SLE is often in an unstable state, with relapses (activity) alternating with remissions as its clinical characteristics. Therefore, it is very important to prevent relapses and make good self-protection. It has been proved that the prognosis of those who have recurrent relapses due to untimely formal treatment after the disease is poor. The following are some of the main measures for relapse prevention.
I. Early and clear diagnosis and timely and correct treatment
Since SLE is a variety of autoantibodies acting on multiple systems and organs, the clinical manifestations are diverse, which often leads to misdiagnosis. In the early stage, it is easy to be misdiagnosed as rheumatic fever, rheumatoid arthritis, chronic nephritis, nephrotic syndrome, tuberculous pleurisy, hemolytic anemia, thrombocytopenic purpura, pericarditis, myocarditis, psychosis, epilepsy, skin disease and so on. Some patients are examined by multiple hospitals to confirm the diagnosis. The reason for misdiagnosis is often that many doctors do not know enough about the characteristics of multi-system and multi-organ damage of the disease, and only grasp the clinical manifestations of one organ without in-depth understanding of the medical history and detailed physical examination, thus making a one-sided diagnosis. Especially in the early stage, most patients only have fever and arthralgia as their first symptoms, so there are more misdiagnosis of rheumatic fever and rheumatoid arthritis. In order to make early diagnosis, one should be highly alert to the disease, be familiar with the clinical manifestations, and do corresponding examinations as soon as possible after the onset of the disease to realize the possibility of lupus erythematosus. ana is the best indicator for screening systemic lupus erythematosus, almost all patients with lupus erythematosus have positive ana and high titer; anti-double-stranded dna antibody and anti-sm antibody are highly specific for the diagnosis of lupus erythematosus.
It is also very important to adhere to the medication after diagnosis and to follow up regularly for a long time. A comprehensive examination should be conducted every 1-2 months, and the medication dose should be adjusted according to the changes of the disease. When the disease is in remission, the hormone can be gradually reduced or stopped.
Second, avoid triggering factors. Common triggering factors are.
1. sun exposure and ultraviolet radiation.
In people with lupus quality, sunlight or ultraviolet irradiation changes intracellular deoxyribonucleic acid and generates antigenic antibody reactions, prompting lupus attacks. Multiple massive X-ray irradiation or strong electric light irradiation can lead to recurrence of the disease. Some limited discoid lupus erythematosus can become systemic lupus erythematosus or evolve from the chronic to the acute form after exposure to sunlight or irradiation. Therefore, patients with lupus erythematosus should avoid sun exposure, and when it is really difficult to avoid, they should use sunshades, or wear broad-brimmed hats, long-sleeved clothes and pants, and apply sunscreen on their skin, such as 15% para-amino benzoic acid ointment, etc.
2. Cold stimulation.
Lupus patients are most likely to suffer from cold. Cold stimulation can lead to recurrence of the disease, so add or remove clothes at any time when the climate changes or the seasons change, and wear hats and gloves when going out in winter to prevent getting cold.
3. Drug-induced.
Some lupus patients develop the disease obviously related to drugs, such as penicillin, sulfonamides, bactrim, hydrazinpyridazine, procainamide, chlorpromazine, phenytoin sodium, isoniazid, oral contraceptives, etc., which can make lupus patients in remission enter the active phase and laboratory changes.
4. Pregnancy and childbirth.
SLE occurs in women of childbearing age, and their fertility is the same as normal people. However, the patient is pregnant and must be cautious. Because SLE and pregnancy have mutual adverse effects. The incidence of fetal abnormalities in pregnancy is higher in patients with SLE than in the normal population. Miscarriage can occur in the first trimester of pregnancy, especially in patients with active lupus nephritis, where 50% of pregnant women have miscarriage and about 2/3 of pregnant women have preterm delivery or stillbirth. Conversely, pregnancy also has a significant impact on lupus erythematosus, with more than half of patients experiencing exacerbation or relapse of the disease during the last trimester of pregnancy and several months after delivery. Pregnant women with lupus in remission are less likely to have a relapse, while pregnant women with active lupus have a much higher rate of disease progression than those in remission. The most serious effect of pregnancy on SLE is kidney damage. Therefore, married women in the reproductive stage must be guided by specialists as to whether they can get pregnant, when they can get pregnant, what problems they should pay attention to after pregnancy, and what contraceptive measures they should take if they cannot get pregnant.
III. Catching the precursors of SLE relapse in time
The remission and relapse of SLE are two opposing aspects of each other, and the opposing sides can be transformed into each other under certain conditions. We can find, capture and create favorable factors for remission and avoid or eliminate unfavorable factors for relapse. Catching early signs of relapse, early medication and self-protection, and putting out the “fire” without waiting for it to burn. Regular immunologic testing is essential, and patients in remission can be tested for ANA and anti-DNA antibodies every six months to a year if possible. Patients who are in remission can be tested for ANA and anti-DNA antibodies every six months to a year. Patients with varying degrees of change in their indicators within three months prior to relapse can keep their disease from relapsing or get it under control in time if they can adjust their treatment plan. Patients who are not in a position to undergo regular immunological examination can estimate the possibility of relapse by self-perception.
Psychological treatment and encouraging patients to establish confidence to overcome the disease
Psychological treatment is an important part of the treatment of systemic lupus erythematosus. Patients with lupus erythematosus commonly have hair loss and facial rash, plus the side effects produced by long-term use of glucocorticoids, such as obesity, full-moon face, buffalo back and other changes in appearance; long-term disease torture has a great impact on patients’ thoughts and emotions. Young women feel ashamed to see others, have a heavy burden of thought, and even have pessimistic and anorexic feelings. Long-term psychological imbalance is very detrimental to the treatment of the disease.
It is very important to maintain a good mood when you are sick, and it can even play a role that drugs cannot play. Maintaining an optimistic mood, the mental immune function is active, the body’s ability to resist disease is strong, recovery is fast; on the contrary, emotional tension, anxiety, the immune system is low, the internal anti-disease function is not fully mobilized, the disease is lingering, recovery is slow. Psychological tension or bad emotion can trigger the recurrence of lupus erythematosus. A female patient whose condition had been stable for four years felt insomnia, loss of appetite, fatigue, joint pain, followed by relapse symptoms such as proteinuria and poor kidney function after quarreling with her lover for several days. Another male patient had been treated for 5 months after the disease, and various symptoms had been reduced or disappeared, but he lost confidence in the treatment due to anxiety caused by a love loss, and his original symptoms reappeared half a month later. Originally, his disease was mild, and added symptoms such as panic, rapid pulse, shortness of breath, etc., and then treated with drugs, the effect was far less than before. It can be seen that maintaining a good emotional state and maintaining the relative stability of immune function is an important guarantee to avoid relapse and recover early.
According to the characteristics of both the excessive uric acid production type and the low uric acid excretion type, the treatment is carried out according to the principle of primary treatment. Exhibit 3 Consistency 2
Recommendation C. (4) The first choice of treatment for the hypo-uric acid excretion type of hyperuricemia is with a drug that promotes uric acid excretion – benzbromarone tablets. However, for those with low renal function, the use of urea synthesis inhibitors alone or in combination with benzbromarone tablets and purinergics is indicated. The dose of purinol needs to be adjusted according to the renal insufficiency.