Disease Stories | How do lupus patients get vaccinated? How to prevent lupus? What factors lead to poor prognosis? Read this article

Because systemic lupus erythematosus (SLE) is difficult to cure and requires long-term treatment, and patients will be tortured by the disease, some people call it the "immortal cancer." But in fact, systemic lupus erythematosus is not "immortal" and even has a higher risk of death. In addition, it has many aliases that few people know.

1. Origin of the name of the disease

The earliest record of lupus can be traced back to 460-375 BC, when Hippocrates, known as the "father of modern medicine", made a diagnosis and called it " herpes esthiomenos ", describing the symptoms as ulcerative skin lesions. Later in 916 AD, Herbernus called this wolf-bite-like skin disease "lupus"; another saying is that in the 13th century, a doctor named Rogerius used the word " lupus " to describe the rash on the face that looked like a wolf bite.

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From 1846 to 1851, French doctor Cazenave used the term " erythema centrifugum ", while another French doctor, von Hebra, coined the term " lupus erythematosus ", which comes from the Greek word " erythros ", which roughly translates to "red". Interestingly, lupus erythematosus is also known as " butterfly disease " because its rash may resemble a butterfly in some cases. Since then, because some lupus affects various body systems, this type of lupus that affects the whole body is called " systemic " lupus erythematosus, accounting for about 70% of cases.

2. Cause of Death

Although systemic lupus erythematosus is called the " immortal cancer ", lupus patients can also die from various causes, with the main causes of death including cardiovascular disease, infection and kidney disease . An analysis of 408 veterans in the United States showed that during an average follow-up of 11 years, 144 patients died, of which 134 patients (93%) had their cause of death determined - the disease itself was the most common cause of death, occurring in 49 patients (34%), followed by infection (n = 32; 22%), cardiovascular disease (n = 23; 16%), cerebrovascular disease (n = 8; 6%) and cancer (n = 8; 6%).

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Data from an analysis of 4283 patients with systemic lupus erythematosus in Italy showed that the five-year and eight-year survival rates were 91% and 89%, respectively. The underlying cause of approximately half of the deaths was cardiovascular disease or cancer, while infections were less frequently reported. Results from a Canadian study of 6092 patients with systemic lupus erythematosus showed no statistically significant difference between the early cohort (1997-2005) and the late cohort (2006-14). Excess mortality was caused by kidney disease [3.04 (2.29, 4.05)], infection [2.74 (2.19, 3.43)], and cardiovascular disease [2.05 (1.77, 2.38)], but not cancer [1.18 (0.96, 1.46)]. In addition, although the disease is approximately 10 times more common in women than in men, factors associated with a poor prognosis include African American race, kidney disease (particularly diffuse proliferative glomerulonephritis), [male sex], younger age, older age at presentation, hypertension, low socioeconomic status, antiphospholipid antibody syndrome, the presence of antiphospholipid antibodies, and high overall disease activity.

3. Prevention

Systemic lupus erythematosus is an autoimmune disease. Only T-cell vaccines and protein peptide vaccines have been found to be treatable, but there is no preventive vaccine. Therefore, the best management method is to seek medical treatment as soon as possible and receive standardized treatment as soon as possible. In addition, genetic, immune, endocrine and environmental factors may all be predisposing factors for systemic lupus erythematosus. Therefore, in addition to early diagnosis and treatment, chronic disease management (especially cardiovascular disease) and avoid infection (vaccination, etc.) should be done well. Considering that different vaccines may cause changes in immunogenicity due to treatment methods, an article published in the British Medical Journal (BMJ) this year systematically lists the recommendations for 5 vaccines for patients with systemic lupus erythematosus: 1. Pneumococcal vaccine: According to the European Federation of Rheumatology Associations, it is strongly recommended that patients with systemic lupus erythematosus receive pneumococcal vaccination. For patients with rheumatic diseases treated with disease-modifying antirheumatic drugs, it is best to first receive the 13-valent pneumococcal conjugate vaccine (PCV13), followed by a dose of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) at least 8 weeks later, and another dose of PPSV23 after 5 years. The American College of Rheumatology guidelines recommend pneumococcal vaccination for patients with rheumatic and musculoskeletal diseases who are younger than 65 years and are receiving immunosuppressive medications.

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Patients receiving rituximab should receive a pneumococcal vaccine at least 2 weeks (preferably 4 weeks) before the next rituximab injection is due. 2. Influenza vaccine: It is recommended that all patients with systemic lupus erythematosus be vaccinated once a year. According to the European Federation of Rheumatology guidelines, in the case of rituximab, the influenza vaccine should ideally be administered before starting rituximab or within 2-4 weeks after the last rituximab dose and before the next dose. 3. COVID-19 vaccine: The American College of Rheumatology guidelines recommend that the interval be as long as possible within a time range of 2-4 weeks after the last dose and before the next rituximab dose. 4. Tetanus vaccine: **According to the European Federation of Rheumatology guidelines, patients with systemic lupus erythematosus (if indicated) should receive a tetanus vaccine before starting rituximab treatment. Routine tetanus vaccination is recommended for patients receiving belimumab. 5. Herpes zoster vaccine: According to the European Federation of Rheumatology Associations guidelines, high-risk patients are recommended to receive the herpes zoster vaccine, while the recent American College of Rheumatology guidelines do not describe the specific situation and recommend that all rheumatic patients over 18 years old receive the herpes zoster vaccine.

Disclaimer: This article was created out of personal interest, only to help more ordinary people have a clearer understanding of vaccines. The content and views do not represent any organization, unit, or institution, and it has not accepted any form of sponsorship. All pictures are from public online platforms. If the content is incorrect, please do more self-criticism (not).