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*Only for medical professionals to read and reference.
Listen to your words, win over ten years of doctors.
On May 20-22, 2021, the 25th academic conference of the Rheumatology Society of the Chinese Medical Association was held in Shenzhen.
This conference was full of big names and bright spots.
In order to make more colleagues in the academic circle who could not participate in the conference in time, it is time to meet and be immersed in the conference, the medical field specially established the "Famous Doctor Kung Fu Tea, Approaching CRA" live broadcast room on the front line of the conference.
Recently, we were fortunate to have Professor Zhao Dongbao, Department of Rheumatology and Immunology, Changhai Hospital, Professor Su Yin, Department of Rheumatology and Immunology, Peking University People’s Hospital, Professor Ye Shuang, Department of Rheumatology and Immunology, Renji Hospital, Shanghai Jiaotong University School of Medicine, and Renji, Shanghai Jiaotong University School of Medicine.
Professor Nan Shen from the Department of Rheumatology and Immunology of the Hospital (in the order of interview time) was a guest in the live broadcast room to share the wonderful content and personal academic insights of this conference.
Emphasis on glucocorticoid-induced osteoporosis (GIOP) is urgent.
Moderator: At a time when osteoporosis (OP) has become one of the most important public health issues facing the world, how do you think the Chinese people pay attention to this issue? As an expert in the field of rheumatism, what is your opinion on the prevention and treatment of GIOP? Professor Zhao Dongbao said that everyone generally has a certain understanding of the primary OP problem in the elderly and postmenopausal women.
However, the general public, including some doctors, need to pay more attention to OP caused by rheumatism and treatment (mainly glucocorticoids).
GIOP has become the third most common cause of OP after the elderly and postmenopausal women.
However, when doctors use glucocorticoid control, they generally only pay attention to controlling the patient's blood sugar and blood pressure, and ignore the prevention and treatment of GIOP.In this regard, the Rheumatology Branch of the Chinese Medical Association, the Osteoporosis and Bone Mineral Disease Branch of the Chinese Medical Association, etc.
, issued the "2020 Chinese Expert Consensus on the Prevention and Treatment of Glucocorticoid Osteoporosis" last year.
The consensus clearly stated Until now, all adult patients who are expected to require hormone therapy for ≥3 months (any dose, route of administration) should be treated with GIOP prevention and treatment, that is, no matter how low the initial dose of hormone is, whether it is by inhalation or Oral medication, as long as the patient's expected duration of use is ≥3 months, it belongs to the prevention and treatment group of GIOP.
When it comes to specific prevention and treatment measures, the new consensus proposes the use of FRAX for stratified treatment of patients.
If the patient is a low-risk population, calcium and vitamin D can be supplemented; if the patient is assessed as a moderate or high fracture risk, in addition to calcium and vitamin D supplementation and life>
Finally, Professor Zhao Dongbao added that it is not recommended to use the two anti-OP drugs in combination.
The picture shows Professor Zhao Dongbao as a guest in the live broadcast room.
There are three reasons why rheumatoid arthritis control is not ideal.
Host: You have made wonderful sharing on the long-term management of rheumatoid arthritis (RA) at the National Rheumatism Annual Conference.
Is there a wise opinion on the reasons why RA is difficult to treat? Based on his decades of clinical experience, Professor Su Yin concluded that about 70% of RA patients are difficult to control.
The main reasons are as follows.
One is that some doctors have failed to identify and intervene early on the disease; the other is that the patient's own medication is not standardized and the compliance is poor.
A specific example is that the patient found that after reading the methotrexate instructions.
For anti-tumor drugs, it is likely to refuse to take the medicine, or not to take the medicine at the prescribed dosage and frequency; if the patient avoids the above two problems and the disease control is still not ideal, the problem of refractory RA must be considered.
Clinically, there are no specific markers that can be used to identify refractory RA.
The European Union Against Rheumatism (EULAR) defines RA treatment failure as: traditional synthetic disease-improving anti-rheumatic drugs (csDMARDs) treatment failure, and ≥ 2 different Mechanism of action biological agents DMARDs/targeted synthetic DMARDs (bDMARDs/tsDMARDs) have not reached a low disease activity state after treatment. Professor Su Yin believes that for such patients, early application of biological agents and targeted drugs can achieve greater benefits.
Professor Su Yin believes that finding a scientific method to help early identification of refractory RA can provide a great help to improve the overall prognosis of patients.
In fact, his team is also contributing to research in this area and looks forward to learning from patients.
Breakthroughs have been made in several perspectives such as the characteristics and the speed of disease imaging.
The picture shows the rapid progress of MDA5 antibody-positive dermatomyositis in the live broadcast by Professor Su Yin? Moderator: Could you please briefly introduce the main features and prognosis of MDA5 antibody-positive dermatomyositis? In addition, for the same MDA5 antibody-positive dermatomyositis, some patients have rapid disease progression, while others are relatively mild.
How do you predict these patients clinically? Professor Ye Shuang replied that MDA5 antibody-positive dermatomyositis is a representative type of dermatomyositis, which progresses quickly, has a poor prognosis, and is relatively high in East Asia.
It is an important clinical challenge and problem for rheumatologists in my country.
.
Early diagnosis and accurate treatment before the disease is decompensated are the key to improving the prognosis.
Regarding the prediction of the patient’s disease progression rate, Professor Ye Shuang shared that there is no accurate data to support this prediction.
He pointed out that most patients with MDA5 antibody-positive dermatomyositis have rapid disease progression, and some patients are diagnosed at the time of diagnosis.
Pulmonary interstitial disease is still very mild, but it progresses to respiratory failure in just 3 months, even life-threatening.
Close and regular follow-up is the only way for us to catch patients with rapid progress in time.
Sometimes, the intensity of follow-up monitoring may even be necessary to increase to 1 time per week.
With his own years of clinical experience, Professor Ye Shuang concluded that the disease progression of patients with MDA5 antibody-positive dermatomyositis with these characteristics may be relatively mild: children with juvenile dermatomyositis (these patients generally have heavier skin lesions, but Pulmonary interstitial lesions are mild); biomarkers (such as inflammatory indicators or lactate dehydrogenase, etc.
) are not significantly elevated; patients with a long time interval from the appearance of skin lesions to lung interstitial involvement ( More than half a year is considered a longer interval).
However, Professor Ye Shuang also repeatedly emphasized that what clinicians have to do is to attach great importance to every patient with MDA5-positive dermatomyositis and closely monitor the patient's condition.
The picture shows that Professor Ye Shuang is a guest to block the activation pathway of interferon and the new target for the treatment of systemic lupus erythematosus.
Host: You shared relevant content on the relationship between interferon and autoimmune diseases at the 2021 CRA conference.
Would you please briefly introduce the progress in related fields? In addition, your scientific research results have attracted worldwide attention.
As a leader in the field of rheumatism in my country, what are your expectations for the vast number of young doctors in my country? In the past few decades, genomics and immunobiology related research data have found that the activation of type I interferon plays a core role in the occurrence and development of many autoimmune diseases, including systemic lupus erythematosus (SLE).
The blocking of this pathway is likely to become a potential targeted therapy for these autoimmune diseases.
Many large pharmaceutical companies have completed phase III clinical trials of this targeted therapy, and related research has made gratifying progress in the field of SLE in particular.
Professor Nan Shen believes that the treatment is expected to become an emerging treatment for SLE approved by the U.
S.
Food and Drug Administration (FDA).
"From the perspective of new use of old drugs, in fact, many drugs that have been put into the clinic also inhibit the interferon pathway to varying degrees, such as hydroxychloroquine and JAK inhibitors.
" Professor Nan Shen added.
In addition, Professor Nan Shen also put forward a new point of view-in the past, many randomized controlled trials (RCT) data and the clinical experience of rheumatologist immunologists have told us that targeted therapies for B cells and T cells are not used in the management of SLE.
It is satisfactory, but recent studies have also found that the activation of the interferon pathway has a synergistic effect on the activation of the B cell pathway and the abnormality of T cells in SLE.
Therefore, combination therapy (targeting B cell or T cell therapy while combining target Interferon pathway therapy) is likely to be a strategy to improve the effectiveness of B-cell or T-cell targeted therapy.
At the end of the interview, as an important leader in the field of rheumatology in my country, Professor Nan Shen also gave a message to the vast number of young doctors and students in the field of rheumatology.
He said that rheumatology is a complex subject that faces a wide range of biological sciences.
Preparations and targeted drugs, if you want to be a rheumatologist, in addition to rich clinical experience, doctors should also have a solid basic skills in the field of basic research, so that they can have a deeper understanding of the mechanism of disease.
So as to better serve patients. At the same time, he also expressed his hope that younger generations are better than blue, and lead my country's rheumatology to play a more important role on the world stage.
The picture shows Professor Shen Nan as a guest in the live broadcast room
Listen to your words, win over ten years of doctors.
On May 20-22, 2021, the 25th academic conference of the Rheumatology Society of the Chinese Medical Association was held in Shenzhen.
This conference was full of big names and bright spots.
In order to make more colleagues in the academic circle who could not participate in the conference in time, it is time to meet and be immersed in the conference, the medical field specially established the "Famous Doctor Kung Fu Tea, Approaching CRA" live broadcast room on the front line of the conference.
Recently, we were fortunate to have Professor Zhao Dongbao, Department of Rheumatology and Immunology, Changhai Hospital, Professor Su Yin, Department of Rheumatology and Immunology, Peking University People’s Hospital, Professor Ye Shuang, Department of Rheumatology and Immunology, Renji Hospital, Shanghai Jiaotong University School of Medicine, and Renji, Shanghai Jiaotong University School of Medicine.
Professor Nan Shen from the Department of Rheumatology and Immunology of the Hospital (in the order of interview time) was a guest in the live broadcast room to share the wonderful content and personal academic insights of this conference.
Emphasis on glucocorticoid-induced osteoporosis (GIOP) is urgent.
Moderator: At a time when osteoporosis (OP) has become one of the most important public health issues facing the world, how do you think the Chinese people pay attention to this issue? As an expert in the field of rheumatism, what is your opinion on the prevention and treatment of GIOP? Professor Zhao Dongbao said that everyone generally has a certain understanding of the primary OP problem in the elderly and postmenopausal women.
However, the general public, including some doctors, need to pay more attention to OP caused by rheumatism and treatment (mainly glucocorticoids).
GIOP has become the third most common cause of OP after the elderly and postmenopausal women.
However, when doctors use glucocorticoid control, they generally only pay attention to controlling the patient's blood sugar and blood pressure, and ignore the prevention and treatment of GIOP.In this regard, the Rheumatology Branch of the Chinese Medical Association, the Osteoporosis and Bone Mineral Disease Branch of the Chinese Medical Association, etc.
, issued the "2020 Chinese Expert Consensus on the Prevention and Treatment of Glucocorticoid Osteoporosis" last year.
The consensus clearly stated Until now, all adult patients who are expected to require hormone therapy for ≥3 months (any dose, route of administration) should be treated with GIOP prevention and treatment, that is, no matter how low the initial dose of hormone is, whether it is by inhalation or Oral medication, as long as the patient's expected duration of use is ≥3 months, it belongs to the prevention and treatment group of GIOP.
When it comes to specific prevention and treatment measures, the new consensus proposes the use of FRAX for stratified treatment of patients.
If the patient is a low-risk population, calcium and vitamin D can be supplemented; if the patient is assessed as a moderate or high fracture risk, in addition to calcium and vitamin D supplementation and life>
Finally, Professor Zhao Dongbao added that it is not recommended to use the two anti-OP drugs in combination.
The picture shows Professor Zhao Dongbao as a guest in the live broadcast room.
There are three reasons why rheumatoid arthritis control is not ideal.
Host: You have made wonderful sharing on the long-term management of rheumatoid arthritis (RA) at the National Rheumatism Annual Conference.
Is there a wise opinion on the reasons why RA is difficult to treat? Based on his decades of clinical experience, Professor Su Yin concluded that about 70% of RA patients are difficult to control.
The main reasons are as follows.
One is that some doctors have failed to identify and intervene early on the disease; the other is that the patient's own medication is not standardized and the compliance is poor.
A specific example is that the patient found that after reading the methotrexate instructions.
For anti-tumor drugs, it is likely to refuse to take the medicine, or not to take the medicine at the prescribed dosage and frequency; if the patient avoids the above two problems and the disease control is still not ideal, the problem of refractory RA must be considered.
Clinically, there are no specific markers that can be used to identify refractory RA.
The European Union Against Rheumatism (EULAR) defines RA treatment failure as: traditional synthetic disease-improving anti-rheumatic drugs (csDMARDs) treatment failure, and ≥ 2 different Mechanism of action biological agents DMARDs/targeted synthetic DMARDs (bDMARDs/tsDMARDs) have not reached a low disease activity state after treatment. Professor Su Yin believes that for such patients, early application of biological agents and targeted drugs can achieve greater benefits.
Professor Su Yin believes that finding a scientific method to help early identification of refractory RA can provide a great help to improve the overall prognosis of patients.
In fact, his team is also contributing to research in this area and looks forward to learning from patients.
Breakthroughs have been made in several perspectives such as the characteristics and the speed of disease imaging.
The picture shows the rapid progress of MDA5 antibody-positive dermatomyositis in the live broadcast by Professor Su Yin? Moderator: Could you please briefly introduce the main features and prognosis of MDA5 antibody-positive dermatomyositis? In addition, for the same MDA5 antibody-positive dermatomyositis, some patients have rapid disease progression, while others are relatively mild.
How do you predict these patients clinically? Professor Ye Shuang replied that MDA5 antibody-positive dermatomyositis is a representative type of dermatomyositis, which progresses quickly, has a poor prognosis, and is relatively high in East Asia.
It is an important clinical challenge and problem for rheumatologists in my country.
.
Early diagnosis and accurate treatment before the disease is decompensated are the key to improving the prognosis.
Regarding the prediction of the patient’s disease progression rate, Professor Ye Shuang shared that there is no accurate data to support this prediction.
He pointed out that most patients with MDA5 antibody-positive dermatomyositis have rapid disease progression, and some patients are diagnosed at the time of diagnosis.
Pulmonary interstitial disease is still very mild, but it progresses to respiratory failure in just 3 months, even life-threatening.
Close and regular follow-up is the only way for us to catch patients with rapid progress in time.
Sometimes, the intensity of follow-up monitoring may even be necessary to increase to 1 time per week.
With his own years of clinical experience, Professor Ye Shuang concluded that the disease progression of patients with MDA5 antibody-positive dermatomyositis with these characteristics may be relatively mild: children with juvenile dermatomyositis (these patients generally have heavier skin lesions, but Pulmonary interstitial lesions are mild); biomarkers (such as inflammatory indicators or lactate dehydrogenase, etc.
) are not significantly elevated; patients with a long time interval from the appearance of skin lesions to lung interstitial involvement ( More than half a year is considered a longer interval).
However, Professor Ye Shuang also repeatedly emphasized that what clinicians have to do is to attach great importance to every patient with MDA5-positive dermatomyositis and closely monitor the patient's condition.
The picture shows that Professor Ye Shuang is a guest to block the activation pathway of interferon and the new target for the treatment of systemic lupus erythematosus.
Host: You shared relevant content on the relationship between interferon and autoimmune diseases at the 2021 CRA conference.
Would you please briefly introduce the progress in related fields? In addition, your scientific research results have attracted worldwide attention.
As a leader in the field of rheumatism in my country, what are your expectations for the vast number of young doctors in my country? In the past few decades, genomics and immunobiology related research data have found that the activation of type I interferon plays a core role in the occurrence and development of many autoimmune diseases, including systemic lupus erythematosus (SLE).
The blocking of this pathway is likely to become a potential targeted therapy for these autoimmune diseases.
Many large pharmaceutical companies have completed phase III clinical trials of this targeted therapy, and related research has made gratifying progress in the field of SLE in particular.
Professor Nan Shen believes that the treatment is expected to become an emerging treatment for SLE approved by the U.
S.
Food and Drug Administration (FDA).
"From the perspective of new use of old drugs, in fact, many drugs that have been put into the clinic also inhibit the interferon pathway to varying degrees, such as hydroxychloroquine and JAK inhibitors.
" Professor Nan Shen added.
In addition, Professor Nan Shen also put forward a new point of view-in the past, many randomized controlled trials (RCT) data and the clinical experience of rheumatologist immunologists have told us that targeted therapies for B cells and T cells are not used in the management of SLE.
It is satisfactory, but recent studies have also found that the activation of the interferon pathway has a synergistic effect on the activation of the B cell pathway and the abnormality of T cells in SLE.
Therefore, combination therapy (targeting B cell or T cell therapy while combining target Interferon pathway therapy) is likely to be a strategy to improve the effectiveness of B-cell or T-cell targeted therapy.
At the end of the interview, as an important leader in the field of rheumatology in my country, Professor Nan Shen also gave a message to the vast number of young doctors and students in the field of rheumatology.
He said that rheumatology is a complex subject that faces a wide range of biological sciences.
Preparations and targeted drugs, if you want to be a rheumatologist, in addition to rich clinical experience, doctors should also have a solid basic skills in the field of basic research, so that they can have a deeper understanding of the mechanism of disease.
So as to better serve patients. At the same time, he also expressed his hope that younger generations are better than blue, and lead my country's rheumatology to play a more important role on the world stage.
The picture shows Professor Shen Nan as a guest in the live broadcast room
