How to carry out the treatment of lupus erythematosus in the pediatric system

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by the presence of autoantibodies and multi-organ involvement, with highly heterogeneous clinical manifestations

General treatment

In the acute phase, bed rest should be used to strengthen nutrition and avoid sun exposure

drug therapy

Nonsteroidal anti-inflammatory drugs

Effective for mild conditions such as fever, fatigue, rash myalgia, arthralgia, and pleurisy in children with SLE

Antimalarial drugs

These include chloroquine and hydroxyquine

Adrenocortical hormones (hereinafter referred to as hormones)

Hormones are the mainstay of treatment for SLE

Hormones control general symptoms quickly and do not need to be too large to be effective

In the process of long-term medication, attention should be paid to the side effects of hormones, such as serious bacterial infection, tuberculosis spread, fungal infection or viral infection, in addition, hypertension, osteoporosis, aseptic necrosis of the femoral head, growth and development arrest, gastrointestinal bleeding, cataracts, diabetes and psychiatric symptoms, etc.

For severe lupus nephritis, such as diffuse proliferative nephritis and central nervous system symptoms, methylprednisolone shock therapy can be used at a dose of 15 to 30 mg/kg, up to a maximum of 1 g, once a day for 3 days, and then switched to prednisone orally

The clinical manifestations of disease activity were observed to be exacerbated rash, joint swelling and pain, and massive alopecia, and laboratory indicators were accelerated erythrocyte and/or thrombocytopenia, hemolytic anemia (decreased hemoglobin, increased reticulocytes and positive Coombs test), and decreased

immunosuppressant

Commonly used drugs are cyclophosphamide, azathioprine and methotrexate

Cyclophosphamide is effective for all types of SLE, particularly severe renal impairment such as diffuse proliferative nephritis, central nervous system, and lung damage

Notes:

• In acute renal failure, cyclophosphamide shock may be followed by methylprednisolone shock when creatinine clearance is below 20 ml/min

Cyclophosphamide should be used with caution if there has been a serious infection in the past 2 weeks, or the white blood cell count is lower than 4*109/L, or if cyclophosphamide is allergic, or other immunosuppressants have been used within 2 weeks, severe nephrotic syndrome manifestations

Since the peak incidence of SLE in children is between 11 and 15 years of age, pubertal development should be considered before treatment

Cyclosporine is not widely used

Other therapies

Intravenous infusion of large doses of gamma globulin has some therapeutic effect on SLE

Plasmapheresis therapy can be used for severe SLE
.

References:

Immunology Group of Pediatrics Branch of Chinese Medical Association.
Guidelines for the diagnosis and treatment of systemic lupus erythematosus in children in China (2021)[J].
Chinese Journal of Pediatrics,2021,12,59(12):1009-1025.