"Wolf Warriors" have their own tricks: a brief introduction to drugs for treating systemic lupus erythematosus

"Wolf Warriors" have their own tricks: a brief introduction to drugs for treating systemic lupus erythematosus

Author: Shi Yanling

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Systemic lupus erythematosus (SLE) sounds a bit scary. Many people think it is a serious skin disease. In fact, SLE is a systemic autoimmune disease with the main clinical features of multi-system and multi-organ involvement, repeated relapses and remissions, and the presence of a large number of autoantibodies in the body. If not treated in time, it will cause irreversible damage to the affected organs and eventually lead to the patient's death. [1] "Erythema" is manifested as skin and mucous membrane damage, with discoid erythema and butterfly erythema.

The male-to-female ratio in mainland China is 1:10-12 [2-4]. The "wolf" of systemic lupus erythematosus prefers women of childbearing age, and this "wolf nature" is very difficult to deal with. It cannot be completely cured for the time being, but humans still have "wolf warrior weapons" to contain the "wolf nature". Currently, these "wolf warrior weapons" are five major types of drugs: antimalarial drugs, glucocorticoids, traditional immunosuppressants, biological agents and traditional Chinese medicines.

1. Treatment principles and objectives of systemic lupus erythematosus

The treatment principles of systemic lupus erythematosus are early detection, early diagnosis, and early treatment, so as to alleviate the disease as quickly as possible[5].

Short-term treatment goals: to control disease activity, improve clinical symptoms, achieve clinical remission or the lowest possible disease activity.

Long-term treatment goals: to prevent and reduce relapses, reduce adverse drug reactions, prevent and control organ damage caused by the disease, achieve long-term sustained remission of the disease, improve the patient's quality of life, and reduce mortality [5].

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2. “Wolf Warrior Weapons”: Drugs

1. The first “Wolf Warrior weapon”: antimalarial drugs

Representative drug: Hydroxychloroquine

Medication principles:

*For SLE patients without contraindications, long-term use of the antimalarial drug hydroxychloroquine is recommended as basic treatment.

Common adverse reactions: blurred vision due to visual accommodation disorders.

Ocular risk assessment: High-risk SLE patients are advised to undergo an eye examination once a year, and low-risk SLE patients are recommended to undergo an eye examination once a year starting from the 5th year of medication.

2. “Wolf Warrior Weapon” No. 2: Glucocorticoids

Representative drugs: prednisone, methylprednisolone, etc.

Medication principles:

* Mild SLE: When hydroxychloroquine or nonsteroidal anti-inflammatory drugs are ineffective, low-dose glucocorticoids may be considered

(≤10 mg/d prednisone or equivalent dose of other hormones)

Moderate SLE: 0.5-1 mg*kg·d-1 prednisone or other equivalent doses of hormones

* Severe SLE: ≥ 1 mg*kg·d-1 prednisone or other equivalent dose of hormones

* Lupus crisis: hormone pulse therapy

Common adverse reactions: central obesity, thinning skin, peptic ulcer, infection, etc.

3. The third weapon of the Wolf Warriors: traditional immunosuppressants

Representative drugs: mycophenolate mofetil, cyclophosphamide, leflunomide, etc.

Medication principles:

* Hormones combined with hydroxychloroquine are not effective

*Unable to adjust hormone dose to a relatively safe dose

* Organ involvement

* Lupus crisis

Common adverse reactions: gastrointestinal discomfort, liver damage, bone marrow suppression, etc.

4. "Wolf Warrior Weapons" No. 4: Biological Agents

Representative drugs: Belimumab, Rituximab, etc.

Medication principles:

*Suitable for SLE patients who have poor response, intolerance or relapse after hormone and/or immunosuppressant treatment.

Common adverse reactions: infection, headache, infusion reaction, etc.

5. “Wolf Warrior Weapons” No. 5: Traditional Chinese Medicine

Representative medicine: Tripterygium wilfordii

Medication principles:

*Suitable for SLE patients who do not desire to have children.

Common adverse reactions: menstrual disorders and amenorrhea in women, male infertility, dry mouth, nausea, etc.

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3. Notes

1. Since the efficacy and adverse reactions of various drugs for the treatment of systemic lupus erythematosus vary greatly from person to person, they should be taken under the guidance of a doctor or pharmacist and should not be changed or discontinued without authorization.

2. Avoid excessive exposure to sunlight, and try to take sun protection measures when going out, such as: using a parasol, wearing long-sleeved clothes, wearing a hat, sunglasses, etc.

3. Avoid contact with foods that are prone to allergies: mushrooms, lamb, shrimps and crabs, coriander, celery, etc.

4. Quit smoking and drinking, maintain a calm mind, relieve physical and mental stress, and avoid emotional fluctuations.

5. Exercise moderately, ensure adequate sleep, and avoid overwork.

6. Appropriate supplementation of vitamin D can reduce inflammation and disease activity in SLE patients.

"Lupus" loves beautiful women, but beautiful women are not necessarily doomed to a tragic fate. As long as the patient actively cooperates with the treatment under the guidance of the doctor, has regular check-ups, and closely monitors the changes in the disease, and keeps "lupus" under control in a stable state, the patient can return to normal life and dance with the "wolf".

References:

[1] Zeng Xiaofeng, Chen Yaolong. 2020 Chinese Guidelines for the Diagnosis and Treatment of Systemic Lupus Erythematosus[J]. Chinese Journal of Internal Medicine, 2020(3):172-185. DOI:10.3760/cma.j.issn.0578-1426.2020.03.002.

[2]Li M, Zhang W, Leng

[3] Zhang S, Su J, Li

[4]Wang Z, Li M, Zhao J, et al. 220 Clinical characteristics and remission of patients with systemic lupus erythematosus in china: results from SLE Treatment and Research Group (CSTAR) registry with a real-time collecting system [J. Lupus Sci Med, 2019, 6(Suppl 1):A164. DOI: 10.1136/lupus-2019-lsm.220.

[5] Zeng Xiaofeng, Li Mengtao, Tian Xinping. China Systemic Lupus Erythematosus Development Report 2020. Liaoning Science and Technology Press.