Be aware of personality changes in lupus patients! Last week, I met a young female patient aged about 22 years old with previous lupus, and as soon as she entered the clinic I noticed that she was talking a lot and some of her words made me feel that she was not normal. Her family also thought that this girl had changed a lot and had become bored with her, interrupting her from time to time. I carefully reviewed her labs and found that the indicators of lupus activity were obviously abnormal, such as: complement C3 and C4 were very low, CRP and ESR were obviously abnormal, and immunoglobulins were abnormally elevated. The symptoms included significant hair loss and Raynaud’s phenomenon on both hands. Based on these, I judged that this patient had active lupus and might have combined psychoneurological lesions, and recommended immediate hospitalization. I also repeatedly warned the patient’s parents to pay attention to the need for active treatment after admission, and that the condition should be controlled quickly and could still return to normal. After they were discharged from the clinic, I returned to the nurses’ station in the ward and said that I must reserve a bed for them first. However, when I returned to the ward from the clinic, the patient did not come to the ward to be admitted. There was no phone number left on the visit card. At that time, I was a little disappointed, but more than that, I felt sorry for the girl. She did not come to our department for hospitalization, I really hope that she will either go to the First Affiliated Hospital of Zheng University or to the Provincial People’s Hospital, otherwise I am really worried about her future. Li Songwei of the Rheumatology Department of the First Affiliated Hospital of Henan College of Traditional Chinese Medicine also met a 38-year-old female lupus patient from Yuzhou City this morning. She was considered incurable at the age of 23 due to chronic high fever and urinary and fecal incontinence, but her father was unwilling to give up and borrow money to go to the First Affiliated Hospital of Zhengda for inpatient treatment. However, this patient did not adhere to the medication after discharge, and was very averse to hormones and rarely used other drugs, probably because she was worried about financial problems. This view was proved to be seriously wrong by subsequent experience. lupus nephritis with massive proteinuria appeared in 2007, cerebral infarction in 2010, and venous thrombosis of the right lower extremity was found in 2013. my consultation was invited to the peripheral vascular department of our hospital in early 2015, and it was confirmed that all the above manifestations were due to lupus activity. If the hormones were maintained in small doses at the beginning, it would not have cost much and the disease would have been better controlled, but the disease became more and more serious along the way, and it also cost a lot financially, which was really more than worth the loss and was sadly regrettable. These two examples are to tell us that mild activity in the early stages of lupus must be taken seriously, both by the parents and the patients themselves. In addition, I will summarize the characteristics of neuropsychiatric lupus for your reference: neuropsychiatric lupus (NPSLE) is a more serious complication in patients with systemic lupus erythematosus (SLE), and its clinical manifestations are complex and diverse. 14% to 75% of lupus patients have neuropsychiatric symptoms, ranging from life-threatening stroke and transverse myelitis to subclinical abnormalities in cognitive function, and the neuropsychiatric system The wide range of neuropsychiatric syndromes is one of the important reasons affecting the prognosis of SLE. A domestic research group found that 29.7% of patients developed neuropsychiatric symptoms within 1 year of the onset of SLE (this number may be a bit high and not representative, after all, it is not a nationwide survey), while the remaining patients developed neuropsychiatric symptoms after 1 year of the onset of SLE, reflecting that neuropsychiatric lupus can appear at the beginning of the onset of SLE or at any stage in the course of SLE. The clinical presentation of NPSLE is complex and can be diffuse, focal, or both, with diffuse damage showing functional damage to the cerebral hemispheres without focal symptoms, and focal damage with corresponding localized signs. In 1999, the ACR issued new diagnostic criteria for NPSLE, including 19 clinical subtypes. In this study, 236 patients with NPSLE were collected, and there were 14 subtypes, of which the most common were epileptiform seizures, followed by psychiatric abnormalities, lupus headache, and cerebrovascular lesions. NPSLE is a manifestation of active SLE. 171 patients (72.5%) with NPSLE in this study had a disease activity index greater than 15 and were in the severe active stage of SLE, indicating that the degree of neurological damage and damage to other organs of the body This indicates that the degree of neurological damage and the damage to other organs of the body are basically the same. The basic pathogenesis of NPSLE is not fully understood, but it is generally believed that the damage is caused by diffuse vasculitis and autoantibodies binding to nerve cells. The combination of cyclophosphamide and glucocorticosteroids can exert a synergistic effect, allowing the timely control of active endovasculitis and cerebral neuronal damage, because the two drugs act at different stages of cellular immunity. Cyclophosphamide mainly acts on the immune system and is directed at stem cells, inhibiting their cell differentiation and proliferation, and has no direct effect on effector cells. Therefore, methylprednisolone and cyclophosphamide shock therapy can have a positive effect on the prognosis of severe NPSLE. However, the treatment of NPSLE still faces many problems, such as some patients have poor effect of MP shock therapy, or combined with serious systemic infections, diabetes and hypertension and other diseases are not suitable for MP and CTX shock therapy, the treatment of these patients is very contradictory. Combined herbal treatment can effectively improve the clinical symptoms of patients, such as headache, dizziness, irritability, poor sleep, etc., control the disease as soon as possible and reduce the amount of hormone as much as possible. At the same time, in the early stage when the disease is not serious, it is also possible to control or even eliminate the neuropsychiatric manifestations by combining Chinese herbal medicine without increasing the dosage of hormones. In addition to medication, it is also very important for parents and relatives to show more care and consideration. It is also important to provide more care and consideration to parents, relatives and friends. Participating in outdoor activities, breathing fresh air and maintaining an optimistic attitude can also help to avoid or reduce this manifestation. In fact, most of the patients have recovered very well, got married and had children, and have a happy family as long as they actively cooperate with the treatment.