How to manage SLE pregnancy?

*It is only for medical professionals to read and reference.
What wonderful academic views did the five major experts in the field of rheumatism and immunology share at the conference? On August 28-29, 2021, the sixth "Renji Autoimmune Summit Forum" was held in Shanghai
.

The conference was hosted by the Department of Rheumatology and Immunology, Renji Hospital, Shanghai Jiaotong University School of Medicine
.

A number of top international rheumatologists and more than ten domestic experts gave special academic reports.
The conference was specially equipped with simultaneous interpretation and webcasting, making the conference a feast for exchanging top scientific research and delivering the latest academic progress
.

In order for colleagues in the academic circle to easily grasp the key points of the conference and review the highlights of the forum, the "medical community" has the honor to invite Professor Ye Shuang, Professor Shen Nan, Professor Lv Liangjing, Professor Li Ting, and Professor Fuqiong from the Department of Rheumatology and Immunology of Renji Hospital to participate in the interview.
Exciting content such as pregnancy management of systemic lupus erythematosus (SLE), treatment of inflammatory joint disease, application prospects of targeted drugs and biological agents were shared
.

The management of SLE patients before, during and after pregnancy is different.
Q1SLE is more common in women of childbearing age.
How can patients be managed during the special periods before, during and after pregnancy, so as to reduce the incidence of adverse pregnancy outcomes? Professor Lu Liangjing: SLE is an autoimmune disease that can affect multiple organs throughout the body
.
The incidence of SLE is higher in women of childbearing age .

Therefore, pregnancy is a very important event in the course of the patient's illness
.

Maternal autoantibodies, autoreactive lymphocytes and cytokines can affect embryos and cause adverse pregnancy outcomes such as recurrent miscarriage, premature delivery, fetal growth retardation, and stillbirth.
On the other hand, the increased estrogen level during pregnancy can activate humoral immunity.
Promote disease activity
.

Therefore, SLE patients belong to the high-risk pregnancy population, and their management before, during and after pregnancy is very important
.

Before pregnancy: Comprehensive assessment, planning pregnancy
.

SLE patients are advised to strictly contraception, and patients with fertility needs need doctors to evaluate the disease activity and drug use
.

Only patients with stable condition for more than 12 months, prednisone dose not greater than 10 mg/day, and no pregnancy contraindications can be planned for pregnancy
.

It is recommended to take hydroxychloroquine 3-6 months before pregnancy and continue until 3 months postpartum
.

Pregnancy: Regular monitoring and identification of high-risk factors
.

Once the pregnancy is confirmed, the rheumatology and immunology department and obstetricians should participate in regular monthly follow-ups
.

In patients with stable disease, the gestational age is over 38 weeks, and the pregnancy is recommended to be terminated when the fetus matures
.

If there is disease activity and low-dose prednisone and hydroxychloroquine cannot be controlled, consider using azathioprine, cyclosporine, tacrolimus and other relatively safe immunosuppressants during pregnancy.
In severe cases, intravenous glucocorticoids can be used.
, Immunoglobulin, plasma exchange and other treatments, and discuss with the obstetrician whether to terminate the pregnancy
.

Postpartum: Prevent thrombosis, scientific breastfeeding
.

In 3 months postpartum, especially during the puerperium, SLE patients are still at a higher risk of disease changes, and need to monitor disease activities to prevent and treat thrombotic events
.

SLE patients taking small doses of prednisone and hydroxychloroquine can breastfeed.
If the prednisone dose is more than 20mg/day, they can breastfeed 4 hours after taking the drug
.

The treatment of inflammatory joint disease should be "three early" Q2 What principles need to be followed in the treatment of inflammatory joint disease? Can you talk about the research progress and prospects of interleukin-17 (IL-17) inhibitors in the field of arthritis treatment? Professor Li Ting: The concept of early diagnosis, early treatment, early achievement of standards and continuous achievement of standards is conducive to early control of inflammation, reducing joint damage, and improving patient prognosis
.

"Early diagnosis" relies on the overall medical diagnosis and treatment system
.

Including two levels of popular science education for the general public and professional training of grassroots doctors, so as to help early identification of diseases and timely referral to specialists
.

"Early treatment" includes the scientific choice of drugs
.

The first-line and second-line treatments we often say are based on comprehensive consideration of factors such as drug effect, safety, and price, so as to obtain the priority order of drug selection at a specific disease stage
.

In addition to stratifying according to the guidelines, the individualized treatment of patients is also important.
It can formulate the most suitable treatment plan based on the patient's subjective demands, disease activity and quality of life requirements
.

At present, the treatment of spondyloarthropathy has always been a major challenge faced by rheumatologists
.

Because in some patients, even if the inflammation is well controlled, the development of bone sclerosis cannot be prevented
.

The treatment of IL-17 monoclonal antibody is a new development in the treatment of psoriasis and spondyloarthropathy.
This drug that specifically regulates the IL-17 pathway has shown excellent effects in improving skin lesions and preventing new bone formation.
At the same time, it has good safety and helps to achieve standard treatment for patients with inflammatory joint disease
.

Targeted drugs have broad prospects in the treatment of autoinflammatory diseases.
Q3 Could you please talk about how to distinguish autoinflammatory diseases from autoimmune diseases in clinical practice? How do you see the application prospects of targeted drugs in the treatment of autoinflammatory diseases? Professor Fu Qiong: Immune system disorders include innate immunity and adaptive immunity disorders, which are mainly involved in different molecules and cells, forming autoimmune diseases with different clinical phenotypes
.

Autoimmune diseases are characterized by the production of autoreactive lymphocytes and autoantibodies that attack the host, such as SLE and genetically-related autoimmune lymphocytosis
.

Auto-inflammatory diseases are mainly characterized by activation of inflammatory pathways, often without typical autoantibodies.
Patients often present with fever, rash, and markedly increased inflammation indicators.
The most representative one is single-gene auto-inflammatory diseases
.

In clinical practice, patients with autoimmune diseases will also show the characteristics of auto-inflammation at a certain stage of the disease
.

There are network effects and cascade effects in inflammatory response pathways related to autoinflammatory diseases.
One cytokine may be involved in the pathogenesis of several diseases
.

With the deepening of the understanding of the pathological mechanism of autoinflammatory diseases, we will identify the "HUB" in the inflammatory response pathway of different diseases.
Therefore, the application prospects of targeted drugs in autoinflammatory diseases are very broad
.

Non-immune cells also need to be "targeted" Q4 What academic hotspots are worth sharing in this forum? What are the development prospects of immunosuppressive agents and biological agents in the field of SLE? Professor Nan Shen: The pathogenesis of SLE is very complicated
.

What is the key molecule that causes disease? In which cells do these molecules play a role? Only after these problems are clearly studied, can patients with different molecules and clinical phenotypes be more targeted and precise treatment
.

In this meeting, Professor George Tsokos shared a new mechanism in the process of tissue damage in lupus nephritis, which emphasizes the role of some key molecules in non-immune cells
.

Non-immune cells are specific types of cells including renal tubular epithelial cells.
Professor Tsokos’ research results suggest that non-immune cells are not passive victims of tissue damage as previously thought.
On the contrary, these cells aggravate tissue damage
.

Many of the existing immunosuppressive agents and biological agents are targeted at immune cells and cytokines, which inevitably will bring many side effects, such as reducing the body’s immunity and increasing the risk of infection
.

If targeted drugs for non-immune cells or cell products can be developed, they can inhibit the destruction and loss of function of the cells themselves, and prevent tissue damage caused by these cells
.

This recognition provides important information for the development of new targeted therapies and is a highlight of this forum
.

Three major bottlenecks that biologics need to break through Q5 Could you please talk about your suggestions for the application of biologics in rheumatic diseases? How do you think we should promote the continuous development of rheumatism and immunology? Professor Ye Shuang: In the past 20 years, rheumatic immune diseases have entered the era of biological targeting in the field of treatment, which has greatly improved the disease outcome and patient prognosis
.

But so far, there are still many bottlenecks to be broken through in the clinical treatment of rheumatic immune diseases with existing biological agents
.

First, the coverage is not enough
.

Taking SLE as an example, the existing targeted drugs mostly target the B-cell pathway, which is far from meeting the need to improve the overall long-term prognosis of SLE patients.
We look forward to more comprehensive coverage of precise methods in order to achieve individualized treatment
.

Second, the accessibility is not strong
.

Because bio-targeted drugs are usually expensive, it is difficult to achieve universal clinical applications
.

With the advancement of medical insurance policies and the emergence of bio-generic drugs, the availability of bio-targeted drugs will gradually increase
.

Third, standardized application
.

The clinical research and clinical experience of new drugs are relatively limited, and the popularization of standardized diagnosis and treatment will take time
.

The research of drug efficacy, risk, pharmacoeconomics and optimization of diagnosis and treatment plan will provide guarantee for standardized application
.

The 6th Renji Autoimmune Summit Forum is divided into five major sections: SLE, inflammation, dermatomyositis and interstitial lung disease, arthritis, immunity and pregnancy.
The latest developments in clinical diagnosis and treatment and academic frontier hotspots in various fields were discussed.
The discussion has promoted in-depth exchanges and cooperation in the fields of rheumatism and immunology at home and abroad
.

Professor Ye Shuang said that Renji Rheumatology will devote itself to clinical research and basic research of rheumatic immune diseases, promote the cross integration of related disciplines, promote the dissemination of advanced diagnosis and treatment knowledge and experience, form an innovative diagnosis and treatment system with Chinese characteristics, and promote Chinese rheumatology Continuous development of the cause
.

Introduction to Shanghai Puji Rheumatism Care Center Shanghai Puji Rheumatism Care Center ("Puji Rheumatism Care") is a non-profit social service organization approved and registered by the Shanghai Municipal Civil Affairs Bureau (Shanghai Social Management Bureau) in 2015 , Mainly focuses on the popularization and dissemination of knowledge about systemic lupus erythematosus, ankylosing spondylitis, rheumatoid arthritis, myositis and other rheumatic diseases
.

The center cooperates with the Department of Rheumatology of Shanghai Renji Hospital and the Department of Rheumatology at all levels of hospitals across the country to jointly promote the academic exchanges of rheumatology diagnosis and treatment and the popularization of rheumatology.
In order to realize this vision, the center’s work focuses include-universalization The common sense of rheumatism and immune diseases organizes disease information related to rheumatism and immune diseases in a cautious manner; transmits disease knowledge in a way that the public loves to see; thereby increasing the proportion of early prevention, early diagnosis, and early treatment of rheumatism and immune diseases
.

Systematic health education can help patients reduce their uncertainty about the disease and improve compliance, thereby ensuring prognosis and improving the quality of life
.

Cooperate with more public welfare platforms to promote the understanding of rheumatism and immunity in the whole society, provide a more friendly social environment for patients, and enhance the self-confidence of rheumatism patients in life
.

Combining social forces to help improve the diagnosis and treatment technology of rheumatism, and subsidize impoverished patients with rheumatism
.

Attracting rheumatism patients to participate in the work of the center, making the center become a public welfare organization organized and managed by rheumatism patients and serving rheumatism patients
.

This article is only used to provide scientific information to medical and health professionals, and does not represent the platform's position
.