How Would You Deal With These Four Common Complications Of SLE?

Systemic lupus erythematosus (SLE) is a multi-system involved, highly heterogeneous autoimmune disease. The clinical manifestations and immunological abnormalities of multi-system involvement are the main characteristics of SLE. Common complications of SLE include antiphospholipid syndrome, infection and vaccination, cardiovascular disease, and osteoporosis. Different complications have different clinical treatment methods. Here, the editor has sorted out the treatment methods for common complications of SLE, hoping to help your diagnosis and treatment.

1. Antiphospholipid syndrome

When SLE patients have antiphospholipid syndrome, they are stratified according to whether there are high-risk antiphospholipid antibody (aPL) characteristics and previous history of thrombosis/obstetric complications.

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High-risk aPL characteristics refer to patients with positive lupus anticoagulants (2 or more positives, at least 12 weeks apart), two or three positive aPLs, or persistent high titer aPLs. Medium-to-high titer aPL refers to antiphospholipid antibody IgG type>40GPL, or IgM type>40MPL; anti-β2 glycoprotein antibody IgG type or IgM type>99th percentile.

For SLE patients without thrombosis or obstetric complications combined with high-risk aPL characteristics, low-dose aspirin (50-100mg/d) is recommended for preventive treatment; for SLE patients with first thrombosis, warfarin treatment is given, and the INR is adjusted to 2-3, and the treatment time is 3-6 months; for SLE patients with recurrent thrombosis, long-term anticoagulation treatment is recommended.

In terms of SLE fertility management:

For SLE patients with positive aPL but not meeting the criteria of antiphospholipid syndrome, low-dose aspirin (50-100 mg/d) should be used for treatment from the beginning of planned pregnancy and continued throughout the pregnancy, while hydroxychloroquine treatment should be continued; SLE patients with obstetric antiphospholipid syndrome should be treated with low-molecular-weight heparin. The dose of low-molecular-weight heparin and the duration of medication during pregnancy should be individualized according to the clinical characteristics of the patient.

For SLE patients diagnosed with obstetric antiphospholipid syndrome before or in early pregnancy, changes in aPL titers during pregnancy should not be used as a basis for drug dose adjustment or discontinuation.

During the postpartum period, low-molecular-weight heparin treatment should be continued for 6-12 weeks according to the risk factors for thrombosis in SLE patients.

2. Infection and vaccination

Infection has become the leading cause of death in SLE patients in my country. During SLE treatment and follow-up, the possible infection risks should be promptly assessed, including advanced age/frailty, diabetes, kidney involvement, immunosuppressants, use of biologics and hormones, and general preventive measures (including vaccination) should be taken as well as early identification and control of infection through multiple channels.

The principles that SLE patients should follow for vaccination include:

Vaccination should be done when the disease is stable as much as possible;

Vaccination should be done before planned immunosuppressive therapy, especially B cell depletion therapy, and if possible, 2 to 4 weeks before the start of immunosuppressive therapy;

It is recommended to give priority to inactivated vaccines and recombinant protein vaccines, and mRNA vaccines can be selected. Viral vector vaccines are not recommended. When other process vaccines are available, live attenuated vaccines are not recommended;

It is recommended to be evaluated by a specialist before vaccination;

Abnormal immune responses and adverse reactions may occur after vaccination, and it is recommended to be diagnosed and treated under the guidance of a specialist;

It is recommended that SLE patients receive influenza vaccines and pneumococcal vaccines; high-risk SLE patients receive hepatitis A, hepatitis B and herpes zoster vaccines; SLE patients receive human papillomavirus (HPV) vaccines.

3. Cardiovascular disease

SLE patients are at high risk of cardiovascular disease and should regularly assess traditional and disease-related risk factors for cardiovascular disease.

Traditional risk factors include smoking, weight, blood pressure, blood lipids, blood sugar, etc.;

Disease-related risk factors include persistent activity of SLE, prolonged course of disease, medium/high titer aPL, renal involvement (especially persistent proteinuria and/or glomerular filtration rate <60ml/min), and long-term use of hormones;

According to the above risk assessment, corresponding prevention strategies can be adopted, including low-dose aspirin and/or lipid-lowering drugs.

In addition, according to the 2022EULAR guidelines, in SLE patients, lower blood pressure levels are associated with a lower incidence of cardiovascular events, and blood targets should be considered to be controlled at <130/80mmHg. In patients with lupus nephritis, all patients with a urine protein to creatinine ratio >500mg/g or arterial hypertension are recommended to use angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers.

IV. Osteoporosis

Osteoporosis is divided into primary and secondary, the latter caused by diseases and/or drugs that affect bone metabolism. SLE patients who take hormones for a long time are prone to osteoporosis and fractures. Regardless of the hormone dose and the route of administration, it is recommended that all patients who need long-term (≥3 months) hormone treatment should be treated with glucocorticoid-induced osteoporosis (GIOP) for prevention and treatment.

It is recommended that an initial assessment of fracture risk be performed within 6 months after the start of hormone treatment, and patients who continue to receive hormone treatment should be reassessed every 12 months.

Different treatment plans are selected based on the assessment of the condition before initial treatment and the stratification of fracture risk.

In the initial treatment, it is recommended to adjust the lifestyle and supplement calcium and vitamin D for patients with low fracture risk.

In the initial treatment, in addition to supplementing calcium, and vitamin D and adjusting lifestyle, bisphosphonates are recommended as the first choice for patients with moderate and high fracture risks; if bisphosphonates are intolerant, teriparatide, denosumab, and raloxifene can be selected. During the above treatment, if there is pain caused by osteoporosis, calcitonin can be used to relieve pain, and the recommended use period is no more than 3 months. It is not recommended to use calcitonin alone to prevent and treat GIOP.

Follow-up treatment

For adult patients who still need continuous hormone treatment, when the initial anti-osteoporosis treatment is ineffective, such as fractures after ≥18 months of oral bisphosphonate treatment, or a significant decrease in bone density (≥10%/year), it is recommended to switch to other types of anti-osteoporosis drugs (such as teriparatide, denosumab) on the basis of calcium and (active) vitamin D treatment. If oral bisphosphonates are intolerant or poorly compliant, intravenous use of bisphosphonates can be considered.

Adult patients who have stopped hormone therapy: ① If assessed as having a low risk of fracture, anti-osteoporosis drugs can be discontinued, and calcium and (active) vitamin D treatment can be continued; ② If assessed as having a moderate risk of fracture, it is recommended to continue to use calcium, vitamin D and anti-osteoporosis drugs; ③ If assessed as having a high risk of fracture, it is strongly recommended to use anti-osteoporosis drugs in addition to adequate calcium and vitamin D.

Special populations (such as women of childbearing age, patients receiving ultra-high-dose hormone therapy, and organ transplant patients) should choose appropriate GIOP prevention and treatment strategies based on age and fracture risk stratification.

Women of childbearing age: only oral calcium and vitamin D are recommended during pregnancy; for those who have no pregnancy plans and use effective contraceptive measures or are not sexually active, if they are assessed to have a moderate or high risk of fracture, in addition to calcium and (active) vitamin D, oral bisphosphonates are recommended. If there are contraindications to oral bisphosphonates, teriparatide should be selected; while intravenous bisphosphonates and denosumab have potential teratogenic risks during pregnancy, and there is currently a lack of safety data.

Adult patients receiving ultra-high-dose hormone treatment (initial prednisone dose ≥30mg/d or equivalent, cumulative dose >5g per year): bisphosphonates combined with calcium and (active) vitamin D are recommended. If bisphosphonates are not suitable for treatment, other anti-osteoporosis drugs can be selected for treatment according to the patient's age.

Adult patients undergoing organ transplantation: Due to the use of multiple immunosuppressants, the simultaneous use of denosumab may lead to aggravated infection, so denosumab is not recommended at present.

How Does Cistanche Treat Kidney Disease?

Cistanche is a traditional Chinese herbal medicine used for centuries to treat various health conditions, including kidney disease. It is derived from the dried stems of Cistanche deserticola, a plant native to the deserts of China and Mongolia. The main active components of cistanche are phenylethanoid glycosides, echinacoside, and acteoside, which have been found to have beneficial effects on kidney health.

Kidney disease, also known as renal disease, refers to a condition in which the kidneys are not functioning properly. This can result in a buildup of waste products and toxins in the body, leading to various symptoms and complications. Cistanche may help treat kidney disease ase through several mechanisms.

Firstly, cistanche has been found to have diuretic properties, meaning it can increase urine production and help eliminate waste products from the body. This can help relieve the burden on the kidneys and prevent the buildup of toxins. By promoting diuresis, cistanche may also help Reduce high blood pressure, a common complication of kidney disease.

Moreover, cistanche has been shown to have antioxidant effects. Oxidative stress, caused by an imbalance between the production of free radicals and the body's antioxidant defenses, plays a key role in the progression of kidney disease. ies help neutralize free radicals and reduce Oxidative stress, thereby protecting the kidneys from damage. The phenylethanoid glycosides found in cistanche have been particularly effective in scavenging free radicals and inhibiting lipid peroxidation.

Additionally, cistanche has been found to have anti-inflammatory effects. Inflammation is another key factor in the development and progression of kidney disease. Cistanche's anti-inflammatory properties help reduce the production of pro-inflammatory cytokines and inhibit the activation of inflammation mandatory pathways, thus alleviating inflammation in the kidneys.

Furthermore, cistanche has been shown to have immunomodulatory effects. In kidney disease, the immune system can be dysregulated, leading to excessive inflammation and tissue damage. Cistanche helps regulate the immune response by modulating the production and activity of immune cells, such as T cells and macrophages. This immune regulation helps reduce inflammation and prevent further damage to the kidneys.

Moreover, cistanche has been found to improve renal function by promoting the regeneration of renal tubes with cells. Renal tubular epithelial cells play a crucial role in the filtration and reabsorption of waste products and electrolytes. In kidney disease, these cells can be damaged, leading to damaged renal function. Cistanche's ability to promote the regeneration of these cells helps restore proper renal function and improve overall kidney health.

In addition to these direct effects on the kidneys, cistanche has been found to have beneficial effects on other organs and systems in the body. This holistic approach to health is particularly important in kidney disease, as the condition often affects multiple organs and systems. che has been shown to have protective effects on the liver, heart, and blood vessels, which are commonly affected by kidney disease. By promoting the health of these organs, cistanche helps improve overall kidney function and prevent further complications.

In conclusion, cistanche is a traditional Chinese herbal medicine used for centuries to treat kidney disease. Its active components have diuretic, antioxidant, anti-inflammatory, immunomodulatory, and regenerative effects, which help improve renal function and protect the kidneys from further damage. , cistanche has beneficial effects on other organs and systems, making it a holistic approach to treating kidney disease.