Diagnosis of SLE In 2009, the SLICC revised the ACR classification criteria for SLE. The new criteria include 11 clinical manifestations and 6 immunological indicators, in addition to renal biopsies, and Professor Petri presented some interpretations of the classification criteria: 1. Subacute lupus is less common, but the rash of such patients is very photosensitive. 2. In recent years, seizures and psychotic-like manifestations are less common than before, and other neuropathies are more common, so the neurological manifestations in the SLICC classification criteria have increased to include polyneuritis mononeuritis, myelitis, peripheral neuropathy, and encephalitis. 3, the detection of anti-double-stranded DNA antibodies include immunofluorescence and ELISA, the latter is widely used in the United States because of the convenience and low cost. However, practice has found that its specificity is not ideal, so the immunological standards for this method requires results greater than two times the upper limit of normal values. 4. Some patients may only have positive direct Coomb’s test without hemolytic anemia, so the new standard has added “positive direct Coomb’s test without hemolytic anemia” in addition to hemolytic anemia. Pathogenesis of SLE 1. Susceptibility genes: GWAS studies have identified almost all genes associated with the disease, including HLA-DR/DQ, STAT4, IRF5, etc. 2, immune disorders: mainly focus on the development of immune complexes, abnormal immune signaling and abnormal TLR/IFN1 pathways. Environmental triggers: Currently recognized include ultraviolet light, drugs (especially echinacea and cotrimoxazole), smoking (which may counteract the therapeutic effects of hydroxychloroquine), infections (especially EBV and cytomegalovirus), and environmental pollutants including silicon, mercury, and pesticides. Clinical manifestations of SLE 1. male patients are more likely to have renal involvement and cardiovascular disease: male: female = 2-3:1. 2. different autoantibodies correspond to slightly different clinical manifestations. patients with positive Sm antibodies are more likely to have proteinuria and nephrotic syndrome, and less likely to have hematologic involvement; patients with dsDNA antibodies combined with positive Ro/La antibodies are more likely to have dry syndrome; dsDNA antibodies combined with acl antibodies are more likely to have dry syndrome. Patients with dsDNA antibodies combined with positive Ro/La antibodies are prone to dry syndrome; patients with dsDNA antibodies combined with positive acl/β2GP1 antibodies are prone to thrombosis and less likely to develop pteroidal erythema or discoid erythema. 3, SLE clinical manifestations: including chronic active type and relapsing-remitting type, the former is far more common than doctors think. Studies have found that only 3.4% of patients are in remission, and the average time to remission is only 4.9 years. Treatment of SLE 1. The side effects of hormones and their impact on patients’ health are very significant: 50% of organ involvement is due to hormones in patients taking them for a long time; 6 mg of prednisone per day can increase the risk of cardiovascular disease by 5 times when taken for a long time. Therefore, Prof. Petri strongly recommends to reduce the dose and duration of hormone application as much as possible. 2. Hydroxychloroquine has many benefits for SLE, so it should be used as a basic medication and the patient’s blood concentration should be monitored so that the doctor can understand how the patient is taking the medication and adjust the dose. 3. It is recommended to apply the urine “protein/creatinine” ratio to monitor the changes of lupus nephritis. Central nervous system lupus 1. Lupus myelitis: Professor Petri suggested that lupus myelitis is actually a longitudinal myelitis, involving multiple spinal cord segments, rather than a transverse myelitis. It includes the gray matter type and the white matter type. The gray matter type is characterized by prodromal symptoms such as fever and urinary retention, and requires high-dose hormone therapy. The white matter type is characterized by clinical manifestations such as spasticity and hyperreflexia, and is associated with antiphospholipid antibodies as well as NMO antibodies, and rituximab combined with hormone therapy has certain efficacy. 2, cognitive impairment:Professor Petri pointed out that cognitive impairment is a significant proportion of SLE patients and has serious impact on patients’ employment and so on. The pathogenesis is currently thought to be related to anti-neural tissue antibodies that can cross the blood-brain barrier, but the specific antibodies are unclear. Anti-NR2 antibodies confirmed in animal models do not play a role in the cognitive impairment of SLE in humans. SLE and cardiovascular disease The risk of cardiovascular disease in SLE patients is 2.66 times higher than in healthy controls, yet the results of the “LAPS” study on statin prevention of early atherosclerosis development in SLE patients were a failure. Studies have found that atorvastatin did not prevent coronary calcification, carotid intima-media thickness, or carotid plaque development, and failed to reduce ultrasensitive CRP. studies of Omega 3 found no significant endothelial protection and increased LDL, so the U.S. Food and Drug Administration has issued a warning about the use of Omega 3.