How to take hormones for lupus

Systemic lupus erythematosus (SLE) is a disease that is becoming more and more common in modern society. It is more common in young women. Common symptoms are fever, butterfly rash, joint pain, etc. Once the disease breaks out, it will affect multiple organs in the body, causing damage to multiple parts of the body. Now the main treatment for lupus is hormones. Of course, hormones cannot be taken indiscriminately and must be taken under the doctor's orders. Let's learn about how to take hormones for lupus.

(1) Mild SLE: Short-term topical application of hormones to treat rash, but strong hormonal topical medications should be avoided on the face as much as possible. Once used, they should not exceed 1 week. Low doses of hormones (such as prednisone ≤ 10 mg/day) can relieve symptoms. Professor Chen Shunle from Shanghai proposed the PMC regimen (low-dose hormones, MTX and chloroquine), which is suitable for patients with mild to moderate activity and no obvious visceral involvement. It has significant efficacy and reduces the adverse reactions of infection and Cushing's syndrome.

(2) Severe SLE: Treatment is mainly divided into two stages, namely induction of remission and consolidation therapy. Since the pharmacological effects of different hormone doses have different emphases and the sensitivity to hormones varies among conditions and patients, clinical medication should be individualized.

Generally, the standard dose for severe SLE is prednisone 1 mg/kg body weight, once a day. Two weeks after the condition stabilizes or within 8 weeks of treatment, the dose should be slowly reduced by 10% every 1 to 2 weeks. After the dose is reduced to 0.5 mg/kg body weight per day, the rate of reduction can be appropriately slowed down according to the condition. If the condition permits, the hormone dose for maintenance treatment should be as low as possible below 10 mg/day of prednisone.

During the medication reduction process, if the condition is unstable, the original dose may be temporarily maintained or the dose may be increased or immunosuppressant combination therapy may be added as appropriate. Immunosuppressants such as cyclophosphamide, azathioprine, methotrexate, etc. can be used in combination to induce disease remission and consolidate therapeutic effects more quickly, and avoid serious adverse reactions caused by long-term use of large doses of hormones. In the case of SLE with involvement of important organs, or even lupus crisis, higher doses (≥2 mg/kg body weight per day) or even methylprednisolone (MP) pulse therapy can be used. MP can be used up to 500-1000 mg, once a day, added to 250 ml of 5% glucose, slowly intravenously dripped for 1-2 hours, and 3-5 consecutive days as a course of treatment. The interval between courses is 5-30 days. During the interval and after the pulse therapy, 0.5-1 mg/kg body weight of prednisone should be taken orally every day.

The course of hormone therapy used by SLE patients is relatively long, so attention should be paid to protecting the hypothalamus-pituitary-adrenal axis and avoiding the use of long-acting hormones such as dexamethasone that have a greater impact on this axis.

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