Prof. Zhang Wei: Interpretation of systemic lupus erythematosus classification criteria

outline:

• What progress in the diagnosis and treatment of systemic lupus erythematosus (SLE) at the 2021 ACR Congress deserves the attention of clinicians?

• How should the classification criteria of SLE be selected clinically, and what are the advantages of each?

• How can clinicians reduce the risk of multiple organ involvement in patients?

• What should clinicians pay attention to when facing women who need to prepare for pregnancy?

• How to communicate with patients who believe in remedies?

What progress in the diagnosis and treatment of systemic lupus erythematosus (SLE) at the 2021 ACR Congress deserves the attention of clinicians?

What progress in the diagnosis and treatment of systemic lupus erythematosus (SLE) at the 2021 ACR Congress deserves the attention of clinicians?

diagnosis and treatment

How should the classification criteria of SLE be selected clinically, and what are the advantages of each?

How should the classification criteria of SLE be selected clinically, and what are the advantages of each?

How can clinicians reduce the risk of multiple organ involvement in patients?

How can clinicians reduce the risk of multiple organ involvement in patients?

What should clinicians pay attention to when facing women who need to prepare for pregnancy?

What should clinicians pay attention to when facing women who need to prepare for pregnancy?

How to communicate with patients who believe in remedies?

How to communicate with patients who believe in remedies?

Q1: What progress in the diagnosis and treatment of systemic lupus erythematosus is worthy of attention at the ACR conference in 2021?

Q1: What progress in the diagnosis and treatment of systemic lupus erythematosus is worthy of attention at the ACR conference in 2021?

The dosage of glucocorticoids is still the focus of everyone's attention

The dosage of glucocorticoids is still the focus of everyone's attention

The adverse reactions caused by long-term use of glucocorticoids have reached a consensus in the industry , but there are still many patients who still need high-dose hormone therapy for various reaso.

The consensus is that long-term use of glucocorticoids should be controlled below 20 mg per day, and it is best to gradually reduce it to below 5 .

Targeted drug development is still the mainstreamTargeted drug development is still the mainstream

There is a lot of information on the development and experimentation of new targeted drugs at this meeti.

Precision treatment is the highest state of SLE treatment

Precision treatment is the highest state of SLE treatmentPrecision treatment is the highest state of SLE treatment Precision

The basis of precision therapy is targeted drugs, but targeted drugs are only part of precision thera.

Tailor-made and precise treatment for different patients with limited dru.

Q2: What is your understanding of the current clinically commonly used systemic lupus erythematosus classification criteria (2012 SLICC diagnostic criteria and the latest 19-year EULAR/ACR criteria), and what are their characteristics?

Q2: What is your understanding of the current clinically commonly used systemic lupus erythematosus classification criteria (2012 SLICC diagnostic criteria and the latest 19-year EULAR/ACR criteria), and what are their characteristics? diagnosis

The significance of the updated classification criteria is to help clinicians make early diagnosis

The significance of the updated classification criteria is to help clinicians make early diagnosisThe significance of the updated classification criteria is to help clinicians make early diagnosis

SLE is a very specific disease, in a sense it can be said to be a syndro.

(such as peptic ulcer, myocardial infarction , e.

Serological diagnosis is very important in the SLE classification criteria

Serological diagnosis is very important in SLE classification criteriaSerological diagnosis is very important in SLE classification criteria

Different rheumatism diagnostic patterns are differe.

If the patient has no serological abnormalities, SLE should be diagnosed with caution at this ti.

SLICC has added kidney biopsy, SLE has a pathological diagnosis item for the first timeSLICC has added a kidney biopsy, SLE has a pathological diagnosis item for the first time

Kidney biopsy is added to the SLICC standa.

It can reduce misdiagnosis or missed diagnos.

 

 

The ACR classification standard in 2019 has changed to a point-based syst.

The ACR classification standard in 2019 has changed to a point-based syst.

 

Q3: Systemic lupus erythematosus affects multiple orga.

Q3: Systemic lupus erythematosus affects multiple orga.

Clinicians should be aware that SLE will involve multiple organ damage, and know the patient's organ involvement in a timely mannerClinicians should be aware that SLE will involve multiple organ damage, and timely know the patient's organ involvement

SLE is a systemic disease with multiple organ damage, and the involvement of organs is directly related to the quality of life and prognosis of patien.

Quality of Life

There are also some patients who may have been in the early stage of visceral involvement, and the patients have not yet developed related symptoms, but can be detected by currently available means, such as a small amount of proteinuria detected by urine routine; pulmonary artery detected by cardiac ultrasound High blood pressure; chest CT examination for interstitial lung disease, blood routine can detect leukopenia, thrombocytopenia,e.

Clinicians should have the awareness that SLE is a multi-organ disease involving multiple organs when receiving consultation, know which organs are easily affected, and issue corresponding doctor’s orders and make relevant examinations to determine whether the patient has subclinical diseas.

symptoms of organ involveme.

Pay attention to some special clinical markers

Pay attention to some special clinical markersPay attention to some special clinical markers

Some biomarkers can be found through clinical examination, and these markers can suggest to doctors that the patient may have corresponding clinical involveme.

For example, patients with high titers of anti-double-stranded DNA antibodies are prone to nephritis; anti-RNP antibodies are prone to Raynaud's disease and pulmonary hypertension; anti-SSA antibodies may have symptoms similar to dryness, high immunoglobulins , high erythrocyte sedimentation rate; phospholipids Antibody positivity may be associated with thrombotic events, resulting in damage to the corresponding orga.

immune thrombosis

Clinicians should also pay attention to the effects of drugs on patients' organs

Clinicians should also pay attention to the effects of drugs on patients' organsClinicians should also pay attention to the effects of drugs on patients' organs

Treating lupus is a marathon that requires a long-term effort by both physicians and patien.

Therefore, we should pay attention to whether the drug will cause secondary organ damage to the patient when treating SL.

For example, glucocorticoids, immunosuppressive drugs and even new biological agents may cause damage to organ functio.

Attention should be paid to whether the drug will cause secondary organ damage to the patie.

In addition to common bone marrow suppression and impaired liver and kidney function, special adverse reactions that may be caused by specific drugs should also be known, such as pulmonary fibrosis caused by MTX, and visual impairment caused by antimalarial dru.

This requires timely follow-up of patients, and doctors should conduct tests during the follow-up process to find abnormalities at the first ti.

If abnormalities are found, the patient's risk-benefit ratio should be reassess.

If it is obvious that the risk is relatively high, then the clinician should adjust the plan in ti.

Pulmonary fibrosis caused by MTX, visual impairment caused by antimalarial drugs,e.

The patient's condition is in dynamic changes, and the treatment plan should be adjusted in time

The patient's condition is in dynamic change, and the treatment plan should be adjusted in timeThe patient's condition is in dynamic change, and the treatment plan should be adjusted in time

Clinicians must also understand that the patient's condition is in dynamic chang.

A diagnosis and treatment plan may be appropriate at a specific time, but it does not mean that it will be appropriate in the futu.

The patient should be instructed to follow up in time, and then based on the actual situation of the patie.

Adjust the treatment plan in ti.

Q4: Faced with female SLE patients who need to prepare for pregnancy, what should be paid attention to in the treatment process?

Q4: Faced with female SLE patients who need to prepare for pregnancy, what should be paid attention to in the treatment process? Q4: Faced with female SLE patients who need to prepare for pregnancy, what should be paid attention to in the treatment process?

This is a very real and often encountered clinical probl.

Around the 1980s, we did not advocate fertility in SLE patients because abnormal estrogen during pregnancy may induce lupus activity , and there are some problems with fetal development in SLE patien.

However, it was later found that if the patient's reproductive needs cannot be solved, not only the quality of life of the patient will be deteriorated, but also the stability of the patient's family will be affected, causing many social proble.

Abnormal estrogen may trigger lupus activity

Since the late 1980s, our hospital has carried out multidisciplinary diagnosis and treatment (MDT) cooperation between Zhang’s rheumatology department and obstetrics and gynecology departme.

We have jointly discussed this issue and have some successful experiences:

Multidisciplinary Care Model (MDT)

Carry out a comprehensive and basic assessment of the patient before pregnancy to determine the risk of pregnan.

If the risk is relatively high, pregnancy will not be recommended

Perform a comprehensive basic assessment of the patient before pregnancyPerform a comprehensive basic assessment of the patient before pregnancy ,

The patient also needs to participate in the assessment of the conditi.

Patients should be invited to participate in the evaluation of the disease, and doctors should respect the subjective feelings of patients

The patient also needs to participate in the assessment of the conditi.

The patient also needs to participate in the assessment of the conditi.

It is very important to adjust medicines during pregnancy and during pregnan.

It is very important to adjust medicines during pregnancy and during pregnan.

It is very important to adjust medicines during pregnancy and during pregnan.

Drugs with higher safety to the fetus are preferr.

For example, glucocorticoids and antimalarial drugs have relatively small effects on the fetus and can be used preferential.

Cytotoxic drugs such as cyclophosphamide and certain immunosuppressants have teratogenic effects on the fetus and should be used with cauti.

Clinicians need to do a lot of work to ensure the mother's condition is under control without the drug affecting the fet.

The patient should be told not to stop the drug, otherwise it will affect the health of the mother and the fet.

The patient should be told not to stop the drug, otherwise it will affect the health of the mother and the fet.

The patient should be told not to stop the drug, otherwise it will affect the health of the mother and the fet.

Many patients have such a misunderstanding that as long as they take medicine, they will affect the fetus, and they stop taking the medicine without authorizati.

On the one hand, stopping the drug puts the mother at a huge risk of lupus recurrence, which is very dangerous for both the mother and the fetus during pregnan.

On the other hand, if the disease is not controlled by drugs, the disease activity will affect the blood supply and nutrition of the placenta, thereby affecting the growth and development of the fet.

If the patient stops the drug without listening to the doctor's advice, there may be very serious complications: massive proteinuria, high blood pressure , preeclampsia, e.

, and sometimes even termination of the pregnan.

hypertension

Under the supervision of MDT, many patients and their fetuses will have good outcom.

Under the supervision of MDT, many patients and their fetuses will have good outcom.

Under the supervision of MDT, many patients and their fetuses will have good outcom.

In .

Zhang Wei's clinical work for many years, under the supervision of MDT, the patient's pregnancy status is relatively good, whether it is the mother or the fetus can get a good outcome: the mother's lupus activity during pregnancy is acceptable, the fetus It is almost no different from a normal fet.

The incidence of SLE in fetuses born to SLE patients is approximately 2% to

The mother's lupus activity during pregnancy is acceptable, and the fetus is almost indistinguishable from a normal fet.

2%~

Postpartum breastfeeding also needs to be carried out under the guidance of a doct.

Postpartum breastfeeding also needs to be carried out under the guidance of a doct.

Postpartum breastfeeding also needs to be carried out under the guidance of a doct.

Patients who are breastfeeding also need the guidance of a professional clinici.

Q5: Have you ever encountered a patient who believes in superstitious remedies in clinical practice? How do you usually communicate with such patients?

Q5: Have you ever encountered a patient who believes in superstitious remedies in clinical practice? How do you usually communicate with such patients? Q5: Have you ever encountered a patient who believes in superstitious remedies in clinical practice? How do you usually communicate with such patients?Fully understand the psychology of the patient's superstitious remedies, and guide and educate the patie.

Fully understand the psychology of the patient's superstitious remedies, and guide and educate the patie.

SLE is a highly heterogeneous disease, and individualized treatment is importa.

SLE is a highly heterogeneous disease, and individualized treatment is importa.

Many unknown drugs contain hormones, and the risks of long-term use are hu.

Many unknown drugs contain hormones, and the risks of long-term use are hu.

The idea that botanicals have no side effects should be abandoned

The idea that botanicals have no side effects should be abandoned

Abandon this message