How SLE is treated

  1.General treatment is applicable to all SLE patients. It includes psychological and spiritual support, avoidance of sunlight or ultraviolet radiation, prevention and treatment of infection or other comorbidities, and selection of appropriate exercise according to the condition.  (1) Non-steroidal anti-inflammatory drugs (NSAIDS): for patients with low fever, joint symptoms, rash and pericarditis and pleurisy, but caution for those with hematologic lesions.  (2) Antimalarials: Chloroquine or hydroxychloroquine, effective for rash, hypothermia, arthritis, mild pleuritis and pericarditis, mild anemia and reduced blood white blood cell count and combined with dry syndrome, use with caution in patients with ophthalmia. Long-term use is useful for reducing hormone doses and maintaining remission. The main adverse effects are cardiac conduction disorders and retinal pigmentation, and electrocardiogram and ophthalmologic examination should be performed regularly.  (3) Glucocorticoids: Different doses and dosage forms are used according to the condition. The adverse effects of hormones include Cushing’s syndrome, diabetes mellitus, hypertension, various infections complicated by low resistance, stress ulcers, aseptic osteonecrosis, osteoporosis and growth or stagnation in children.  (4) Immunosuppressants: ① Cyclophosphamide (CTX) is effective against nephritis, pulmonary hemorrhage, central nervous system vasculitis and autoimmune hemolytic anemia. Adverse effects include gastrointestinal discomfort, bone marrow suppression, liver damage, hemorrhagic cystitis, alopecia, amenorrhea and reduced fertility. (ii) Azathioprine is useful orally for autoimmune hepatitis, nephritis, skin lesions and arthritis. Adverse effects include gastrointestinal discomfort, bone marrow suppression, liver damage and allergic reactions. ③Methotrexate (MTX) is effective for arthritis, pluritis and fever when given orally, and needs to be reduced for renal impairment, with occasional adverse reactions of enhanced photosensitivity. ④Cyclosporine A (CSA) is given orally and is currently used mainly for SLE patients who have failed to respond to other drug treatments. ⑤ Vincristine is given quietly, which is effective for thrombocytopenia.  3.Other treatments High-dose immunoglobulin shock and plasma exchange are suitable for patients with severe disease, uncontrolled or intolerable by conventional treatment, or with contraindications.  4.Treatment of lupus nephritis ①Glucocorticoid. ②Immunosuppressants. ③Plasma replacement and immunosorbent therapy. ④High-dose immunoglobulin shock therapy is suitable for those with active LN and immunocompromised combined with infection. ⑤Others such as anticoagulants, systemic lymph node irradiation and traditional Chinese medicine, and dialysis treatment is feasible for renal insufficiency.