Recently, topics related to "lupus erythematosus" have been on the hot search many times and have attracted the attention of the public.
Lupus erythematosus is an autoimmune disease that is usually divided into two types according to the site of involvement: cutaneous lupus erythematosus and systemic lupus erythematosus. Among them, systemic lupus erythematosus is an autoimmune disease that can affect multiple tissues and organs throughout the body. This disease can invade almost all organs in the body, including the skin, blood, kidneys, heart, lungs, gastrointestinal tract, nervous organs, etc., causing multi-system damage. The erythema is due to the fact that patients with this disease mostly have facial skin lesions, which are manifested as butterfly erythema, discoid erythema, etc.
"At present, the cause of lupus erythematosus is complex, related to genetics, hormones, environment and other factors, and there is no cure at present, and most patients are facing repeated recurrence of the disease, which will be life-threatening in severe cases. Professor Zhang Xiao, chief physician of the Department of Rheumatology of Guangdong Provincial People's Hospital and vice president of the Rheumatology Professional Committee of the Chinese Medical Doctor Association, said in an interview with The Paper (www.thepaper.cn) that women of childbearing age are the most common patient population of lupus erythematosus, and women in the reproductive period account for about 90%. Due to individual differences, the survival time of lupus erythematosus varies between 20-50 years, and the mainland is currently around 30 years. If patients with lupus erythematosus can be closely controlled and take their medications carefully, most patients can live like normal people.
Professor Zhang Xiao, Chief Physician of the Department of Rheumatology of Guangdong Provincial People's Hospital and Vice President of the Rheumatology Professional Committee of the Chinese Medical Doctor Association. Photo courtesy of the interviewee
It is highly common in women of childbearing age, and recurrent attacks are the main cause of fatality
According to the Guidelines for the Diagnosis and Treatment of Systemic Lupus Erythematosus released this year, lupus erythematosus is a chronic autoimmune disease characterized by systemic inflammation and autoantibody production. The etiology of lupus erythematosus is complex, and may be related to a variety of factors such as genetics, environment, and immune system abnormalities, and it is more common in women of childbearing age, and the age of onset in women is mostly 15-40 years old.
People at high risk of lupus erythematosus include people with a family history of lupus erythematosus, women, especially women of childbearing age, and people who have been exposed to ultraviolet rays from the sun for a long time. Zhang Xiao introduced that the most common clinical manifestations of lupus erythematosus are rashes, repeated mouth ulcers, joint swelling and pain after sun exposure, and some patients have fever or lower limb edema, proteinuria, etc.
Zhang Xiao said that women of childbearing age are the most common group of patients with lupus erythematosus, and about 90% of women are in the reproductive period. Other risk factors include the environment, such as prolonged exposure to ultraviolet rays, and medications may also be triggers. Due to individual differences, the survival time of lupus erythematosus varies between 20-50 years, and the mainland is currently around 30 years. "In the 50s, when we first came into contact with this disease, the survival period was relatively short, and there was a very lack of drugs, and many reports called it 'immortal cancer'. ”
Lupus erythematosus causes inflammation of multiple organs throughout the body, such as the kidneys, skin, joints, nervous system, heart, etc. "Since long-term use of hormones may lead to drug side effects and complications, such as osteoporosis, infection, etc., the main causes of death of patients are lupus encephalopathy, lupus nephritis and secondary infections. Zhang Xiao said.
If not well controlled, patients with lupus erythematosus will present a vicious cycle of flare-up, remission, and recurrence, and each episode will cause irreversible damage to multiple organs in the body. Zhang Xiao introduced that there is no unified data on the survival rate of lupus erythematosus patients, but some data show that the 5-year survival rate of patients should be about 98%, and the 10-year survival rate can also reach about 80%. However, with the prolongation of the disease, the compensatory function of the body declines, coupled with non-standard monitoring and treatment, the recurrence of the disease has become the main cause of death in lupus erythematosus. "Clinically, we often see that if a patient gets sick at the age of 30, the life expectancy is 60-65 years old, which is about ten years shorter than that of healthy people. ”
According to the cause, strict control can lead to long-term survival with the disease
Zhang Xiao said that if the cause can be controlled well, the disease can survive for a long time. "Most patients can live like normal people, but they need to be closely controlled and take their medications carefully. Second, the chance of infection needs to be reduced. Long-term medication will cause certain damage to the organs, so we are now committed to developing some new biological drugs to reduce the side effects caused by long-term medication and reduce the risk of shortened survival of patients. ”
Currently, lupus erythematosus remains incurable. The international and domestic treatment goals for lupus erythematosus are: short-term control of disease activity, improvement of clinical symptoms, and achievement of clinical remission or low disease activity; The long-term goals are to prevent and reduce recurrence, reduce adverse drug reactions, prevent and control organ damage caused by diseases, achieve long-term sustainable remission, reduce disability and mortality rates, and improve the quality of life of patients.
With the advancement of science and technology, innovative drugs for the treatment of lupus erythematosus have been developed one after another. Zhang Xiao introduced that the current treatment has changed greatly, first of all, although hormones are the most basic drugs, but now it is advocated from the concept of reducing hormones to the minimum dose after the condition is stabilized, or even hormone-free state; Second, in terms of immunosuppressants, in order to avoid the negative effects of long-term immunosuppressants on the organs, the long-term maintenance of immunosuppressants should be reduced as much as possible; The third is that there are now targeted drugs.
"There are several main ways of biological drugs on the market now: such as the drugs that have been developed to target B cells, in addition, the second targeted drug of lupus erythematosus is type I interferon channel monoclonal antibody, which has 4 years of experience in the world, and the effect of improving rash, arthritis and even lupus nephritis is still satisfactory, and our country is doing confirmatory clinical studies, and this drug should be approved soon. Zhang Xiao said.
Zhang Xiao mentioned that some patients do not pay attention to lupus erythematosus as a long-term chronic disease, and some patients do not have good compliance and cannot come to the hospital for regular follow-up and monitoring. "There are also many people who stop taking the drug when they feel that their symptoms have improved, and come back to see a doctor the next time they relapse, which are all factors that contribute to the poor prognosis. ”
Therefore, Professor Zhang Xiao emphasized that in daily life, patients should pay attention to two points, the first is to avoid infection, because infection can activate the immune system and cause excessive immunity, and the second is ultraviolet rays and some drugs, including contraceptives and estrogen-related drugs, antituberculosis drugs, drugs for mental illness, and anesthetics, which may become triggers. "If you have a family history of lupus erythematosus or rheumatism, you should pay attention to whether you will have mouth ulcers, rashes, and joint pain when taking these drugs. ”
Source: The Paper