I can't think of that, do you? Young women have acute abdominal pain, which may be the disease...

Author: LV Liangjing, rheumatology department, Renji Hospital Affiliated to Shanghai Jiaotong University Medical College, should consider the possibility of systemic lupus erythematosus (SLE) if young women have acute abdominal pain. The diagnosis can be made according to the classification criteria of SLE formulated by the international lupus research clinical collaboration group in 2012 or the European anti rheumatism alliance and American rheumatism society in 2019.SLE is a non organ specific autoimmune disease, which is characterized by excessive production of autoantibodies and formation of immune complexes, which affects almost all human organs. The prevalence of SLE in China is about 70 / 100000.among them, 8% - 40% of SLE patients can involve gastrointestinal tract, but the classification standard of SLE has not covered the gastrointestinal manifestations. Some patients with acute abdominal pain or diarrhea as the first symptom and go to the digestive department, general surgery department or emergency department often lead to misdiagnosis and mistreatment, and some patients even die because of the timing of misdiagnosis.the mortality rate of SLE complicated with abdominal pain is the highest, and half of SLE patients have no specific clinical symptoms involving digestive system, which can be manifested as nausea, vomiting, abdominal pain, diarrhea and other discomfort. Severe cases may have gastrointestinal bleeding, and even develop into acute abdomen such as intestinal necrosis and intestinal perforation.gastrointestinal tract is the most common site of SLE involving digestive system, accounting for 29% - 65% of SLE patients with abdominal pain.studies have shown that the mortality of SLE complicated with acute abdominal pain is up to 50%. Therefore, early diagnosis and timely treatment are very important for the prognosis of patients.lupus mesenteric vasculitis (LMV) is the most common clinical manifestation, followed by Pseudointestinal obstruction (IPO), protein loss enteropathy (PLE) and other rare complications, such as panniculitis and IBD.abdominal enhanced CT examination is helpful for the early diagnosis of SLE. There are no specific serum markers involved in the gastrointestinal tract. Therefore, it is necessary to identify gastrointestinal infection, adverse drug reactions or comorbidities related to other digestive system diseases according to other clinical lines.no specific autoantibodies related to gastrointestinal lesions of SLE have been found.the laboratory examination indexes often show the overall change of SLE activity.abdominal enhanced CT examination is helpful for the early diagnosis of gastrointestinal involvement in SLE.Figure 1: CT scan of gastrointestinal vasculitis showed mesenteric vessel filling (comb sign, white arrow) and thickening and enhancement of intestinal wall (target sign, black arrow). For SLE patients with gastrointestinal involvement, gastroscopy and colonoscopy can show mucinous ischemia or ulcer changes. However, biopsy specimens of submucosa are not easy to obtain and due to its pathological changes The diagnosis value of mucosal histopathology is not high.timely treatment is very important. Due to the lack of large-scale clinical research and evidence-based medicine evidence, there is still a lack of specific treatment guidelines.early diagnosis, comprehensive evaluation and timely intervention are very important for disease control.the general treatment principle is to protect organs, control disease activity, assist and support treatment, prevent secondary infection and reduce adverse reactions of related drugs, and take surgical treatment when necessary.for SLE patients with gastrointestinal symptoms, we should first assess whether SLE is in the active stage, exclude infection, drugs and other factors, and further determine whether digestive system organs are involved through abdominal CT and other methods, and determine the patient's condition.most patients responded well to glucocorticoid treatment, and their abdominal symptoms improved after 7-10 days of medication. for patients with poor response to treatment, it is suggested that immunosuppressants should be used in time on the basis of avoiding infection, and biological agents, plasma exchange and immunoadsorption should be used as appropriate. at present, there is a lack of large-scale clinical research, and more high-quality studies are expected to provide more accurate diagnosis and treatment plans. LV Liangjing Professor: executive deputy director of rheumatology department of Renji Hospital Affiliated to Medical College of Shanghai Jiaotong University, deputy director of Shanghai Rheumatology Research Institute, chief scientist of Rheumatology precision medical project of national key research and development plan in 2017 Nephritis Network (AlnN) member source: Chinese Journal of Gastroenterology more details "reading the original" editor: Li Hui reviewed by: Wang Lina contribution to medical journal Public email: yishibao2017@163.com [note] some of the pictures are from the network and wechat circle of friends. Dear Author, the doctor's Daily has prepared the contribution fee for you. Please contact the editor on duty: 58302828-6808 review of previous issues ● latest《 Doctor's daily 651 e-paper comes out, reading is a power ● being a doctor is the last thing I regret! 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