The hottest topics in rheumatism are all here!

*Only for medical professionals to read for reference.
If you talk with you, you will win over ten years of medicine! On May 20-22, 2021, the 25th Academic Conference of the Chinese Association of Rheumatology (CRA) in 2021 will be held in Shenzhen.

The big names of the conference were gathered and there were many highlights.

The “medical community” invited Professor Li Zhanguo from Peking University People’s Hospital, Professor Jiang Lindi from Zhongshan Hospital Affiliated to Fudan University, Professor Xue Jing from the Second Affiliated Hospital of Zhejiang University School of Medicine, and Professor Liu Yi from West China Hospital of Sichuan University.
Be a guest at the special site of "Famous Doctor Kung Fu Tea" 2021CRA in the medical field, and invite them to share the wonderful content and personal academic views of the conference to the online audience, and recruit millions of doctors.

Professor Li Zhanguo: Long-term remission and immune homeostasis of systemic lupus erythematosus Moderator: Long-term remission is one of the most concerned issues for patients with systemic lupus erythematosus (SLE).
How do you think that the long-term remission of SLE can be better achieved clinically? Professor Li Zhanguo: The clinical treatment of SLE has made great progress, but there are still many problems.

Some patients still cannot achieve relief after long-term treatment, and the main problem is the lack of standard medication.

When hormones and immunosuppressants are used in some moderate to severe patients, the dose of the drug and the course of treatment (compared with the standard dose) are often biased.

Second, the treatment of SLE must be individualized.

During follow-up, if the patient's condition has not improved for a long time, the treatment plan should be adjusted in time.

 Moderator: How to understand "immune homeostasis" and what significance does it have for the control of SLE? Professor Li Zhanguo: "Immune homeostasis" is a concept that has been put forward more in the immunology field and clinically.

In the direction of current treatment, we emphasize that it is necessary to suppress excessive immune responses, but also to enhance those suppressed immune cells (levels), improve immune function, and achieve immune balance and clinical remission.

 Moderator: In recent years, your team has conducted in-depth explorations on the use of low-dose IL-2 to treat autoimmune diseases.
Can you share some results for the audience? Professor Li Zhanguo: IL-2 has been treated (we) for many years.

A large number of studies have proved that in many patients (autoimmune diseases) the level of regulatory T cells in the blood is low, which is often related to the lack of IL-2.

The effects of high-dose IL-2 and low-dose IL-2 are completely different.

In the field of oncology, the dose of IL-2 is often ten to fifteen times the dose of IL-2 we use for treatment.

When we use low-dose IL-2 treatment, immune adverse reactions rarely occur, and most of them are safe.

Low-dose IL-2 can improve the patient's immune balance, promote the significant proliferation of regulatory T cells, and significantly enhance the activity and function.

At the same time, it can also suppress inflammatory immune cells and help patients achieve immune balance.

In addition, low-dose IL-2 can also reduce the incidence of infection.

Our research has found that compared with lupus patients who use conventional treatment programs, the incidence of infection in lupus patients treated with IL-2 is significantly less, from about 27% to about 6%.

Therefore, when patients with lupus have an infection or are worried about their higher risk of infection, IL-2 can be considered.

 Moderator: What are the main research directions of your team in the future? Professor Li Zhanguo: As clinicians, we mainly focus on solving clinical problems.

In recent years, the research direction of our team is mainly in two aspects.
On the one hand, early diagnosis methods, such as serum markers for diseases such as SLE, rheumatoid arthritis, Sjogren’s syndrome, etc.
; on the other hand, the development of targeted drugs and treatment plans.
Optimization, such as the application of IL-2, and the exploration of combined treatment options.

The picture shows Professor Li Zhanguo's guest in the live broadcast room.
Professor Jiang Lindi: Problems in the diagnosis and treatment of arteritis-related hypertension Moderator: Who are the high-risk groups of arteritis-related hypertension? Professor Jiang Lindi: High blood pressure associated with arteritis is very common, but many patients have low blood pressure when the blood pressure is measured because of the stenosis of the subclavian artery, which may cause the doctor to misjudge.

Therefore, we emphasize that when the patient’s bilateral radial arteries cannot be touched, the blood pressure of the patient’s lower extremities should be measured.
If the blood pressure of the lower extremities cannot be measured, the specialist should be consulted to perform intravascular pressure measurement to correctly determine whether the patient has high blood pressure.
Blood pressure may be.

In addition, the doctor should also examine the patient's blood vessels throughout the body to see if the patient has stenosis of the abdominal aorta, thoracic aorta, renal artery, carotid artery, or dilated aorta in addition to the stenosis of the subclavian artery.

Severe lesions of these blood vessels may cause hypertension.

If the electrocardiogram indicates that the patient has a high left ventricular voltage, or the echocardiography indicates changes in the left ventricular wall, be careful that the patient has high blood pressure.

 Moderator: Different degrees of carotid artery stenosis will affect the goal of blood pressure reduction? Professor Jiang Lindi: The target of blood pressure reduction in patients with arteritis-related hypertension is the same as that of traditional hypertension, but patients often have multiple arterial involvement, such as carotid artery involvement.
If the blood pressure is too low, intracranial perfusion May be affected, dizziness, darkness, or even fainting.

Therefore, the specific blood pressure goal should be determined according to the patient's tolerance.

 Moderator: The treatment of arteritis-related hypertension is mainly based on multidisciplinary cooperative diagnosis and treatment led by the Department of Rheumatology and Immunology, with early diagnosis, comprehensive evaluation, and layered treatment.

So, what are the principles of treatment of arteritis-related hypertension? Professor Jiang Lindi: Takayasu's arteritis is fundamentally caused by vascular immune inflammation, so it is particularly important to control inflammation.

Active patients should be given active anti-inflammatory treatment.
After the patient's condition is stable, it should be observed whether important organs are damaged and what causes it.

If it is caused by vascular stenosis and insufficient blood supply, we need to ask the surgeon to help see if revascularization can be performed to improve blood supply.

If the lumen is completely occluded and the surgical operation cannot restore the blood supply, it is also necessary to consult the doctors in the relevant department to formulate a comprehensive strategy and take measures to maintain organ function.

 Moderator: According to the severity of the disease, what are the stages of arteritis? Professor Jiang Lindi: The classification of arteritis is very complicated and can be divided into low-risk, intermediate-risk, and high-risk.

High-risk patients should be actively treated internally, supplemented by multidisciplinary diagnosis and treatment.

For intermediate-risk patients, we should first actively fight inflammation to stabilize the patient's condition.
When conditions are right, improve blood supply through surgery or other multidisciplinary diagnosis and treatment, so that the patient's damaged organ function can be restored to a certain extent, and the patient's quality of life can be improved.

For mild patients, regular follow-up should be done to maintain the stability of the disease as much as possible.

 Moderator: Some drugs used to treat aortic arteritis can also cause high blood pressure.
How to distinguish it from aortic arteritis-related hypertension? Professor Jiang Lindi: Drugs for the treatment of arteritis, such as hormones, leflunomide, tacrolimus, etc.
, may cause high blood pressure.

Clinically, patients with high blood pressure may increase their hypertension after using these drugs.
Therefore, doctors must carefully monitor the patient's blood pressure and adjust the medication according to the results.

The picture shows Professor Jiang Lindi as a guest in the live broadcast room.
Professor Liu Yi: Chronic disease management and clinical scientific research for patients with rheumatism.
Host: At this conference, you made a wonderful presentation for the audience around the theme of "Chronic Disease Management and Clinical Scientific Research for Rheumatic Patients Speech, can you share some wonderful content for the online audience? Professor Liu Yi: This year I chose the topic of how chronic disease management serves the construction of disciplines, especially clinical research.

Chronic disease management is mostly led by nurses and assisted by doctors.

It may be difficult for nurses to find a suitable angle to conduct research on rheumatism, and there are few research resources.
However, the chronic disease management model integrated with medical care provides the nursing team with tools for clinical research.
For example, nurses can manage patients to establish databases and evaluate patients.
Clinical indicators, psychological status, family situation, financial burden, etc.
during follow-up.

By sorting out these data, asking questions, and analyzing, it is possible to get good scientific research results.

For doctors, chronic disease management provides doctors with a "hands" for long-term follow-up, and research is no longer limited to "cross-section.
"
Doctors can better evaluate the efficacy of patients through multiple follow-up data.

The database of doctors and nurses can also be mutually verified, and the research results are more credible.

 Moderator: Regarding chronic disease management of rheumatism, what advanced experience does your department have? Professor Liu Yi: The chronic disease management model of our department mainly includes the packaged service model and the regional network alliance model.

The packaged service model is to package more than 70 medical services together, and to attract patients through preferential registration, green channels, etc.
, to achieve long-term and stable follow-up.

The regional network alliance is mainly aimed at patients in different places.
We now have 15 close medical consortia, which can share patient information and facilitate patients to seek medical treatment.

In addition, more models such as the community medical center type have been explored.

 Moderator: How should young doctors find research directions? Please introduce some experience.

Professor Liu Yi: The first point is to ask a few more whys during the rounds.
When looking for questions from the clinic, the patient is the best teacher.

After asking the question, you must actively search for relevant information to find out whether the predecessors have already given the answer; second, understand the frontier development of the subspecialty, and maintain a keen sense of touch; the third is thinking, even if you have the answer, you can’t swallow it all.
Think further.

 Moderator: What research directions are your team currently doing? Can you share it with the audience? Professor Liu Yi: We in West China have mainly done these things in recent years: The first is the study of the preclinical state of rheumatoid arthritis.
We have discovered the influence of some intestinal flora on the occurrence and development of rheumatoid arthritis.
And explored how to use special food to interfere with patients, affect the intestinal flora, and block the occurrence of rheumatoid arthritis.

The second is to explore new treatment technologies, such as stem cells and stem cell derivatives, for research on diseases such as arthritis and dry eye.

In terms of basic research, we have the Institute of Immuno-Inflammation, currently focusing on new therapeutic targets such as PDE-4.

In the research model, we have also made some updates, not according to the type of disease, but according to the occurrence process of the disease.

For example, in the process of studying Sjogren’s syndrome, we tried to explore the pathogenesis of lymphoma, breaking through the boundaries of rheumatology.

The picture shows Professor Liu Yi's guest in the live broadcast room.
Professor Xue Jing: Check the progress of ankylosing spondylitis Host: Based on your own experience, what do you think are the difficulties in the diagnosis and treatment of ankylosing spondylitis? Professor Xue Jing: The two major difficulties in the diagnosis and treatment of ankylosing spondylitis should be "standard" and "long-term".

Standardization refers to the overall assessment of the patient, the formulation of a plan according to the patient's specific condition, and the standardized treatment.

Some patients may be more active in the acute stage of the disease, but will no longer insist on treatment in the chronic stage.
Therefore, how our doctors can make patients persist, receive long-term treatment, and improve long-term results should be a major clinical difficulty.

At this conference, you reviewed the latest developments in the field of ankylosing spondylitis.
Can you share some exciting content for our online audience? The focus is mainly on the following aspects: One is the extra-articular damage of ankylosing spondylitis.
At this conference, I specifically mentioned a study from Sweden.

The Swedish national database is very complete, so there are some long-term studies, the time span may be as long as ten or fifteen years.

The data of more than 8,000 patients tell us that the extra-articular manifestations of ankylosing spondylitis cannot be ignored, especially acute anterior uveitis, inflammatory bowel disease, psoriasis, etc.

The second aspect is the structural damage of ankylosing spondylitis.
The goals of ankylosing spondylitis treatment include functional maintenance and reduction of structural damage.
We also pay special attention to this topic and make some inventory of related clinical studies.

 Moderator: Among these studies, which one are you most interested in? Prof.
Xue Jing: A meta-analysis explored the question of whether patients with ankylosing spondylitis can become pregnant.
More than 1,000 articles were screened, and 18 articles were finally included.

The results found that most of the pregnancy outcomes of patients with ankylosing spondylitis are still good.
The only difference from normal people is that patients with ankylosing spondylitis are more inclined to choose cesarean section, and it is an elective cesarean section rather than an emergency cesarean section.
Produce.

Part of the reason for choosing a cesarean section is the willingness of the doctor and the patient, and the other part is related to the severity of the disease.

Therefore, we should also pay more attention to (pregnant patients), and control the condition before pregnancy, so that these "pregnant mothers" with ankylosing spondylitis can give birth normally.

 Moderator: Most patients with ankylosing spondylitis require life-long treatment.
What do you think is the best control state that can be achieved with ankylosing spondylitis? Professor Xue Jing: The international treatment of ankylosing spondylitis emphasizes long-term management.

Maintaining patient function, reducing the pain caused by disease symptoms, and avoiding internal organs and structural damage should be the ultimate goal of treatment.

An individualized plan should be developed for each patient, and not all patients need drug intervention.

For patients in the active phase, active treatment strategies should be chosen to quickly control symptoms.

A study showed that for patients with active ankylosing spondylitis, if their disease activity score is effectively reduced within three months, the function of these patients can also be improved after three years.

The picture shows Professor Xue Jing as a guest in the live broadcast room