How is systemic lupus erythematosus treated? Can female patients still get pregnant and have children?

Author: Wu Donghai, Chief Physician of China-Japan Friendship Hospital

Reviewer: Zhang Zhuoli, Chief Physician, Peking University First Hospital

Systemic lupus erythematosus is an autoimmune disease with an unknown etiology that can affect multiple organs. Currently, there are about 1 million patients in my country, most of whom are women of childbearing age.

Because the cause of systemic lupus erythematosus has not yet been clearly identified, it is impossible to treat the cause specifically. In addition, the disease course is long, so it is generally believed that it is difficult to cure.

1. What are the treatment principles for systemic lupus erythematosus?

The treatment of systemic lupus erythematosus is mainly to control disease activity, improve clinical symptoms, achieve clinical remission, prevent and reduce relapses, reduce adverse drug reactions, prevent and control organ damage caused by the disease, achieve sustained remission, reduce disability and mortality rates, and improve the patient's quality of life.

The main drugs for the treatment of systemic lupus erythematosus are antimalarial drugs, hormones, immunosuppressants and biological agents. The current treatment guidelines tend to reduce the use of hormones. For most patients with systemic lupus erythematosus, they need to take low-dose drugs with better safety for a long time to maintain a stable condition and prevent recurrence.

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In addition to drug treatment, patients with systemic lupus erythematosus should also change their lifestyle, such as sun protection, smoking cessation, appropriate physical exercise, and weight control; control blood pressure and blood sugar; if antiphospholipid antibodies are positive, they should be closely monitored and antiplatelet and anticoagulant therapy should be carried out if necessary.

2. What are the drugs for treating systemic lupus erythematosus?

Systemic lupus erythematosus is divided into mild and severe forms.

Mild cases are generally treated with hydroxychloroquine, which is the basic drug for treating systemic lupus erythematosus.

If the only symptom is joint pain or swelling, a small dose of hormone can be given, generally not more than 6 tablets per day.

Treatment of severe systemic lupus erythematosus, especially lupus nephritis, is generally divided into two parts: induction therapy and remission therapy.

Induction therapy often requires the use of large doses of hormones, or even intravenous hormone shock therapy. In addition to hormones, immunosuppressants are generally used in combination, such as cyclophosphamide, mycophenolate mofetil, azathioprine, etc. If the condition is severe and the response to the above treatment is poor, biological agents such as belimumab, tetasip, rituximab and human immunoglobulin for injection can be added.

After the induction treatment has relieved the disease, the drug dosage is gradually reduced to maintain treatment and prevent recurrence. Repeated attacks of the disease will cause organ damage. Once the damage accumulates to a certain extent, the function of the organ will be affected, such as renal insufficiency. After the acute phase, while continuing to use immunosuppressants, the hormone dosage for maintenance treatment can be gradually reduced. During the reduction process, the recurrence of the disease and the side effects of the drug should be closely monitored. Once recurrence is found, the hormone reduction should be stopped and timely medical treatment should be sought.

3. Can female patients with systemic lupus erythematosus still get pregnant?

According to surveys, women with systemic lupus erythematosus have no less fertility than normal women. However, if patients want to get pregnant, they must meet the following conditions:

First of all, you cannot get pregnant during the active phase of lupus erythematosus, because a large amount of medication may be required during the acute phase, and large-scale use of systemic lupus erythematosus treatment drugs is bound to have a certain impact on the fetus.

Secondly, it is necessary to ensure that the condition is in a stable state and there is no sign of recurrence in the past six months. At the same time, the condition allows the cessation of the use of drugs that are harmful to the fetus, such as methotrexate, cyclophosphamide, etc.

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It is worth noting that although systemic lupus erythematosus has a genetic tendency, that is, the incidence rate of children with patients is higher than that of children in ordinary families, it is not a hereditary disease. This means that even if the mother has systemic lupus erythematosus, her children do not necessarily have the disease.