Diagnosis and management of SLE during the outbreak: weighing the primary and handling carefully.

The most important stage of SLE treatment is that the disease is stable.as an autoimmune disease, the immune system of patients with systemic lupus erythematosus (SLE) is in a state of disorder and easy to be infected. Novel coronavirus pneumonia (novel coronavirus pneumonia, WHO named COVID-19) raged during, and the risk of infection increased in SLE patients. At the same time, anxiety and anxiety may arise from fear, or the phenomenon of stopping drug withdrawal appeared due to the inconvenience of follow-up. Therefore, the diagnosis and management of diseases became different from before.in the special period, the standing member of the 11th Committee of Rheumatology branch of Chinese Medical Association, the chairman designate of Rheumatology branch of Beijing Medical Association, and Professor Su Yin of Rheumatology and Immunology Department of people's Hospital of Peking University shared some of her views.Novel coronavirus pneumonia is a novel coronavirus pneumonia.1 diagnosis method during the epidemic period, "fever" these two words make the Department of rheumatism doctors particularly alert, for example, common diseases of rheumatoid immunology SLE will also show low fever and fatigue. If the disease is involved in the lungs, it will also appear similar to the new crown pneumonia, such as dry cough, hypoxemia and even severe alveolar hemorrhage, which may be life-threatening. More serious.novel coronavirus pneumonia should be distinguished from SLE new cases or SLE disease activity or new crown pneumonia infection. The novel coronavirus pneumonia in1. is difficult to identify. It can be concluded from the following points: first, whether there is an epidemiological contact history, which is very important. We must tell patients that we must not hide the history of the disease, otherwise it is very unfavorable for the diagnosis and treatment of the disease.1. The novel coronavirus pneumonia is often accompanied by dry cough.second is concerned with the accompanying symptoms of fever patients. The typical SLE is accompanied by skin and mucosal involvement, such as oral ulcers, rashes, alopecia, joint swelling and pain. Most patients suffer from chest pain and cough. Novel coronavirus pneumonia was detected inthird, and new SLE showed bilateral pleural effusion and pleural thickening. Double lung phafroid could be seen in the early stage of new crown pneumonia.Fourth, the detection of autoantibodies. Novel coronavirus pneumonia may occur in the presence of,SLE, but there are also autoimmune factors.fifthly, it is necessary to detect the nucleic acid of new coronavirus.2. novel coronavirus pneumonia should be identified if SLE is active in patients with SLE.first of all, we should ask about the epidemiological contact history; secondly, we should pay attention to the medication history of SLE patients, whether they have adjusted the medication or stopped the medication by themselves; thirdly, we should pay attention to the symptoms accompanied by fever and whether there are new symptoms of SLE, such as oral ulcer, photoallergy, skin rash and hair loss. finally, chest CT and nucleic acid test of new coronavirus should be done in time if cough is accompanied. If novel coronavirus pneumonia is novel coronavirus pneumonia in SLE patients, 3. may cause SLE disease activity and make the primary lesion extremely dangerous. pay attention to this condition, timely diagnosis, rapid and active antiviral treatment, short-term reduction or discontinuation of immunosuppressants; at the same time, closely monitor the changes of SLE condition, find problems and treat as soon as possible to avoid aggravation of the disease. Professor Su said that the prevention of infection is still the most important for SLE patients. SLE patients must follow the advice of national official institutions, and do self-protection more strictly. 2 management and treatment suggestions: do not panic or despise 01 follow-up visit to the hospital. Professor Su Yin said that patients with stable condition should not go to the hospital as much as possible. the drug can be used according to the original scheme, and it must not reduce and stop the drug by itself! If it is a small dose of oral hormone, keeping the original scheme unchanged for a few weeks has little effect on the disease. if there are some mild abnormalities, such as sore throat, sneezing, etc., don't panic too much, you can try some cold medicine. if you can't get better or the condition has special changes, such as sudden fever, joint swelling and pain, rash, oral ulcer, or fatigue aggravation, white blood cells, platelets and other blood changes, you should not hesitate to go to the hospital for treatment under the condition of good protection. The novel coronavirus pneumonia novel coronavirus pneumonia treatment strategy for 02SLE is once diagnosed. SLE is combined with new crown pneumonia. The treatment should take into account both the two factors. novel coronavirus pneumonia and lung injury caused by new crown pneumonia may lead to fatal outcomes in SLE. in the course of treatment, which drugs have attracted people's attention? The novel coronavirus pneumonia is different from novel coronavirus pneumonia in 2003. SARS advocated the use of hormones during SARS. However, the fifth edition of the new health care committee's fifth edition of the new crown pneumonia treatment plan does not advocate a large dose of glucocorticoids, and advocates the use of short-term and appropriate use. therefore novel coronavirus pneumonia is the novel coronavirus pneumonia. When the two are combined and new crown pneumonia is the main, corticosteroids can be used according to the guidelines for treatment of new crown pneumonia [after a short period (3-5 days), no more than the methylprednisolone 1-2mg/kg/ day][1], and a short-term stop or reduction of immunosuppressive agents. When SLE is the main treatment, hormone and immunosuppressive agents are selected according to the degree of SLE activity, and the stable hormone after treatment is stable. Therefore, the supplement of vitamin D and vitamin D should be strengthened. (2) Professor gamma globulin Su recalled that during the SARS period, a SLE patient hospitalized in people's Hospital of Peking University developed fever and cough, and had imaging manifestations similar to SARS pulmonary infection, but SLE complicated with pulmonary infection could not be ruled out. in this case, while actively isolating patients, it is suggested to add gamma globulin which has the functions of regulating immune function and antiviral, and finally the disease is under control. Novel coronavirus pneumonia, SLE professor believes that the treatment of patients with new crown pneumonia should be necessary if the disease is active and anti viral. (3) Sun Yanrong, deputy director of biological center of chloroquine phosphate Ministry of science and technology, said at the press conference of the National Health Commission that in addition to radcivir, other antiviral drugs, such as chloroquine phosphate, were found. This reminds people of the derivative of chloroquine, the basic drug for the treatment of SLE, hydroxychloroquine sulfate is also an antimalarial drug, which has a certain antiviral effect. novel coronavirus pneumonia is reported to be launched soon. The hope is that the drug will achieve good results and bring good news to SLE and new crown pneumonia patients. (4) as the guideline of management recommendation on SLE updated by the European Union Against Rheumatism (EULAR) in 2019 mentioned that patients who did not respond well to conventional treatment (antimalarials + glucocorticoids combined / not combined with immunosuppressive agents) or patients whose glucocorticoids could not be reduced to an acceptable dose (≤ 7.5mg / D), baileumab could be considered for treatment [3]. therefore, this has also caused widespread concern. 3 summary the treatment of SLE is a protracted war, and in a special period, the stability of the disease is the most important. rheumatologists should tell patients not to panic excessively, but to protect themselves, prevent infection and spend it smoothly. however, for patients with special disease changes, doctors should fully understand the disease status, weigh the advantages and disadvantages, and give early treatment. The novel coronavirus pneumonia diagnosis and treatment plan (trial version fifth). [1] / http:, reference: Official Website of the national health and Health Committee of the State Council. [2] A, et al.2019 update of the EULAR recommendations for the management of systemic lupus  erythematosus.Ann Rheum dis 2019; 0:1 – 10. - end love me please show me!