Decoding the rheumatism live broadcast room ①Improve the standardization of rheumatism diagnosis and treatment to benefit more rheumatism patients

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 involved in the diagnosis and treatment of rheumatic diseases, including standardized diagnosis and treatment promoted by the Chinese Academy of Sciences, unmet needs for lupus treatment, treatment goals, and comprehensive treatment
.

01 Li Mengtao: Disciplinary construction guarantees the standardized diagnosis and treatment of rheumatism, Professor Zhao Yan, chairman of the Chinese Medical Association Rheumatology Branch, once said, "The nine prescriptions issued by ten doctors in the United States are the same, while the nine prescriptions issued by ten doctors in China are the same.
The prescriptions may all be different"
.

In response to improving the homogeneity of rheumatism diagnosis and treatment in China, Professor Li Mengtao, deputy chairman of the Rheumatology Branch of the Chinese Medical Association, gave an introduction
.

In order to improve the level of diagnosis and treatment of rheumatism in China, the Chinese Academy of Sciences has promoted three aspects of work: 1) There are many patients with rheumatism in China and there are few doctors, and the construction of disciplines is facing huge challenges
.

Therefore, the Rheumatology Branch of the Chinese Medical Association and the Rheumatology and Immunology Physician Branch of the Chinese Medical Doctor Association are promoting the establishment of an independent rheumatology and immunology department and the training of young rheumatology immunologists
.

2) Develop guidelines and norms, so that basic rheumatologists have rules to follow, and gradually realize the homogenization of medical treatment
.

For example, the Rheumatology Branch of the Chinese Medical Association has formulated Chinese diagnosis and treatment guidelines for gouty arthritis, rheumatoid arthritis, and systemic lupus erythematosus (SLE), and conducted guide tour training
.

3) The construction of the National Clinical Research Center for Skin and Immune Diseases, which is being promoted at the national level, will promote the improvement of the diagnosis and treatment of rheumatism in China in both scientific research and clinical aspects
.

The ultimate goal of the National Clinical Medical Research Center is to feed back the clinic from clinical to research
.

At present, a standardized diagnosis and treatment center for rheumatoid arthritis, gout, ankylosing spondylitis, and China's systemic lupus erythematosus has been established.
Through the standardized diagnosis and treatment center project, more rheumatologists in hospitals are encouraged to achieve standardized diagnosis and treatment
.

Professor Li further exemplified the significance of the construction of standardized diagnosis and treatment centers
.

For example, SLE is a major challenge for rheumatologists.
It is very difficult to achieve homogenized and standardized diagnosis and treatment for different patient conditions
.

Through the construction of the SLE standardized diagnosis and treatment center project, a model for the construction of SLE treatment centers has been set for the national counterparts, and more hospitals and departments will be promoted to achieve standardized SLE treatment efforts
.

02 Zhao Dongbao: What are the unmet needs for the treatment of lupus? SLE is a very harmful disease, and it is also a difficult point in the diagnosis and treatment of rheumatism.
What are the clinical problems that need to be solved urgently? Professor Zhao Dongbao from the Department of Rheumatology and Immunology of Shanghai Changhai Hospital brought answers
.

"SLE is a complex disease with many unmet clinical needs
.

" Professor Zhao Dongbao said
.

First, there are fewer drugs to treat SLE; secondly, the side effects of drugs are greater
.

SLE basis of two categories of drugs, corticosteroids and immunosuppressants long-term use, there will be infections, high blood pressure, diabetes, osteoporosis, cataracts
.

Third, the SLE disease itself is relatively complicated, and its disease is characterized by repeated relapses, and its pathogenesis is still unclear.
Therefore, the drugs and methods that can treat the disease are very limited
.

Although the 10-year survival rate of patients has reached more than 90%, 10% of patients still die
.

Fourth, organ damage caused by diseases can accumulate
.

Even if the disease is well controlled and there are no clinical symptoms, its system damage is still developing
.

Therefore, there is an urgent need for clinically innovative lupus treatment drugs to control diseases and relieve organ damage
.

Fifth, lupus is often misdiagnosed, on the one hand, it is related to the complexity of the disease; on the other hand, non-rheumatic immunologists often have headaches when treating the disease, and some patients’ diseases have not been systematically diagnosed and treated
.

The bio-targeted drug that has been used in clinical practice, belimumab, can delay the progression of organ damage [1-2] and effectively reduce the amount of hormones [3-7]
.

Based on clinical experience, Professor Zhao suggested that biological preparations should be used for at least 6 months, and there have been patients abroad who have been using drugs safely for more than ten years
.

At present, in China, the adult indication of belyumumab has been included in medical insurance, which has greatly improved the availability of drugs
.

03 Zhang Xuewu: Comprehensive measures are needed to improve the survival rate of lupus patients.
At present, the survival rate of lupus patients has been greatly improved, thanks to early diagnosis, standardized treatment, and the entry of lupus treatment drugs into the clinic
.

However, compared with the normal population, the overall survival of lupus patients is still not optimistic.
In order to improve the survival rate of lupus patients, comprehensive measures should be taken
.

Professor Zhang Xuewu from Peking University People's Hospital shared this
.

"A few years ago, the first feeling I got lupus was whether I would die soon? But now people understand that lupus has become a chronic disease like hypertension and diabetes, which can live with the disease
.

" Professor Zhang Xuewu said
.

Although the cause of lupus is unclear, it is considered to be a disease that involves multiple factors and ultimately leads to autoimmune dysfunction
.

In order to further improve the survival rate of lupus patients, comprehensive measures should be taken in four aspects: 1) The doctor should have a comprehensive understanding of the diagnosis and treatment of lupus, and the efficacy and adverse reactions of the drugs should be monitored and followed up
.

2) At present, the diagnosis of lupus still relies on comprehensive diagnostic criteria, with poor sensitivity and specificity.
For a long time, immunological indicators such as anti-dsDNA antibodies, complement activity, and immune complexes have been classic signs of SLE disease activity
.

With the advancement of technology and the deepening of research, a large number of new SLE-related biomarkers have appeared [8]
.

In the future, researchers should study and discover more specific serum biomarkers, so that doctors have more accurate tools for diagnosing lupus
.

3) There are many adverse reactions to basic medicines for the treatment of lupus, and it is hoped that more medicines will enter the clinic in the future to improve the remission rate and survival rate of patients
.

4) Attention should be paid to the long-term protection of organ functions in patients with lupus, such as osteoporosis and cardiovascular and cerebrovascular diseases caused by long-term use of hormones [9-10]
.

"The current concept is that hormones should be used and should be reduced
.

" Regarding the organ damage caused by the application of hormones, Professor Zhang said that since the 21st century, the treatment of rheumatism has entered the era of biological agents
.

The clinical application of hormones, immunosuppressants, and biologically targeted drugs can better control lupus, reduce the time and dose of hormone use, so that the patient's disease can be stabilized as soon as possible, while also avoiding long-term organ damage
.

04 Qi Wufang: The goal of lupus treatment is to achieve double standards.
Lupus is difficult to treat.
To what extent should it be treated clinically? What is the goal of treatment? With the increase of treatment methods, the concept of lupus treatment becomes clearer and clearer
.

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 lupus treatment goals 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 the 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 immunosuppressive agent without biomarkers to judge? 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 that the conventional treatment is not well controlled and still has high disease activity, the use of biological drugs, after the medication, the hormones are reduced smoothly, and the urine protein turns 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 mainly inhibit immature B cells [11] not only the response rate of patients is significantly improved, but also the autoreactive B cells in the late stage of maturity are prevented from being eliminated.
The safety is good, and the clinical efficacy and safety have been experienced.
Up to 13 years of real-world data verification [1,3-7,13]
.

2023/7 ‍‍‍‍‍‍‍‍‍‍‍‍‍‍​ "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 Shenzhen Hospital of the Chinese Academy of Medical Sciences Cancer 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