Latest! China's systematic lupus diagnosis and treatment guidelines issued, these 12 updates a text to master! Guide time.

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Systemic lupus erythematosus (SLE) is a systemic autoimmune disease, its diagnosis and treatment are very complex.it is imperative to formulate a guideline for SLE diagnosis and treatment in China, which is both in line with international guidelines and close to Chinese clinical practice.the guidelines were jointly led by rheumatology branch of Chinese Medical Association, national clinical research center of skin and immune diseases, and China systemic lupus erythematosus research collaboration group. 12 clinical problems concerned by Chinese frontline rheumatologists were discussed in detail by using the evaluation, formulation and evaluation grading system of recommendation grading and the reporting standards of international practice guidelines Detailed evidence-based recommendation aims to improve the scientificity of SLE diagnosis and treatment and improve the quality of patient-centered medical service.Table 1: evidence quality and recommended intensity classification 01. How to diagnose SLE? Recommendation 1: it is recommended to use the SLE classification criteria formulated by the international lupus research clinical collaboration group (SLICC) in 2012 or EULAR / ACR in 2019 for the diagnosis of suspected SLE (1b); in the medical institutions without rheumatic Immunology Department, it is recommended to invite or consult rheumatic immunology doctors to assist in diagnosis, or to conduct referral / remote consultation (2C) 。02. What are the treatment principles and goals of SLE patients? Recommendation 2: the treatment principle of SLE is early and individualized treatment, which can delay disease progression, reduce organ damage and improve prognosis (1c).the short-term goal of SLE treatment is to control disease activity and improve clinical symptoms (1c) to achieve clinical remission or the lowest possible disease activity; the long-term goal is to prevent and reduce recurrence, reduce adverse drug reactions, prevent and control organ damage caused by disease, achieve long-term continuous remission, reduce mortality and improve the quality of life of patients (1c).03? Recommendation 3: for newly diagnosed and followed-up SLE patients, it is recommended to select SLE disease activity index (sledai-2000) scoring standard, and evaluate disease activity (2C) combined with comprehensive judgment of clinicians; based on sledai-2000 scoring standard, disease activity can be divided into mild activity (sledai-2000 ≤ 6), moderate activity (sledai-2000 7 ~ 12) and severe activity (sledai-2000 & gt; 2); 12) (2D); for SLE patients in active stage, it is recommended to evaluate disease activity (2C) at least every 1 month, and for SLE patients in stable disease stage, disease activity should be evaluated every 3-6 months.if recurrence occurs, it should be treated according to disease activity (2D). How to use glucocorticoid to treat SLE patients? Recommendation 4: hormone is the basic drug for the treatment of SLE (1a); individualized hormone therapy should be made according to the type and severity of disease activity and organs involved, and the lowest dose (1b) required for disease control should be adopted; for patients with mild SLE, when hydroxychloroquine or NSAIDs are not effective, low-dose hormone (≤ 10) should be considered Prednisone or equivalent dose of prednisone or equivalent dose of other hormones) can be used in moderate active SLE patients (0.5 ~ 1 mg · kg-1 · D-1 prednisone or other hormones of equivalent dose) combined with immunosuppressive therapy (2C); for patients with severe SLE, hormone (≥ 1.0 mg · kg-1 · D-1 prednisone or equivalent dose of other hormones) can be used (2C) Prednisone mg · kg-1 · D-1 prednisone or equivalent dose of other hormones) combined with immunosuppressive therapy, after the condition is stable, the appropriate hormone dosage (2C); for SLE patients with lupus crisis, hormone impact combined with immunosuppressive therapy (1b); clinicians should pay close attention to the disease activity of SLE patients, and adjust the hormone dosage according to the disease activity Patients with long-term stable condition can consider gradually reducing and stopping hormone (1c).05. How to use hydroxychloroquine to treat SLE? Recommendation 5: long term use of hydroxychloroquine (1a) is recommended for patients without contraindication of SLE; eye related risk assessment is recommended for patients taking hydroxychloroquine; ophthalmic examination is recommended for high-risk patients and once a year (2C) for low-risk patients since the fifth year of medication. How to use immunosuppressants to treat SLE patients? Recommendation 6: immunosuppressant (2b) is recommended for SLE patients with poor effect of hormone combined with hydroxychloroquine, or patients who cannot adjust the dose of hormone to less than the relative safe dose; for patients with organ involvement, it is recommended to use immunosuppressant (2C) at the initial treatment.Click to see big picture 07. How to use biological agents to treat SLE patients? Recommendation 7: biological agents can be considered for SLE patients with poor response, intolerance or recurrence after hormone and / or immunosuppressive therapy (2b) 08. What should be done when systemic and organ involvement occurs in SLE patients? Recommendation 8.1: for patients with type I lupus nephritis, it is recommended to select treatment according to extrarenal manifestations (2C).for patients with type II lupus nephritis, hormone and / or immunosuppressive therapy (2C) are recommended; recommendation 8.2: for patients with type III, IV and non simple type V (V + III or V + IV) lupus nephritis, hormone combined with cyclophosphamide (1b) or mycophenolate mofetil (1b) is recommended in remission induction phase, and mycophenolate mofetil (1b) or azathioprine (1b) is recommended for maintenance phase Recommendation 8.3: moderate dose hormone combined with mycophenolate mofetil (1b), calmodulin inhibitor (2b) or azathioprine (2b) is recommended for patients with simple lupus nephritis of type V, and angiotensin converting enzyme inhibitor (ACEI) / angiotensin II receptor blocker (ARB) is recommended to strictly control blood pressure (2C); recommendation 8.4: it is recommended that Neuropsychiatric lupus was diagnosed by clinical manifestations, hematology, cerebrospinal fluid examination and neuroimaging findings, and was differentiated from the neurological symptoms caused by antiphospholipid syndrome (2C); recommendation 8.5: for patients with severe neuropsychiatric lupus, it is recommended to take hormone impact (2b) treatment first, and cyclophosphamide (2b) can be added when the effect is not good; recommendation 8.6: to identify It is suggested that patients with thrombocytopenia or autoimmune hemolytic anemia should be treated with hormone (2D) or intravenous immunoglobulin (2D). Immunosuppressive therapy (2D) can be added to patients with poor effect. Rituximab (2C) can be used to treat renal biopsy indications and lupus nephritis in patients with ineffective treatment or life-threatening hematological system involvement Pathological classification should be carried out according to the latest guidelines and standards to provide guidance for subsequent treatment.patients with type II lupus nephritis are at risk of histological transformation and can progress to type III or IV. hormone and / or immunosuppressive therapy are recommended for patients with poor initial treatment effect.09. What other measures can be taken to treat SLE? Recommendation 9: plasma exchange or immunosorbent therapy (2C) can be considered for patients with severe or refractory SLE; intravenous immunoglobulin (2D) can be added to refractory or complicated SLE patients. How to prevent and control the infection of SLE patients? Recommendation 10: infection is the leading cause of death in SLE patients. During the whole treatment period of SLE, the possible infection risk should be evaluated in time, and the infection should be identified, prevented and controlled through various ways (1b).11. How to manage SLE patients during pregnancy? Recommendation 11: for women of childbearing age with SLE, if the condition is stable for at least 6 months and there is no significant organ damage, and the drugs that may cause teratogenesis are stopped until safe enough time, pregnancy (2b) can be considered; if pregnancy is planned, the Department of Rheumatology, obstetrics and Gynecology should be consulted and evaluated before pregnancy (1b); for pregnant SLE patients, the disease activity of SLE should be closely monitored If there is no contraindication, it is recommended to take hydroxychloroquine (1b) throughout pregnancy. In case of disease activity, hormone and azathioprine can be used to control the disease (2C).12? Recommendation 12: lifestyle adjustment is helpful for SLE treatment.patients with SLE should follow the following principles: (1) avoid contact with common dangerous substances; (2) prevent sunscreen; (3) exercise moderately; (4) pay attention to psychological support; (5) quit smoking; (6) supplement vitamin D (1c).Figure 1. SLE diagnosis and treatment pathway map references: