be wary of interstitial pneumonia.
Immune-related interstitial pneumonia is a high-risk disease in the field of rheumatism, which can significantly reduce the survival rate of patients and irreversible lung damage
.

How to make early differential diagnosis and early prevention, Professor Zhao Jiuliang, deputy head of the Youth Group of the Chinese Medical Association Rheumatology Branch, brought sharing
.

Immune-related interstitial pneumonia can be divided into connective tissue disease-related interstitial pneumonia and although it is impossible to confirm which connective tissue disease belongs to, it is also immune-mediated interstitial pneumonia, which is called autoimmune characteristics Interstitial pneumonia (IPAF) is not uncommon in clinical practice6
.

Common clinical pneumonia and immune-related interstitial pneumonia have something in common.
Both may have fever, cough, and sputum, as well as imaging findings of lung CT
.

The two should be differentiated from the etiology, symptoms, signs, and imaging lesions.
7 The treatment methods are also different.
Common pneumonia requires anti-infective treatment, while IPAF requires increased hormone and immunosuppressive treatment8
.

Because IPAF can significantly reduce the survival rate of patients, and seriously affect the recovery of the disease, if the treatment is not early and standardized, it will cause irreversible damage, and eventually respiratory failure and pulmonary fibrosis will lead to death.
Therefore, prevention is the most important way9
.

There are two situations for IPAF prevention and follow-up.
The first type of patients is diagnosed and treated by rheumatologists.
Patients with connective tissue disease who are prone to IPAF.
For such patients, doctors should take the initiative to ask for medical history, regularly do lung function tests, and lung CT.
, And tailor-made early screening programs, after the emergence of IPAF, patients receive timely treatment10
.

The other type is patients who go to the respiratory department due to shortness of breath after the activity, or the patients who are equivalent to the infection department because of suspected infection
.

For such patients, other departments should also tighten the string of autoantibody screening, or consult the rheumatology department
.

03 Li Yinong: The beacon for systematic evaluation of the clinical treatment of SLE.
For all diseases, if you want to know the severity of the disease and whether the treatment is effective, it needs to be evaluated, not to mention more complicated diseases like SLE
.

Therefore, there are also various evaluation tools for SLE
.

Professor Li Yinong, director of the Department of Rheumatology and Immunology, Affiliated Armed Police Hospital of Fujian Medical University, introduced the necessity of systematic evaluation of SLE
.

Professor Li Yinong said that currently the most commonly used assessment tools are the BILAG score of the British Isles, and the SDR assessment of the International Lupus Collaboration Group, which is mainly considered from the aspect of organ damage, but does not consider the disease activity of the patient11- 13
.

Systemic Lupus Erythematosus Disease Activity Score (SLEDAI) has many clinical applications, mainly to assess the disease activity of patients, but the assessment of organ damage is not thorough enough
.

There is also the Clinician’s Overall Assessment (PGA), which is the doctor’s assessment of the patient’s overall condition14
.

It can be seen that different assessment tools have different focuses
.

In recent years, the "Three Score" concept has emerged, which is to consider the three scores of SLEDAI, BILAG and PGA at the same time to produce a comprehensive index SRI15, so that the evaluation of SLE is more comprehensive and scientific
.

In view of the high degree of heterogeneity of SLE, the clinical manifestations of patients are different.
Arrhythmia, heart failure, lupus nephritis, mesenteric disease, infection, etc.
may appear, showing manifestations of multiple organ involvement
.

The changeable performance puts forward higher requirements for treatment.
When do you need to use immunosuppressive agents, hormones, and gamma globules, when do you need anticoagulation and invigorate blood, when you can use biological agents, and the application of these treatments is required.
Make a systematic assessment first
.

Systematic evaluation is very important because it allows clinicians to know the method and timing of treatment
.

‍‍‍‍‍‍‍‍‍‍‍‍Qi Wufang: The goal of lupus treatment is to achieve double standard lupus treatment difficulties.
To what extent should it be treated in clinical practice? What is the goal of treatment? With the increase of treatment methods, the concept of lupus treatment has become more and more clear
.

Professor Qi Wufang from the Department of Rheumatology and Immunology of Tianjin Central Hospital answered questions about standard treatment
.

The target treatment concept has gradually become the consensus of SLE treatment
.

The "2020 Systemic Lupus Erythematosus Guidelines for Diagnosis and Treatment" proposes that the goals of lupus treatment should be achieved in both the short-term and long-term goals.
The two have different meanings, but they are both important for maintaining the long-term survival of patients
.

Significance of double attainment.
First of all, after a patient is diagnosed with lupus, complete remission should be targeted to induce remission quickly.
Even if complete remission cannot be achieved, the disease should be controlled as low as possible, otherwise it will cause organ damage and increase the risk of death.
Affect the long-term prognosis
.

Second, after using hormones to induce remission, attention should be paid to hormone reduction, otherwise it will cause adverse reactions and affect long-term compliance
.

"Lupus is prone to relapse, so you need skills when reducing hormone doses.
Otherwise, it will easily lead to recurrence of the disease and increase hormone doses.
The risk of adverse drug reactions is greater
.

" Professor Qi shared the experience of hormone reduction, she said, use When hormones induce remission, immunosuppressive agents will be used at the same time.
If the patient relapses during hormone reduction, it may indicate that this type of immunosuppressive agent is not suitable for the patient
.

Only re-add hormones and replace immunosuppressive agents
.

The clinical question that needs to be solved urgently is: Which patient uses which immunosuppressant to judge without biomarkers? At present, it can only be judged based on the doctor's experience in clinical practice
.

Advances in drugs have made it easier to achieve standard treatment for lupus.
Each drug has its limitations.
For patients whose hormone and immunosuppressant treatments are not effective, a new clinical solution-biological targeted preparations has also appeared in recent years
.

Professor Qi introduced that a patient with newly diagnosed lupus she treated, under the condition of poor control of conventional treatment and high disease activity, used biological drugs.
After the medication, the hormones were reduced smoothly and the urine protein turned negative
.

Therefore, Professor Qi suggested that in the future, we can try the above-mentioned types of newly-treated patients who can use conventional treatment combined with belyumumab
.

By using biologically targeted drugs to selectively inhibit excessive BLyS in the B cell pathway, it has little effect on advanced B cells and preserves immunity.
At the same time, the patient's response rate has been significantly improved.
The efficacy and safety have been repeatedly verified by clinical applications around the world for more than 10 years
.

et al.
Immunol Rev.
2019 Nov;292(1):102-119.
17.
IaccarinoL, et al.
J Autoimmun 2018;86:1-8.
18.
CollinsCE, et al.
Lupus Sci Med 2016;3(1):e000118.
19.
Schwarting A, et al.
RheumatolTher 2016;3:271–290.
20.
BabiniA, et al.
Arthritis Rheumatol 2016; 68(suppl 10).
21.
ToumaZ, et al.
Rheumatol Int 2017;37(6):865– 87322.
TrentinF, et al.
Clin Rev Allergy Immunol 2018;54:331–343.
23.
VonKempis J, et al.
Swiss Med Wkly 2019;149:w20022.
This information is not an advertisement.
Personnel provide scientific information.
If you are not a healthcare professional, please do not read or disseminate the content PM-CN-BEL-NLTR-210035 EXP: 2023/8 Belliulumab concise prescription information, please click to read the original text layout/edit : Wang Lina Review: Xu Fengyan For more content, please click: Consensus|How to apply the super-hot ketogenic diet in glioma? "Nutritionist guidance" + "Personalized ketogenic diet plan" is a reliable tribute to the Chinese Physician's Day·Healthy China subway train poster story | Wang Lvhua: Tumor radiotherapy "one brother" leads the Chinese Academy of Medical Sciences Cancer Hospital Shenzhen Hospital out of the hospital construction "Shenzhen Speed" "Physician Daily" submission public email: yishibao2017@163.
com [Note] Some pictures are from the Internet and WeChat Moments.
If there is any infringement, please contact to delete, thank you! Tel: 010-58302828-6808 Currently 1130000+ doctors have been following to join us IaccarinoL, et al.
J Autoimmun 2018;86:1–8.
18.
CollinsCE, et al.
Lupus Sci Med 2016;3(1):e000118.
19.
Schwarting A, et al.
RheumatolTher 2016;3:271–290.
20.
BabiniA , et al.
Arthritis Rheumatol 2016; 68(suppl 10).
21.
ToumaZ, et al.
Rheumatol Int 2017;37(6):865–87322.
TrentinF, et al.
Clin Rev Allergy Immunol 2018;54:331–343.
23 .
VonKempis J, et al.
Swiss Med Wkly 2019;149:w20022.
This material is not an advertisement.
This material is intended to provide scientific information to and only to healthcare professionals.
If you are not a healthcare professional, please do not read or spread it For the content PM-CN-BEL-NLTR-210035 EXP: 2023/8 belyumumab concise prescription information, please click to read the original text typesetting/editing: Wang Lina review: Xu Fengyan For more content, please click: consensus | super fire ketogenic How to apply diet in glioma? "Nutritionist guidance" + "Personalized ketogenic diet plan" is a reliable tribute to the Chinese Physician's Day·Healthy China subway train poster story | Wang Lvhua: Tumor radiotherapy "one brother" leads the Chinese Academy of Medical Sciences Cancer Hospital Shenzhen Hospital out of the hospital construction "Shenzhen Speed" "Physician Daily" submission public email: yishibao2017@163.
com [Note] Some pictures are from the Internet and WeChat Moments.
If there is any infringement, please contact to delete, thank you! Tel: 010-58302828-6808 Currently 1130000+ doctors have been following to join us IaccarinoL, et al.
J Autoimmun 2018;86:1–8.
18.
CollinsCE, et al.
Lupus Sci Med 2016;3(1):e000118.
19.
Schwarting A, et al.
RheumatolTher 2016;3:271–290.
20.
BabiniA , et al.
Arthritis Rheumatol 2016; 68(suppl 10).
21.
ToumaZ, et al.
Rheumatol Int 2017;37(6):865–87322.
TrentinF, et al.
Clin Rev Allergy Immunol 2018;54:331–343.
23 .
VonKempis J, et al.
Swiss Med Wkly 2019;149:w20022.
This material is not an advertisement.
This material is intended to provide scientific information to and only to healthcare professionals.
If you are not a healthcare professional, please do not read or spread it For the content PM-CN-BEL-NLTR-210035 EXP: 2023/8 belyumumab concise prescription information, please click to read the original text typesetting/editing: Wang Lina review: Xu Fengyan For more content, please click: consensus | super fire ketogenic How to apply diet in glioma? "Nutritionist guidance" + "Personalized ketogenic diet plan" is a reliable tribute to the Chinese Physician's Day·Healthy China subway train poster story | Wang Lvhua: Tumor radiotherapy "one brother" leads the Chinese Academy of Medical Sciences Cancer Hospital Shenzhen Hospital out of the hospital construction "Shenzhen Speed" "Physician Daily" submission public email: yishibao2017@163.
com [Note] Some pictures are from the Internet and WeChat Moments.
If there is any infringement, please contact to delete, thank you! Tel: 010-58302828-6808 Currently 1130000+ doctors have been following to join us e000118.
19.
Schwarting A, et al.
RheumatolTher 2016;3:271–290.
20.
BabiniA, et al.
Arthritis Rheumatol 2016; 68(suppl 10).
21.
ToumaZ, et al.
Rheumatol Int 2017;37(6): 865–87322.
TrentinF, et al.
Clin Rev Allergy Immunol 2018;54:331–343.
23.
VonKempis J, et al.
Swiss Med Wkly 2019;149:w20022.
This information is not an advertisement.
Health professionals provide scientific information.
If you are not a health care professional, please do not read or disseminate the content PM-CN-BEL-NLTR-210035 EXP: 2023/8 Believumab concise prescription information, please click to read the original text layout /Editor: Wang Lina Review: Xu Fengyan For more content, please click: Consensus|How to apply the super-hot ketogenic diet in glioma? "Nutritionist guidance" + "Personalized ketogenic diet plan" is a reliable tribute to the Chinese Physician's Day·Healthy China subway train poster story | Wang Lvhua: Tumor radiotherapy "one brother" leads the Chinese Academy of Medical Sciences Cancer Hospital Shenzhen Hospital out of the hospital construction "Shenzhen Speed" "Physician Daily" submission public email: yishibao2017@163.
com [Note] Some pictures are from the Internet and WeChat Moments.
If there is any infringement, please contact to delete, thank you! Tel: 010-58302828-6808 Currently 1130000+ doctors have been following to join us e000118.
19.
Schwarting A, et al.
RheumatolTher 2016;3:271–290.
20.
BabiniA, et al.
Arthritis Rheumatol 2016; 68(suppl 10).
21.
ToumaZ, et al.
Rheumatol Int 2017;37(6): 865–87322.
TrentinF, et al.
Clin Rev Allergy Immunol 2018;54:331–343.
23.
VonKempis J, et al.
Swiss Med Wkly 2019;149:w20022.
This information is not an advertisement.
Health professionals provide scientific information.
If you are not a health care professional, please do not read or disseminate the content PM-CN-BEL-NLTR-210035 EXP: 2023/8 Believumab concise prescription information, please click to read the original text layout /Editor: Wang Lina Review: Xu Fengyan For more content, please click: Consensus|How to apply the super-hot ketogenic diet in glioma? "Nutritionist guidance" + "Personalized ketogenic diet plan" is a reliable tribute to the Chinese Physician's Day·Healthy China subway train poster story | Wang Lvhua: Tumor radiotherapy "one brother" leads the Chinese Academy of Medical Sciences Cancer Hospital Shenzhen Hospital out of the hospital construction "Shenzhen Speed" "Physician Daily" submission public email: yishibao2017@163.
com [Note] Some pictures are from the Internet and WeChat Moments.
If there is any infringement, please contact to delete, thank you! Tel: 010-58302828-6808 Currently 1130000+ doctors have been following to join us TrentinF, et al.
Clin Rev Allergy Immunol 2018;54:331–343.
23.
VonKempis J, et al.
Swiss Med Wkly 2019;149:w20022.
This information is not an advertisement.
This information is intended to be provided to healthcare professionals only Scientific information, if you are not a health care professional, please do not read or disseminate the content PM-CN-BEL-NLTR-210035 EXP: 2023/8 Bellyumumab concise prescription information, please click to read the original text layout/editor: Wang Lina Review: Xu Fengyan, please click for more content: Consensus|How to apply the super-hot ketogenic diet in glioma? "Nutritionist guidance" + "Personalized ketogenic diet plan" is a reliable tribute to the Chinese Physician's Day·Healthy China subway train poster story | Wang Lvhua: Tumor radiotherapy "one brother" leads the Chinese Academy of Medical Sciences Cancer Hospital Shenzhen Hospital out of the hospital construction "Shenzhen Speed" "Physician Daily" submission public email: yishibao2017@163.
com [Note] Some pictures are from the Internet and WeChat Moments.
If there is any infringement, please contact to delete, thank you! Tel: 010-58302828-6808 Currently 1130000+ doctors have been following to join us TrentinF, et al.
Clin Rev Allergy Immunol 2018;54:331–343.
23.
VonKempis J, et al.
Swiss Med Wkly 2019;149:w20022.
This information is not an advertisement.
This information is intended to be provided to healthcare professionals only Scientific information, if you are not a health care professional, please do not read or disseminate the content PM-CN-BEL-NLTR-210035 EXP: 2023/8 Bellyumumab concise prescription information, please click to read the original text layout/editor: Wang Lina Review: Xu Fengyan, please click for more content: Consensus|How to apply the super-hot ketogenic diet in glioma? "Nutritionist guidance" + "Personalized ketogenic diet plan" is a reliable tribute to the Chinese Physician's Day·Healthy China subway train poster story | Wang Lvhua: Tumor radiotherapy "one brother" leads the Chinese Academy of Medical Sciences Cancer Hospital Shenzhen Hospital out of the hospital construction "Shenzhen Speed" "Physician Daily" submission public email: yishibao2017@163.
com [Note] Some pictures are from the Internet and WeChat Moments.
If there is any infringement, please contact to delete, thank you! Tel: 010-58302828-6808 Currently 1130000+ doctors have been following to join us For 2023/8 belyumumab's concise prescription information, please click to read the original text typesetting/editing: Wang Lina Review: Xu Fengyan For more content, please click: Consensus|How to apply the super fire ketogenic diet in brain glioma? "Nutritionist guidance" + "Personalized ketogenic diet plan" is a reliable tribute to the Chinese Physician's Day·Healthy China subway train poster story | Wang Lvhua: Tumor radiotherapy "one brother" leads the Chinese Academy of Medical Sciences Cancer Hospital Shenzhen Hospital out of the hospital construction "Shenzhen Speed" "Physician Daily" submission public email: yishibao2017@163.
com [Note] Some pictures are from the Internet and WeChat Moments.
If there is any infringement, please contact to delete, thank you! Tel: 010-58302828-6808 Currently 1130000+ doctors have been following to join us For 2023/8 belyumumab's concise prescription information, please click to read the original text typesetting/editing: Wang Lina Review: Xu Fengyan For more content, please click: Consensus|How to apply the super fire ketogenic diet in brain glioma? "Nutritionist guidance" + "Personalized ketogenic diet plan" is a reliable tribute to the Chinese Physician's Day·Healthy China subway train poster story | Wang Lvhua: Tumor radiotherapy "one brother" leads the Chinese Academy of Medical Sciences Cancer Hospital Shenzhen Hospital out of the hospital construction "Shenzhen Speed" "Physician Daily" submission public email: yishibao2017@163.
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If there is any infringement, please contact to delete, thank you! Tel: 010-58302828-6808 Currently 1130000+ doctors have been following to join us