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    Home > Active Ingredient News > Immunology News > Decoding the rheumatism live room ②Innovation of systematic evaluation guidelines, biological agents and traditional treatment methods complement each other

    Decoding the rheumatism live room ②Innovation of systematic evaluation guidelines, biological agents and traditional treatment methods complement each other

    • Last Update: 2021-10-01
    • Source: Internet
    • Author: User
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    The 25th National Rheumatology Academic Conference of the Chinese Medical Association adheres to the spirit and mission of refinement, innovation, and development.
    It combines scientific rigor and innovative breakthroughs.
    It invites the national rheumatology field and interdisciplinary areas such as kidney, blood, and pediatrics.
    Experts gathered together for an academic feast

    .

    At the meeting, "Physician Daily" set up a "Decoding Rheumatism Live Room" and invited many participating experts to comprehensively interpret rheumatism and immunity
    .

    On the third day, guests in the "Decoding Rheumatology Live Room" were Professor Mu Rong, Director of the Department of Rheumatology and Immunology, Peking University Third Hospital, Professor Li Yinong, Director of the Department of Rheumatology and Immunology, Armed Police Hospital of Fujian Medical University, and Su Yin, Deputy Director of the Department of Rheumatology and Immunology, Peking University People's Hospital Professor Leng Xiaomei, the chief physician of the Department of Rheumatology and Immunology of Peking Union Medical College Hospital, and Professor Li Qin, the chief physician of the Department of Rheumatology and Immunology of the First People's Hospital of Yunnan Province, comprehensively analyzed the "systematic assessment and combination medication" of rheumatism and immunology
    .

    01 Systematic assessment plays an important role in both clinical and scientific research.
    Professor Mu Rong said that rheumatism usually affects multiple organs throughout the body.
    Even for diseases like rheumatoid arthritis, although the name sounds like it only affects joints, But in fact, it can also affect other organs in the body, such as causing pulmonary interstitial fibrosis, atherosclerosis, renal amyloidosis, etc.
    , so almost all rheumatoid immune diseases are systemic and systemic diseases.
    This is the characteristic of this type of disease

    .

    Because of this, the evaluation of rheumatic immune diseases such as systemic lupus erythematosus needs to involve multiple dimensions, and more and more detailed aspects and angles of evaluation are its development trend
    .

    Generally speaking, it is divided into two aspects, one is the assessment of disease activity, and the other is the assessment of the severity of organ damage [1-2]
    .

    Many scores such as PGA, SLEDAI, BILAG, etc.
    can be selected according to the conditions of different patients [2-4]

    .

    In fact, in the process of human beings fighting diseases, many diseases not only require diagnosis and treatment, but evaluation is also a very important part of it
    .

    As Dr.
    Kelvin (Lord Kelvin) said, to measure is to know

    .

    Only by correctly understanding a certain disease, what stage it is currently in, and what it belongs to, can we provide patients with a good treatment strategy for the next step
    .

    Therefore, disease assessment can be said to be a cornerstone of clinical work
    .

    Rheumatic immune disease is different from traditional chronic diseases such as hypertension and diabetes.
    It is relatively more complicated and requires a more comprehensive and systematic evaluation method to indicate to clinicians whether the current treatment plan is effective and whether it needs to be adjusted

    .

    In addition, not only clinically, but also in scientific research, such as the evaluation of the efficacy of new drugs, systematic evaluation also plays an important role
    .

    02 Professor Li Yinong, the beacon of systematic evaluation of the clinical treatment of SLE, said that for all diseases, if you want to know the severity of the disease and whether the treatment is effective, it needs to be evaluated, not to mention more complicated diseases like SLE
    .

    Therefore, there are also various evaluation tools for SLE
    .

    At present, the most commonly used assessment tools are the BILAG score of the British Isles, and the SDI assessment of the International Lupus Collaboration Group, which is mainly considered from the aspect of organ damage, but does not consider the disease activity of the patient [3, 5-6 ]
    .

    Systemic Lupus Erythematosus Disease Activity Score (SLEDAI) has many clinical applications, mainly to assess the disease activity of patients, but the assessment of organ damage is not thorough [4]
    .

    There is also the clinician’s overall assessment (PGA), that is, the doctor’s assessment of the patient’s overall situation [4]
    .

    It can be seen that different assessment tools have different focuses
    .

    In recent years, the three scores of SLEDAI, BILAG and PGA have been considered simultaneously to produce a comprehensive index SRI7, so that the evaluation of SLE is more comprehensive and scientific
    .

    In view of the high degree of heterogeneity of SLE, the clinical manifestations of patients are different.
    Arrhythmia, heart failure, lupus nephritis, mesenteric disease, infection, etc.
    may appear, showing manifestations of multiple organ involvement

    .

    The changeable performance puts forward higher requirements for treatment.
    When is it necessary to use immunosuppressive agents, hormones, and gamma globulin therapy, the application of these basic treatment methods is ultimately attributed to systemic evaluation

    .

    Systematic evaluation is very important because it allows clinicians to know the method and timing of treatment
    .

    03 SLE's high degree of heterogeneity puts high demands on precision treatment.
    Professor Su Yin introduced that the pathogenesis of SLE is affected by many factors, and its mechanism is very complicated.
    Objectively speaking, at present, we are still unclear about the pathogenesis of SLE [8]

    .

    In recent years, relevant research results have focused the cause of SLE on the abnormal activity of B cells, which may be mainly related to the abnormal activation and differentiation of B cells into effector cells, the uptake and presentation of autoantigens, the secretion of autoantibodies, and the release of various cytokines.
    Related [9]

    .

    Therefore, unlike rheumatoid arthritis and other diseases, the targeted therapy of SLE does not have a particularly clear target, and the development of biologically targeted drugs is more bumpy
    .

    One of the reasons is that the heterogeneity of SLE is very strong.
    Patients may show organ damage with renal involvement and neuropsychiatric symptoms[10].
    Other patients are mainly intestinal lesions.
    Therefore, in clinical research, it is effective for drugs.
    It is difficult to have a consistent evaluation standard for sex

    .

    The high degree of heterogeneity of SLE actually puts forward requirements for individualized precision treatment
    .

    It is gratifying that despite such difficult circumstances, the precision targeted therapy of SLE has made some progress
    .

    After the advent of bio-targeted drugs, SLE patients with poor conventional treatments have a better choice, such as the combined use of belyumumab.
    Patients with baseline oral hormones will be treated with belyumumab for 6 months.
    The average hormone reduction dose is 4-12 mg/day [11, 22-28]

    .

    Moreover, as the adult indications of biologically targeted drugs enter medical insurance, the price is lower, and its application prospects are worth looking forward to
    .

    04 Biological preparations are milestone drugs in the field of rheumatism and immunology Professor Leng Xiaomei introduced that in the field of SLE treatment, it can be said that the absence of innovative drug breakthroughs for many years is a major clinical dilemma
    .

    The good news is that after 56 years, an innovative biological agent has finally been approved for the treatment of SLE, providing doctors and patients with an alternative
    .

    With "excellent weapons" in hand, how to use them well is a skill
    .

    The "Guidelines for Diagnosis and Treatment of Systemic Lupus Erythematosus in China in 2020" are very "grounded" and have very practical guiding significance for clinical work
    .

    As long as the guidelines are carefully studied, it is not difficult to discover the secrets of using two weapons, immune agents and biological agents
    .

    The guidelines emphasize that when using hormones combined with hydroxychloroquine or immunologic agents to treat SLE patients with poor effect, intolerance or relapse, biological agents can be considered [2]
    .

    For patients with unsatisfactory response to treatment with conventional hormones combined with immunosuppressive agents, or with good initial response, patients who have relapsed with the reduction of hormones, there are two possibilities, one is the poor response to immune preparations, and the other is hormone dependence
    .

    In this case, timely addition of biological agents may help patients obtain clinical remission as soon as possible [11]
    .

    05 Biological targeting and traditional treatment complement each other.
    Professor Li Qin introduced that since the advent of hormones in the 1940s, they were first used in the treatment of rheumatoid arthritis

    .

    At that time, due to the fast onset of anti-inflammatory effects of hormones, patients with joint swelling and pain can be relieved in a short period of time, so hormones are really regarded as a special medicine for treating rheumatoid arthritis
    .

    However, over time, the side effects of long-term use of hormones gradually became apparent
    .

    Such as femoral head necrosis, osteoporosis, diabetes, etc.
    , will also bring considerable harm to patients

    .

    This is also the reason why the application of hormones in rheumatology and immunology departments has experienced ups and downs
    .

    In the end, everyone reached a consensus that hormones can be used, but the dosage and the applicable population must be controlled
    .

    As for the field of SLE, because most of the early manifestations are not typical, they may only have symptoms such as joint pain and rash.
    Therefore, many patients with multiple systems involved at the time of treatment [12-13]

    .

    In this case, hormones are the first choice for treatment
    .

    Due to the powerful anti-inflammatory and immunosuppressive effects of hormones, there is currently no drug that can completely replace hormones, and it still occupies a cornerstone position
    .

    On the other hand, hormones can also cause organ damage
    .

    For example, the increase in blood lipids and diabetes caused by the use of hormones, if not well controlled, will cause damage to the patient’s kidneys, peripheral nerves, eyes, heart and other organs [14-19]
    .

    Therefore, it is often said that hormones are a double-edged sword
    .

    After the patients initially understand the side effects of hormones, they are prone to fear, resistance, and decreased compliance.
    Many patients reduce or stop the medication without authorization, leading to repeated illnesses and abandoning all previous efforts.
    In addition, in order to control the disease, increase the dose of hormones.
    Come second injury

    .

    The emergence of belyumumab may help solve this dilemma
    .

    Studies have shown that the 13-year long-term follow-up of belyumumab in the treatment of SLE showed good safety, and the rate of key adverse events remained stable or decreased [21], and SLE patients with high disease activity (SLEDAI≥10) were treated for 52 weeks.
    The response rate can be as high as 70.
    4% [12]

    .

    Continuously control disease activity, effectively reduce hormone dosage, reduce the risk of serious recurrence, and delay the progress of organ damage [2,11,20-31]
    .

    The combination of innovative biological agents and traditional treatments can be said to be complementary to each other
    .

    e122-e13 This material is not an advertisement.
    This material is intended to provide scientific information to healthcare professionals only.
    If you are not a healthcare professional, please do not read or spread the content PM-CN-BEL-NLTR-210037 EXP : For 2023/7 belyumumab concise prescription information, please click to read the original text typesetting/editing: Wang Lina Review: Qin Miao For more content, please click: Consensus|How to apply the super fire ketogenic diet in brain glioma?
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