"Wolf Warrior" Handbook | Long-term treatment, rational use of drugs, and winning the "protracted war"

Systemic lupus erythematosus (SLE) is an autoimmune system disease. Its etiology is complex, and it can affect multiple systems throughout the body and is prone to relapse. If treatment is not timely and standardized, it can even lead to death in severe cases. Although the current treatment options for the disease cannot completely cure it, early standardized treatment can reduce damage to multiple organ systems, prolong the patient's life, and improve the quality of life.

The treatment of SLE is a long, individualized process, and the long-term treatment goal is to prevent and reduce recurrences. Hydroxychloroquine and glucocorticoids are the basic drugs for the treatment of SLE. What should be paid attention to in long-term use?

Hydroxychloroquine: Regular follow-up visits are important

Hydroxychloroquine is best taken with meals and can also be taken with milk. After taking hydroxychloroquine, it takes several weeks to take effect. If there are no contraindications, it can be taken for a long time if treatment is needed.

Patients who use hydroxychloroquine for a long time need to pay attention to the following points:

(1) Go to the hospital for regular follow-up visits. If you suddenly experience symptoms such as blurred vision, abnormal color vision, drooping eyelids, weakness, etc. during medication, you should go to the hospital for treatment in time.

(2) When taking antacids, such as the commonly used XXprazole, XXtidine, magnesium aluminum carbonate, etc., they should be taken 4 hours apart from hydroxychloroquine to avoid affecting the absorption of the drug and reducing its efficacy.

(3) Pay attention to sun protection during medication use to avoid strong ultraviolet rays that may aggravate skin damage. If you go out, you need to take sun protection measures, such as applying sunscreen or using a parasol.

Glucocorticoids: Do not stop taking them on your own

Many patients are terrified when talking about hormones, worrying about the side effects. In fact, for patients in the active stage of lupus, the rational use of hormones will benefit more from the treatment of the disease.

The common adverse reactions of long-term and high-dose use of glucocorticoids include: iatrogenic hyperadrenocorticalism, manifested by moon face, buffalo hump, hirsutism, thinning skin, etc.; digestive system complications, inducing or aggravating ulcer disease; cardiovascular system complications, inducing hypertension and arteriosclerosis; osteoporosis, muscle atrophy, delayed wound healing, etc.

Some patients may ask, "Can I take less hormones if there are too many adverse reactions?" "Can I stop taking the medicine if I feel my symptoms are getting better?" It should be emphasized that you must not reduce the dosage or stop taking the medicine on your own. Stopping the medicine suddenly on your own may lead to poor disease control and more serious irreversible adverse consequences. Patients should have regular follow-up visits under the guidance of a doctor, and gradually reduce the dosage or stop taking the medicine after their condition stabilizes.

Patients who take hormones for a long time should also pay attention to the following aspects:

(1) The best time to take hormones is between 7 and 8 in the morning. This is because the body's own glucocorticoid secretion level is highest before 8 in the morning. Taking hormones before 8 in the morning is in line with the body's natural hormone secretion rhythm, the therapeutic effect will be better, and the adverse effects on the body will be relatively small.

(2) Patients who take hormones for a long time or have osteoporosis can take calcium and vitamin D before going to bed at night. Vitamin D not only promotes calcium absorption, but also helps SLE patients reduce inflammation and activity.

(3) In addition to active treatment and proper use of medication, patients should also pay attention to adjusting their lifestyle, such as exercising moderately and quitting smoking, etc. It is also very important to strengthen their body's resistance and avoid infection. In addition to paying attention to sun protection, patients with damaged skin should also avoid contact with hair dyes, eyebrow tattoo agents, etc., so as not to induce or aggravate the disease.

At present, the situation of COVID-19 prevention and control in my country remains severe, and many SLE patients have doubts about whether they can be vaccinated with the COVID-19 vaccine.

For SLE patients, whether to receive the new coronavirus vaccine should be decided by a professional doctor after evaluating their condition and medication. It is recommended that patients who are in the acute phase of the disease or in an uncontrolled period of the disease should avoid vaccination.

Author: Li Xiaoli, pharmacist at the Affiliated Hospital of North Sichuan Medical College

Review expert: Liu Guiyang, Chief Pharmacist of the Pharmacy and Pharmacology Department of the Fourth Medical Center of the PLA General Hospital