Many people look at the pharmaceutical industry according to the general laws of the market, which is inappropriate. The consumer mentality of “cheap is not good, good is not cheap” is not appropriate for seeing a doctor and taking medicine. In fact, for the treatment of lupus erythematosus, expensive drugs ≠ good drugs. The most effective drugs for lupus erythematosus are prednisone for more than one cent, cyclophosphamide for more than ten dollars a month, and methotrexate for less than five dollars a month. And those very expensive drugs, the efficacy is not better than the very cheap drugs. 1, hormone is more than a penny a piece of prednisone is the best Hormone is the basic drug for the treatment of lupus erythematosus, moderate to severe lupus erythematosus patients, in the early stage of treatment, almost inevitably need to use hormone. However, most patients do not need to rely on hormones for a long time, and more than half of them can stop using hormones after 1 to 2 years if they are in good control. There are various kinds of hormone drugs, the best cha is the cheapest prednisone (prednisone acetate tablets), which costs more than 1 cent a tablet. Dexamethasone tablets, cortisone tablets and hydrocortisone tablets are not suitable for the treatment of lupus erythematosus; the former has too many side effects on its own endocrine, while the latter two do not have strong enough effects. Among the hormone tablets taken orally, imported hormones are not superior to domestic drugs. In fact, the domestic prednisone which costs more than one cent is better than the imported hormone which costs more than 2 yuan. Many “rich” patients ask me to prescribe imported hormones, but I always advise them not to “spend money to buy hard feelings”. Nowadays, more than 95% of the hormone drugs used in the treatment of lupus erythematosus around the world are prednisone tablets, and the imported hormones in the domestic pharmaceutical market are not prednisone, so don’t be superstitious about imported hormones. But in severe and acute lupus erythematosus, when hormone injection is needed, methylprednisolone injection is the best choice. Among the hormone injections, dexamethasone is cheap but has a lot of side effects, especially when you need to use hormones for a longer period of time, or when you need shock treatment with hormones, you should not use dexamethasone, unless you are in a really difficult economic situation. Methylprednisolone injection has the advantages of good efficacy and low side effects. 2, expensive immunosuppressants are not good drugs In immunosuppressants, the most effective also happens to be the cheapest. Cyclophosphamide, which costs only a dozen dollars a month, is currently the most effective drug for treating severe lupus erythematosus; methotrexate, the safest and most effective immunosuppressant for treating mild to moderate lupus erythematosus, is less than 5 dollars a month. And those new immunosuppressants which need nearly $5,000 per month, the effect of treating lupus erythematosus is not better than those with a dozen dollars, and the side effects are also more obvious, cyclosporine is an example. Of course, cyclosporine is also an effective drug for treating lupus erythematosus, and there are a few patients who do not do well with cyclophosphamide and are effective with cyclosporine instead; while more patients are effective with cyclosporine instead of cyclophosphamide after cyclosporine is ineffective. Therefore, if your doctor recommends thousands of dollars per month of immunosuppressants as soon as your lupus is diagnosed, it is necessary to ask why and to consult several doctors. Snapdragon is a new immunosuppressant that costs nearly $5,000 per month and is not as effective as cyclophosphamide, which costs a dozen dollars per month, in treating lupus. But cyclophosphamide’s ovarian toxicity can cause women in their thirties to go through menopause early. Whereas primaquine does not have this side effect. Therefore, for severe lupus erythematosus, treatment with cyclophosphamide first requires immediate examination of ovarian function as soon as menstrual flow decreases or amenorrhea occurs. If there are signs of ovarian damage, cyclophosphamide needs to be stopped. At this point, if the lupus erythematosus condition has become more stable, maintenance treatment with methotrexate or azathioprine can be switched. If the disease is not yet stable, there are 2 options: one is to switch to primaquine, which is the best option. Most patients need 1 to 2 years of treatment with primaquine, which costs about 60,000 to 100,000 yuan for the drug; the second is to continue to use cyclophosphamide to control lupus erythematosus at the cost of shedding ovarian function and entering menopause. Whether it is worth spending 100,000 yuan to buy back more than 10 years of youth needs to be determined from person to person. We oppose the use of primaquine at the beginning, although the side effects of primaquine are lower, the positive effects are also lower, and the efficacy of inducing lupus remission is not as good as that of cyclophosphamide. Most of the “supplements” are harmful to lupus. Most of the “supplements”, especially the nutritional products marketed at present, are harmful to lupus but not beneficial. Almost none of the nutritional products are developed for lupus erythematosus. The immune pathology of lupus erythematosus is complex, and it is impossible to rationalize the immune disorder of lupus erythematosus with those so-called “two-way regulation” nutritional products or immune regulators. There is no scientifically proven effective immunomodulator or nutritional product in the world that can smooth out the immune disorder of lupus erythematosus. Many of the “supplements” and nutritional products are touted as being derived or synthesized from dozens and hundreds of herbs. This is even more harmful from the perspective of lupus. Lupus is inherently allergic and allergies are most contraindicated, and allergies can lead to worsening of the disease and even death. The more ingredients contained in the supplements, the higher the chance of allergies. Therefore, most of the “supplements” and nutritional products are harmful but not beneficial to lupus. Every year, we sadly meet some patients who died or had kidney failure because they were allergic to the marketing products or stopped treatment after taking the marketing products. The distributors themselves are not doctors, and they do not know anything about lupus, but they often cite many vivid cases: someone’s lupus has been cured after taking this nutritional product and stopping the hormone, and so on. Or the salesman himself suffers from lupus erythematosus, which is more convincing. In fact, the nutritional products to which some lupus patients are not allergic do not mean that everyone is not allergic. The most important thing is that the medication is “just right”. The treatment of lupus erythematosus does not lie in the use of expensive drugs, not in imported drugs, not in new drugs, but in the use of just right drugs. Cyclophosphamide and methotrexate are old drugs from the 1950s, but in the late 1980s, the medical profession gained a new understanding of them and they became important weapons for the treatment of autoimmune rheumatic diseases. After a decade of accumulation, doctors were able to use these old drugs more comfortably to treat lupus erythematosus. It has enabled most patients with lupus erythematosus to not only stay alive, but to achieve complete remission of the disease. It is now the most effective drug for lupus erythematosus that is unanimously recognized worldwide. The drugs used to treat lupus erythematosus are all poisons, so the benefits and risks coexist in the treatment process, and there is no positive effect of drugs without side effects. A good doctor will fully weigh the advantages and disadvantages when making decisions on medication, and carefully make the best efficacy of medication according to the needs of the disease and the characteristics of the medication, and control the side effects to the lowest degree, so that the medication is “just right”. Although the medication for lupus is not expensive, sometimes the medication for complementary treatment can be much more expensive. For example, antibiotics can be very expensive when there is a co-infection; gammaglobulin is very expensive for people with poor health; and albumin and plasma transfusions are also very expensive for people with hypoproteinemia. Therefore, when a person is very sick and needs to be hospitalized, the cost of medication is higher. And after the disease tends to improve, most of the drug costs are not high during the long outpatient follow-up treatment.