There are 7 major benefits of early intervention for SLE, how should the diagnosis and treatment plan be optimized?

*Only for medical professionals to read for reference.
Early diagnosis and early treatment are vital to the prognosis of SLE patients
.

 At the annual meeting of the American Academy of Rheumatology (ACR) in 2021, Dr.
Michelle Petri will give a lecture on "The importance of early intervention in SLE to prevent further disease progression".
Director Wang Pei of the Department of Rheumatology and Immunology of the hospital explained and brought us to discuss the importance of early intervention for SLE in order to prevent disease progression
.

Systemic lupus erythematosus (SLE) SLE is a classic systemic autoimmune disease, with multiple organ involvement and multiple autoantibodies as the main clinical features.
If it is not diagnosed and treated in time or is not well controlled, it will cause organ damage.
Irreversible damage, even death
.

SLE is the most challenging and fatal rheumatic disease.
Rheumatologists all agree with the importance of its early diagnosis and early treatment
.

Delayed treatment of SLE is related to poor prognosis 1.
Choosing the best classification standard to shorten the delay time of diagnosis Director Wang Pei introduced: "The classification standard of rheumatic immune diseases is gradually changing with the advancement of inspection methods and deepening understanding of the disease.
SLE The diagnostic classification guidelines of ACR have also gone through decades of vicissitudes
.

In 1997, the SLE diagnostic classification standard of ACR was the most widely used diagnostic standard in the world, but due to its relatively low sensitivity, it is easy to miss diagnosis, which is not conducive to early diagnosis
.

Then it is systematic.
The Lupus Erythematosus International Clinical Assistance Group (SLICC) issued a new classification standard in 2012, which has high sensitivity but low specificity
.

Both of these standards restrict the practice of SLE classification due to insufficient sensitivity or specificity.
In 2019, the European Union Against Rheumatism (EULAR) and ACR released the latest diagnostic classification criteria for SLE, which further improved the sensitivity and specificity of the diagnosis.
Improve (Figure 1)
.

"Figure 1: Comparison of sensitivity and specificity of different classification standards.
2.
Delay in diagnosis increases disease activity, organ damage, and risk of death.
The clinical manifestations of SLE are complex and diverse.
Most of them have an insidious onset, beginning with arthritis, rash, and occult nephritis.
After the mild symptoms, severe lupus with multiple system involvement, or even a lupus crisis, will gradually appear
.

It takes about six months to four years from the appearance of the first symptoms to the diagnosis of the disease, which can easily lead to misdiagnosis and missed diagnosis
.

Many studies have shown delays.
Diagnosis increases disease activity, organ damage and the risk of death
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A total of 585 SLE patients were enrolled in a LuLa cohort, and the average time to diagnosis was delayed by 47 months.
The conclusion showed that delayed diagnosis resulted in higher disease activity, more organ damage, More obvious non-specific manifestations such as fatigue
.

A prospective cohort study retrospective analysis included 350 SLE patients for 12 months of observation.
The results of the study showed that SLE disease activity would further aggravate organ damage and increase the risk of mortality
.

A multi-center international cohort study statistics the mortality data of SLE patients
.
The
study evaluated 9547 patients from 28 lupus centers in 7 countries.
Among them, according to ACR standards or clinical standards, clear SLE patients were older than 16 years old.
It was included
.

studies have shown (Figure 2): the most common cause of death in SLE patients with lupus nephritis were, cardiovascular disease, cancer, infection, kidney related diseases, stroke
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Figure 2: The most common cause of death in patients with systemic lupus erythematosus how to carry out early intervention treatment (1) Continuous use of antimalarial drugs brings more benefits: reduce recurrence; reduce organ damage; reduce blood lipids; prevent diabetes; reduce thrombosis ; Improve the complete response rate of lupus nephritis treatment; improve the survival rate
.

(2) Early antimalarial treatment reduces the risk of organ damage A cohort study of lupus patients evaluated whether hydroxychloroquine (HCQ) can prevent early damage in SLE patients (Figure 3)
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The case and the control group were first compared by single factor analysis, and then a conditional logistic regression model was used to adjust the potential confounding factors to study the effect of HCQ on the damage accumulation
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The study followed 481 patients for 3 years or more
.

The results showed that in the multivariate analysis, the use of HCQ was significantly associated with less organ damage (OR 0.
34, 95% CI: 0.
132-0.
867)
.

Figure 3: Analysis of an initial cohort of lupus patients: multivariate analysis of risk factors related to SLE damage accumulation (3) Antimalarial treatment reduces mortality in SLE patients SLE patients using mycophenolate mofetil can prevent the development of the disease and the accumulation of damage , And increase the response of patients with renal involvement to the drug
.

A case-control study of 608 patients (Figure 4) performed a logistic regression analysis of antimalarial treatment and mortality scores to determine whether HCQ also had a protective effect on survival
.

The results showed that 61 of 608 patients died, and HCQ had a protective effect on survival [0.
128 (95% CI 0.
054-0.
301), 0.
319 (95% CI 0.
118-0.
864) after scoring]
.

It can be seen that HCQ is well tolerated in SLE patients, reduces the mortality of SLE patients, and has a protective effect on survival
.

Figure 4: A case-control study of 608 patients: Logistic regression analysis of antimalarial treatment and mortality scores concluded that disease activity is one of the main reasons for the high morbidity and mortality of SLE patients, and the treatment of disease Long-term use of hormones and immunosuppressants can cause new organ damage
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Therefore, both the continuous high activity of the disease of SLE itself and the drug-related toxicity both cause the inevitable damage to the body
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Optimizing the existing treatment methods and changing the treatment mode to achieve long-term disease stability are important goals of SLE treatment
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In order to prevent disease progression, SLE patients need early intervention and treatment, including the following measures: control disease activity, so that it tends to alleviate or reduce disease activity and prevent recurrence; determine patient compliance; early use of immunosuppressive drugs; early use of advanced treatment methods; Reduce the accumulation of organ damage; minimize glucocorticoid therapy
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Expert profile Wang Pei Deputy Chief Physician, Department of Rheumatology and Immunology, Henan Provincial People's Hospital , Member of the Rheumatology Branch of Henan Medical Popularization Society, Member of the Prevention and Treatment Group of Drug Side Effects and Limb Disability of Henan Limb Rehabilitation Professional Committee, Member of the Rheumatology Group of Henan Osteoporosis and Bone Mineral Salt Society
.