Professor Yang mentioned that he was once offered a high price for a treatment plan for lupus erythematosus. Professor Yang laughed and said that there was no way he could earn that money. There were also patients who asked Professor Yang to give them a plan so that they would not have to go back and forth because their homes were far from the hospital and it was difficult to come back for registration and consultation. But Professor Yang still could not meet the patient’s request. ”Why I refuse to give the patient a treatment plan? It’s not that I am conservative, nor is it that I have a secret ancestral formula that I don’t disclose. Rather, it is because each lupus patient has its own special characteristics that cannot be covered by one plan.” Professor Yang explained. Professor Yang said that there is no one most standard treatment for lupus erythematosus, but rather individualized treatment according to the patient’s condition. The choice of regimen is different according to the severity of the disease, the patient’s physical condition, and his or her sensitivity and tolerance to drugs. Moreover, during the follow-up visits, the treatment plan needs to be evaluated and adjusted according to the patient’s response to treatment. ”When a patient first sees me in clinic, I usually prescribe only a week’s worth of medication, not more.” Professor Yang places great emphasis on seeing how the patient responds to the medication within a week and whether there are any adverse reactions, and then based on the lab results, in order to adjust to the most appropriate combination and dosage of medication for that patient. He recommends that patients start with one outpatient visit a week, 2-3 times in a row, and only after that the interval can be extended appropriately. So patients should always bring their previous outpatient records to their follow-up appointments, and those who have been hospitalized should always bring their discharge summaries. “That way, I know very well how serious the patient’s condition was when he was hospitalized and how he is doing now.” During the hospitalization of lupus erythematosus patients, in addition to induction therapy, there is an important purpose of observing the patient’s sensitivity and tolerance to medications, which lays the foundation for the long outpatient treatment after discharge. Hormones are useful, but not overly dependent Many patients are very reluctant to use hormones, especially some young girls. They worry that long-term use of hormones will make them fat and ugly, and will lead to osteoporosis and femoral head necrosis. Hormones are the basic drugs for the treatment of lupus erythematosus, but the role of hormones is mainly anti-inflammatory and relieves the inflammation in the acute stage. Therefore, the dose of hormone depends on the intensity of inflammatory reaction. Those with intense inflammatory response are based on hormones mainly. Those with predominantly proliferative and fibrotic lesions are based on immunosuppression. According to this idea, the hormone dose for a specific patient is determined individually. In the treatment of lupus erythematosus, hormone is only an anti-inflammatory drug, and immunosuppressant is the palliative drug. Therefore, the treatment of lupus erythematosus should not rely excessively on hormones, but should be based on immunosuppressants. Treatment, just effective is not enough Even for very severe lupus erythematosus, with the use of hormones, some patients will achieve efficacy, and some patients can even achieve complete remission. If immunosuppressants are added, the probability of complete remission is even higher. Patients who are not on immunosuppressants have a higher rate of relapse during the drug reduction process. With immunosuppressants, the disease will be more stable and less likely to fluctuate. Therefore, the treatment of lupus erythematosus should not be satisfied with “effective”, but should pursue “better” efficacy under the premise of drug safety – to make the disease less prone to relapse and less prone to fluctuation after remission. The disease is less likely to come back and fluctuate after remission. According to Prof. Yang, a concept of target treatment should be established for lupus erythematosus, and the goal of treatment is complete remission of the disease. Some conditions are so stubborn that it is difficult to achieve complete remission no matter how much medicine is used, then we should control the disease to low activity as much as possible, so that no organ damage occurs and the patient’s life is not endangered. To achieve this goal, induction therapy (also called attainment therapy) is performed, using the safest, most effective and cheapest method to make the disease gradually improve toward the treatment goal. The lowest dose of medication (even as low as “zero medication”) is used to keep the disease at the target state and not to progress any further. Professor Yang asks lupus patients to have regular follow-ups and lifelong follow-ups. This is because critically ill lupus patients need to be evaluated and their treatment plan adjusted at any time. Severely ill lupus erythematosus patients need to be reviewed for all clinical and laboratory indicators within a short period of time. Patients who are initially discharged from the hospital and initially treated in outpatient clinics usually need to be re-evaluated every 1-2 weeks for the first month and monthly thereafter. After the disease is controlled to a low level of activity, follow-up assessments will be performed every 3 months. After remission, reassessment can be done every 3 to 6 months.