Systemic lupus erythematosus is an autoimmune disease that involves multiple systems and organs, with complex clinical manifestations and a recurrent disease course. The incidence rate in China is about 75/105, and early detection, early diagnosis and early treatment are especially important for SLE patients because it often damages important organs of the body and even endangers life. What should patients do in the face of SLE? The following are the aspects of early detection, timely diagnosis, reasonable medication and self-care.
I. Early detection
SLE has no conventional first symptoms and facial erythema does not necessarily appear first. If you find the following symptoms, you should go to a rheumatology specialist in time.
(1) Persistent high fever, excluding sepsis, tuberculosis and other infectious diseases; recurrent low fever, excluding infectious diseases, tumors and hematological diseases. 4/5 patients have febrile symptoms.
(2) Raynaud’s phenomenon, manifested as episodes of alternating pallor, cyanosis and flushing of nail beds, fingers and toes. 3/10 patients with SLE may develop Raynaud’s phenomenon.
(3) Oral ulcers, mostly recurrent, are not combined with ophthalmopathy or pubic ulcers.
(4) Young women present with painful multi-joint swelling, either symmetrically or with morning stiffness, but with negative rheumatoid factor and imaging showing no bony destructive changes.
(5) Unexplained pleural, pericardial, and abdominal effusions. Thoracic and peritoneal effusions are also called pleural fluid and ascites.
(6) Unexplained anemia and thrombocytopenia.
(7) Unexplained proteinuria.
II. Prompt diagnosis
If SLE is suspected, the following tests should be done: immunoglobulin quantification, lymphocyte count, blood routine, reticulocyte count, antinuclear antibody, anti-ds-DNA and anti-Sm antibody, urine routine, 24-hour urine protein quantification, lupus cells, lupus anticoagulant substance, syphilis serological test, etc. The presence of decreased lymphocytes, increased immunoglobulins, anti-nuclear antibodies and anti-ds-DNA and anti-Sm antibodies indicate immune dysfunction in the body. Among them, anti-ds-DNA and anti-Sm antibodies are considered as specific antibodies for SLE. Chest X-ray and abdominal ultrasound should be taken if chest and ascites are suspected. The results of the above tests are important references for the diagnosis of SLE. According to the diagnostic criteria of the American College of Rheumatology for the classification of systemic lupus erythematosus, a diagnosis of systemic lupus erythematosus can be made if a person has four or more of the following 11 criteria
(1) Zygomatic erythema
(2) Discoid erythema
(3) Photosensitivity
(4) Oral ulcers
(5) Arthritis
(6) Plasma membrane including pleurisy pericarditis
(7) Renal lesions including proteinuria tubuluria
(8) Neurological abnormalities including convulsions and psychotic-like changes
(9) Hematologic abnormalities including hemolytic anemia leukopenia lymphocytopenia thrombocytopenia
(10) Immunological abnormalities including positive anti-ds-DNA antibodies anti-Sm antibodies lupus cells lupus anticoagulant substances syphilis serologic test
(11) Positive antinuclear antibodies. The details of the above items will be explained by the specialist. After the diagnosis, if there is one or more of lupus nephritis, lupus encephalopathy, acute vasculitis, interstitial pneumonia, hemolytic anemia, thrombocytopenic purpura, massive plasma cavity effusion, etc., it is considered heavy, and vice versa is considered light, and light often has no obvious systemic damage.
Three, reasonable use of drugs
(1) Western medicine treatment. Mild type: non-steroidal anti-inflammatory drugs, can use Celecoxib (celecoxib), 1 time/day, 200-400mg. sulfonamide allergy, active gastrointestinal bleeding is prohibited; small amount of adrenocorticosteroids, prednisone, 15-20mg/day; immunosuppressants, cyclophosphamide, 2mg/kg/day. Hormones and immunosuppressants should be taken under the supervision of a specialist. Heavy type: methylprednisolone, 800-1000 mg/day, add 200 ml of saline, IV drip, after three days, change to prednisone 1 mg/kg/day, and also cyclophosphamide 500-1000 mg/day, add 200 ml of saline IV drip, once a month. Blood leukocytes should be checked before each IV drip of cyclophosphamide, and if the leukocytes are less than 3×109/L, the cyclophosphamide should be stopped or reduced. In addition, heavy patients with co-infection can be combined with immunoglobulin 400mg/kg/day, intravenous drip, for 2-3 days.
(2) Chinese medicine treatment. According to Chinese medicine, the pathogenesis of this disease is internal obstruction of stagnation, involving the five organs. The treatment should be to resolve the stasis and drain the turbidity, I have formulated my own formula: Serpentine 15g Danshen 15g Angelica 10g Zeilan 15g system rhubarb 8g motherwort 20g Weilingxian 15g Fenghuang 20g Plantago 15g Pelargonium 10g. If the stool is thin and soft, remove rhubarb and add Coix Seed 15g; if the heart of the hands and feet is hot with night sweating, add raw earth 15g Dioscorea 15g; if the high fever does not subside, add antelope horn powder 1g Da Qing Ye 15g cold water stone 15g; for those with psychiatric symptoms, add Calamus 10g Yujin 10g Bile South Star 6g; if the face is swollen, the limbs are sunken, vomiting and nausea, the body is cold and awe-inspiring, use the following instead: Gunner’s Pill 15g White Poria 20g Atractylodes 15g Red Peony 15g Cinnamomum 15g Thornbush 10g Fa Hanxia 15g Cao Guo 12g. for those with scanty urination and urinary shutdown, combine with Calcined Longmu 30g Epiphyllum 30g Rhubarb 15g Cao Doumu 15g Decoction Water retention enema.
Fourth, self-care
Pay attention to keep warm, avoid wind and cold, minimize sun exposure, maintain a relaxed mood and avoid exertion. Systemic lupus erythematosus has a long course of treatment and long-term standardized medication should be adhered to. Avoid spicy, greasy, beef, mutton, dog meat and shrimp.