Systemic lupus erythematosus (SLE) is a highly heterogeneous systemic autoimmune disease characterized by multi-organ involvement, recurrent flares, and chronic progression. With advances in diagnostics and therapeutics, SLE management is shifting from disease control toward long-term remission and organ protection. Incorporating recent global evidence and characteristics of the Chinese population, the National Clinical Research Center for Dermatologic and Immunologic Diseases and the Chinese SLE Treatment and Research Group (CSTAR) have developed the Chinese guidelines for the diagnosis and treatment of systemic lupus erythematosus (2025 edition). Centered on a treat-to-target strategy, the guidelines prioritize clinical remission and low disease activity as primary goals, optimizing the use of glucocorticoids, immunosuppressants, biologics, and novel therapies. Key updates include individualized management recommendations for lupus nephritis, multi-organ involvement, and antiphospholipid syndrome, alongside first-ever evidence-based recommendations on vaccination in SLE patients. By integrating large-scale domestic cohort studies and real-world data, this edition provides more precise and actionable guidance, offering significant value for standardizing and improving SLE diagnosis, treatment, and long-term management in China.

Objective:To improve the clinical diagnostic ability of antiphospholipid syndrome (APS) with onset of autoimmune hemolytic anemia (AIHA).Methods:The diagnosis and treatment of one APS patient with AIHA as the initial manifestation were reported and discussed.Results:A young female patient admitted to Peking Union Medical College Hospital on October 15, 2022 suffered from AIHA and persistent lupus anticoagulant (LA) positivity. After being treated with high-dose glucocorticoid, both symptoms and indicators were improved. However, relapses occurred when the glucocorticoid was tapered. Subsequent attempts to combine multiple immunosuppressants and biologics for treatment was ineffective. During the course of the disease, the patient had experienced intermittent intracranial hypertension which was revealed as cerebral venous sinus thrombosis(CVST) by MRV. Laboratory test revealed that antiphospholipid antibodies and antiphospholipid serine/prothrombin antibodies (aPS/PT) were all positive. She was finally diagnosed with APS. After being treated with high-dose glucocorticoids and immunosuppressants, combined with warfarin and aspirin, the patient′s clinical symptoms were significantly improved.Conclusion:AIHA is one of the extra-criteria manifestations of APS. Patients with AIHA and persistent antiphospholipid antibody profiles should be alerted to the possibility of thrombotic events. It is difficult to control APS-CVST-AIHA patients′disease development and recurrence. Early and adequate antithrombotic therapy is essential for improvement of prognosis. Furthermore, some drugs may lead to false positive in LA testing, making aPS/PT a viable alternative method for assessing LA.

Objective To explore the association between disease activity and health utility values(HUV)in patients with rheumatoid arthritis(RA)in China,and to analyze other factors that may affect health utility values,providing a basis for individualized treatment and health management for RA patients.Methods Based on the Chinese Registry of Rheumatoid arthritis cohort,this study included 1 017 diagnosed RA patients.The EQ-5D-3L scale was used to assess the health utility values,while clinical data,disease activity,and potential influencing fac-tors(such as age,gender,and comorbidities)were collected.Tobit regression models were employed to analyze the association between disease activity and health utility values,and to investigate other potential influencing factors.Results The median health utility value for RA patients was 0.78[0.59,0.89].Patients with moderate to high dis-ease activity had significantly lower health utility values as compared to those in remission phase or with low disease activity(median 0.70 vs.0.87,P＜0.001).Tobit regression analysis showed a significant association between disease activity and health utility values(P＜0.001).Additionally,older age,female gender,use of glucocorticoids,and co-morbidity with diabetes were associated with lower health utility values(P＜0.05).Conclusions Health utility values of RA patients are closely related to disease activity,with higher disease activity leading to a significant reduction in health utility values.Early control of RA disease activity may help improve patients' quality of life.

Objective To establish a multi-state Markov model of systemic lupus erythematosus(SLE)for patients in China and to explore the transition rule of organ damage accumulation and possible factors affecting the transition between states.Methods A retrospective cohort study was conducted using the data from CSTAR.The Systemic Lu-pus International Collaborating Clinics/American College of Rheumatology Damage Index(SDI)was divided into five irreversible disease states(SDI=0,1,2,≥3,and death,marked as S0,S1,S2,S3,Death).The R"mstate"package was used for statistical analysis.Results This study included 23 926 cases of SLE patients with cumulative follow-up of 12 030 visits.Among these patients,21 070 patients had no any organ damage at baseline.At the follow-up period,the transition probabilities of organ damage of S0→S1,S1→S2,S2→S3,S3→Death were 7.01％,12.58％,10.64％,and 12.19％,respectively.The multi-state Markov model showed that age,gender,disease dura-tion,SLEDAI score,corticosteroid dosage,and involvement of major organs were associated with the transition of or-gan damage status,each 1 year increased was associated with a 2％～3％increase in risk of damage accumulation risk(P＜0.01).Also,neurological(S0→S 1:HR=1.34;S1 →S2:HR=1.53;S2→S3:HR=1.73),cardiopulmonary(S0→S1:HR=3.66;S 1→S2:HR=1.51;S2→S3:HR=1.52),renal(S0→S 1:HR=1.24)and hematological involvement(S0→S1:HR=1.24)might be the risk factors.Conclusions The probability of organ damage accumulation in SLE pa-tients increases over time.Therefore,in the early stage of the disease,the involvement of important organs needs to be minimized and the treatment strategy should be dynamically adjusted at different stages of treatment.

To identify factors associated with the recurrence of polymyalgia rheumatica(PMR) within one year.

Objective:To improve clinical understanding of secondary antiphospholipid antibody (aPLs) related multiple organ damage in systemic lupus erythematosus (SLE).Methods:A woman of reproductive age, admitted to Peking Union Medical College Hospital in June 2023, presented with recurrent disease manifestation, this case of SLE with secondary APS with multiple systems involvement such as the hematological system, heart valves, and nervous system was reported. The diagnosis and treatment process were discussed and analyzed.Results:A woman of reproductive age presented with recurrent symptoms. Initially, she was clinically diagnosed with idiopathic thrombocytopenic purpura. Over the course of the disease, she subsequently developed chronic renal insufficiency, mitral valve vegetations, and recurrent episodes of acute stroke. Laboratory investigations revealed positivity for antinuclear antibodies and aPLs. Her condition was generally improved after standardized anticoagulation therapy combined with intensive immunosuppressive treatment.Conclusion:In the context of SLE, elucidating whether the mechanisms underlying organ involvement are associated with aPLs is of significant importance for understanding the pathogenesis of the disease and guiding therapeutic strategies.

Objective:To improve clinical understanding of diffuse alveolar hemorrhage (DAH) secondary to antiphospholipid syndrome (APS).Methods:A patient with DAH as the initial symptom and positive for antiphospholipid antibodies (aPLs) was reported, and their clinical characteristics and diagnosis and treatment process were analyzed.Results:A 43 year old male patient presented with "cough and hemoptysis for more than 3 months", and the imaging and bronchoalveolar lavage fluid confirmed DAH. During the course of the disease, there was a decrease in platelets and an increase in inflammatory markers, as well as high titers of various antiphospholipid antibodies. After excluding other potential causes, the final diagnosis was APS secondary DAH. After receiving high-dose glucocorticoid and immunosuppressant, the patient′s condition was relieved, pulmonary lesions were absorbed, platelets recovered, and aPLs titer decreased.Conclusion:For unexplained DAH, it is necessary to further exclude infection and other factors before screening autoimmune diseases. The patient was diagnosed as APS-DAH after actively screening the cause, and the lesion was absorbed after hormone and cyclophosphamide treatment.Early identification of microvascular events is crucial for improving patient prognosis.

Objective:To improve the clinical diagnostic ability of antiphospholipid syndrome (APS) with onset of autoimmune hemolytic anemia (AIHA).Methods:The diagnosis and treatment of one APS patient with AIHA as the initial manifestation were reported and discussed.Results:A young female patient admitted to Peking Union Medical College Hospital on October 15, 2022 suffered from AIHA and persistent lupus anticoagulant (LA) positivity. After being treated with high-dose glucocorticoid, both symptoms and indicators were improved. However, relapses occurred when the glucocorticoid was tapered. Subsequent attempts to combine multiple immunosuppressants and biologics for treatment was ineffective. During the course of the disease, the patient had experienced intermittent intracranial hypertension which was revealed as cerebral venous sinus thrombosis(CVST) by MRV. Laboratory test revealed that antiphospholipid antibodies and antiphospholipid serine/prothrombin antibodies (aPS/PT) were all positive. She was finally diagnosed with APS. After being treated with high-dose glucocorticoids and immunosuppressants, combined with warfarin and aspirin, the patient′s clinical symptoms were significantly improved.Conclusion:AIHA is one of the extra-criteria manifestations of APS. Patients with AIHA and persistent antiphospholipid antibody profiles should be alerted to the possibility of thrombotic events. It is difficult to control APS-CVST-AIHA patients′disease development and recurrence. Early and adequate antithrombotic therapy is essential for improvement of prognosis. Furthermore, some drugs may lead to false positive in LA testing, making aPS/PT a viable alternative method for assessing LA.

Objective:To improve clinical understanding of secondary antiphospholipid antibody (aPLs) related multiple organ damage in systemic lupus erythematosus (SLE).Methods:A woman of reproductive age, admitted to Peking Union Medical College Hospital in June 2023, presented with recurrent disease manifestation, this case of SLE with secondary APS with multiple systems involvement such as the hematological system, heart valves, and nervous system was reported. The diagnosis and treatment process were discussed and analyzed.Results:A woman of reproductive age presented with recurrent symptoms. Initially, she was clinically diagnosed with idiopathic thrombocytopenic purpura. Over the course of the disease, she subsequently developed chronic renal insufficiency, mitral valve vegetations, and recurrent episodes of acute stroke. Laboratory investigations revealed positivity for antinuclear antibodies and aPLs. Her condition was generally improved after standardized anticoagulation therapy combined with intensive immunosuppressive treatment.Conclusion:In the context of SLE, elucidating whether the mechanisms underlying organ involvement are associated with aPLs is of significant importance for understanding the pathogenesis of the disease and guiding therapeutic strategies.