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Hormone therapy for lupus, dose adjustment varies from person to person

 Last Update: 2023-01-01
 Source: Internet
 Author: User

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According to studies, the current global prevalence of systemic lupus erythematosus (SLE) is 0~241/100,000, and the prevalence of Chinese mainland SLE is about 30~70/100,000 [1-2].

As a systemic autoimmune disease, SLE is mainly characterized by systemic multi-system multi-organ involvement, repeated recurrence and remission, and the presence of a large number of autoantibodies in the body, if not treated in time, it will cause irreversible damage to the affected organs, and eventually lead to the death
of the patient.

Hormones are the cornerstone of SLE treatment, and clinicians should tailor a hormone regimen based on disease activity and the type and severity of organs involved, using the lowest dose
necessary to control disease.

1.
Dose adjustment

of patients with different degrees ▍1.
Hormone therapy is generally not required for mildly active SLE patients
, and when hydroxychloroquine or nonsteroidal anti-inflammatory drugs are not effective, the use of low-dose hormones (≤10mg/ 10mg / d prednisone or equivalent doses of other hormones).

▍2.
Patients with moderately active SLE can be treated with hormones (0.
5~1mg/kg/d prednisone or equivalent doses of other hormones) combined with
immunosuppressants
。 Patients with moderate SLE who are difficult to control quickly with medium-dose hormones can be combined with immunosuppressants on the basis of appropriately increasing the dose of hormones to reduce the cumulative dose of hormones and reduce the risk of
long-term adverse reactions.

▍3.
Patients
with severely active SLE can be treated with hormones (≥1 mg/kg/d prednisone or equivalent doses of other hormones) combined with immunosuppressants, and the dosage
of hormones will be adjusted appropriately after the condition is stable.
In patients with severe SLE, pulse hormone therapy
may be used if necessary.

▍4.
SLE patients
with lupus crisis can be treated
with hormonal shock combined with immunosuppressants.
Hormonal shock therapy is intravenous infusion of methylprednisolone 500~1 000mg/d, usually used continuously for 3d as a course of treatment, with an interval of 5~30d
.
After shock therapy, oral prednisone 0.
5~1mg/kg/d or equivalent doses of other hormones are usually treated for 4~8 weeks, but the specific course of treatment should depend on the condition
.

Clinicians should pay close attention to the disease activity of patients with SLE, adjust the amount of hormones according to the degree of disease activity, and consider gradually reducing hormones in patients with long-term stable disease
.

The most common short-term adverse reactions related to hormones are stomach discomfort, excitement, palpitations, insomnia, etc.
, and long-term adverse reactions include secondary infection and fragility fractures
.

Second, the equivalent dose of azathioprine commonly used glucocorticoids for the treatment of lupus, how to make general dose

adjustment? Where to see more commonly used drugs in rheumatology?

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References: [1] Rees F，Doherty M，Grainge MJ，et al.
The worldwide incidenceand prevalence of systemic lupus erythematosus:a systematicreview of epidemiological studies[J].
Rheumatology，2017，56（11）:1945‐1961.
DOI:10.
1093/rheumatology/kex260.
[2]Zeng QY，Chen R，Darmawan J，et al.
Rheumatic diseases inChina[J].
Arthritis Res Ther，2008，10:R17‐R27.
DOI:10.
1186/ar2368.
[3] 2020 Chinese guidelines for the diagnosis and treatment of systemic lupus erythematosus ▼▼▼Click to read the original article to download the App

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