Chen Shunle (1932-2021), a renowned specialist in Internal Medicine, served as the former Director of the Rheumatology Department at Renji Hospital.

Introduction

Dedicated to alleviating human suffering, he brought hope to his patients through his medical skill and compassion. A leading authority in China’s rheumatology community, he earned the title “Father of Lupus in China” for his pioneering research. Driven by a childhood dream of becoming a doctor, he worked diligently throughout his life, achieving remarkable success.

The Path to be a Physician Scientist

His first major setback came in junior high when his father died of stomach cancer. Devastated by the loss, Chen Shunle resolved to become a doctor and save lives. From that point on, he dedicated himself to his studies.

In 1951, his dream took its first step when he was accepted to St. John’s University Medical School.

St. John’s University, a prestigious church-affiliated institution in Shanghai, was known for its rigorous curriculum and English-language instruction. Students received comprehensive medical training with extensive lab and clinical practice. Here, Chen thrived, eagerly absorbing medical theory and practical skills.

Chen graduated with honors in 1956, earning a Bachelor of Medicine. He was assigned to Renji Hospital, where he found influential mentors in Professors Huang Mingxin and Jiang Shaoji, two leading figures in internal medicine. Under Professor Huang, his chief mentor, Chen’s clinical and research skills flourished. With Professor Jiang, an expert in digestive diseases, he deepened his expertise in that field.

His career faced a major interruption during the Cultural Revolution when his research was halted. Reassigned to the hospital’s acupuncture group, he studied “acupuncture treatment for asthma.” Chen saw this as an unexpected opportunity to explore the integration of Chinese and Western medicine for immune-related diseases. He pioneered a small-dose acupoint injection technique that achieved positive results, which further sparked his interest in immunology.

After the Cultural Revolution, Chen chose to join the Nephrology Department in 1979, a field closely linked to immunology, where he would work for the next nine years.

The kidneys play a vital role in the immune system, regulating filtration and producing hormones. However, autoimmune diseases can cause the immune system to attack the kidneys, leading to significant damage. During his time in the Nephrology Department, Chen studied the immunology of kidney transplantation, deepening his understanding of these complex interactions.

Focus on Systemic Lupus Erythematosus

In 1979, the establishment of the Shanghai Institute of Immunology, led by Professor Yu Yi, marked a significant step forward for China’s immunology research. As each team defined its focus, Chen Shunle made a clear proposal. He argued that systemic lupus erythematosus (SLE) was the most typical autoimmune disease and, with its poor prognosis due to limited diagnostic and treatment methods, should be a primary research target.

His suggestion received strong support from esteemed professors Huang Mingxin and Jiang Shaoji, cementing SLE as Chen’s research direction. With great dedication, Chen and his team developed clinical diagnostic criteria and treatment plans for SLE, significantly improving patient outcomes and survival rates.

At the time, China was in the early stages of its “Reform and Opening-Up” period, and a significant gap existed between domestic and international medical standards. Chen and his colleagues worked proactively to address critical domestic healthcare needs. As rheumatology was an emerging discipline in China, they faced immense challenges. Unable to rely on established models, they organized their own training classes to involve more doctors and systematically build the country’s capacity for rheumatology research and diagnosis.

The first rheumatology training class in 1982 brought together experts from related fields. Professor Huang Mingxin, a strong supporter, detailed the course’s purpose in its manual, highlighting that rheumatology was a new specialty intersecting internal medicine, immunology, orthopedics, dermatology, and neurology. Through these collaborative discussions, experts from various fields helped define the framework of rheumatology in China, laying a solid foundation for its future.

In the spring of 1982, Shanghai hosted the first National Academic Conference on Rheumatic Diseases. To further accelerate progress and address a severe shortage of professionals and publications, the institute, with the backing of the Chinese Medical Association’s Shanghai branch, launched a city-wide lecture series on rheumatology. Between 1982 and 1984, two systematic series featuring 29 lectures attracted nearly 12,000 participants, playing a crucial role in educating a new generation of physicians across China.

A Journey to Australia: Internationalizing China’s Modern Medicine

In 1982, with the support of his medical association and hospital, Chen Shunle traveled to Australia as a visiting scholar in the Department of Rheumatology at the Royal Melbourne Hospital.

He seized every opportunity to learn, focusing on Western models for establishing and managing rheumatology departments and mastering advanced detection techniques for SLE. His days were rigorous: mornings spent on clinical work and animal experiments, followed by afternoons at the Walter and Eliza Hall Institute (WEHI), Australia’s premier immunology research institution.

Through his relentless effort, Chen earned high praise from his Australian mentors. His work was featured in Australian newspapers, and he was named an Honorary Member of the Australian Rheumatology Association.

Upon returning to China, Chen immediately applied the diagnostic methods he had learned, such as using Hep-2 cells as a substrate for antinuclear antibody testing. In 1988, this project won the Second Prize for Science and Technology Progress from the Shanghai Municipal Health Bureau.

This experience solidified Chen’s belief that while China had a long way to go in medical research, international collaboration was the key to progress. He used the new technology to advance his discipline and cultivate talent. He set a clear requirement for his staff going abroad: to have a clear mission, learn advanced techniques, and return to develop the department and mentor others. He believed that studying abroad was not just about acquiring scientific knowledge but also about engaging in international dialogue to broaden one’s academic perspective.

This philosophy led to a systematic international training program. Young doctors from Renji Hospital’s Department of Rheumatology were sent to study in countries including Australia, the United States, Japan, and the Netherlands. This approach not only deepened their expertise but also broadened their international outlook, enhancing the department’s global reputation and ensuring its work remained at the forefront of medical science.

Assessing Our Resources, Advancing with Resolve

To understand the current situation of systemic lupus erythematosus in China, Chen Shunle, together with Gu Yueying, led the organization of the world’s largest epidemiological study on systemic lupus erythematosus. This study involved 33,668 employees of the Shanghai textile system, applying advanced detection techniques and methodologies learned from Australia, and obtained a series of valuable epidemiological data through careful screening and testing.

This study revealed for the first time the epidemiological characteristics of systemic lupus erythematosus in China. The data showed that the prevalence rate of systemic lupus erythematosus in China was 70 per 100,000 people, with the prevalence rate among women as high as 113 per 100,000 people, approximately 1/1000. Additionally, this study found that patients were predominantly mild to moderate cases. These data provided valuable support for the research and clinical practice of systemic lupus erythematosus in China.

After two years of systematic research and investigation, in June 1986, Chen Shunle was invited to the auditorium of the University of California, Los Angeles (UCLA) in the United States, where he presented to the world the results of his epidemiological survey on systemic lupus erythematosus conducted in China, receiving widespread acclaim and a high reputation globally.

This research allowed China to grasp for the first time the specific incidence rate of systemic lupus erythematosus in the country, breaking foreign misunderstandings and speculations about China’s lupus prevalence rate. The survey data has been widely cited, providing valuable references for global lupus research and treatment.

PMC Combination Therapy

For a long time, the standard treatment for systemic lupus erythematosus (SLE) was a combination of hormones (P) and chloroquine ©. Concerned by the severe side effects of high-dose hormones, Chen sought an alternative. Drawing inspiration from treatments for rheumatoid arthritis, he introduced methotrexate (M), creating the innovative “PMC combination therapy.” This approach significantly reduced the required hormone dosage, effectively controlled mild to moderate SLE, and lowered the incidence of infections and complications like hyperlipidemia and hyperglycemia. The therapy was also cost-effective, reducing expenses related to complications. In 2005, Chen’s team was awarded the First Prize for Shanghai Science and Technology Progress for this achievement.

Beyond therapeutic innovation, Chen insisted on rigorous long-term patient follow-up. By collaborating with statisticians and meticulously analyzing data, his team at Renji Hospital achieved remarkably low rates of serious complications. This success was attributed to Chen’s “tight control” strategy, which emphasized early diagnosis and consistent, careful monitoring. Patients underwent regular check-ups, and any minor relapses were addressed immediately, reducing disease recurrence and exacerbation.

Chen focused not just on controlling the disease, but also on improving patients’ overall quality of life. He championed the “HCP” (Health, Competent, Pretty) concept, a holistic approach to help patients achieve their desires for health, capability, and well-being. He insisted on individualized treatment and patient education, empowering them to fully understand and manage their condition.

Once considered a fatal disease with a 20% survival rate, SLE is now effectively controlled, allowing patients to live and work normally. According to data from Renji Hospital’s Department of Rheumatology, the 15-year survival rate for their patients now exceeds 90%. SLE has transformed from a death sentence into a manageable, chronic condition, restoring confidence and hope to countless patients.

Furthermore, fertility issues for female SLE patients have been significantly improved. Previously, pregnancy often induced or worsened the disease, leading to adverse outcomes. After more than a decade of clinical research, Chen and his team established clear pregnancy guidelines for Chinese SLE patients. As a result, hundreds of female patients have successfully fulfilled their dreams of motherhood, bringing immense hope to the SLE community.

Serving the Public, Reaching the World

In 2000, through years of dedicated work and strong international communication skills, Chen was elected President of the Asia Pacific League of Associations for Rheumatology (APLAR), successfully bringing Chinese rheumatology onto the global stage. His achievements and medical ethics earned him the deep respect of his international peers. One Asian professor, initially distant, became a close friend after getting to know Chen, calling him a “gentleman.”

Domestically, Chen’s team received numerous grants, awards, and honors. In 2009, the SLE research project he led won the Second Prize of the National Science and Technology Progress Award, the first time a rheumatologist in China had received this distinction. This was a powerful recognition of the team’s years of exploration and dedication.

Chen never lost sight of his original mission. He was deeply committed to medical education and public outreach. Through children’s health organizations and public lectures he founded, he continuously popularized medical knowledge, helping more people understand health and contributing to public welfare.

Under Chen’s leadership, the rheumatology team at Renji Hospital created a supportive treatment environment that earned widespread recognition. He integrated medicine and the arts, offering a new perspective on fighting disease. His practice not only improved SLE treatment but also provided new ideas for the entire field of rheumatology.

At 0:30 on January 23, 2021, Dr. Chen Shunle, the “Father of Lupus in China,” passed away at Renji Hospital at the age of 89.

He embodied the ideals of a dedicated physician, demonstrating unwavering commitment throughout his life. His pioneering contributions were instrumental in advancing rheumatology in China, and he set a powerful example for the nation’s medical community. He leaves a lasting legacy, not only in the field of medicine but also as a figure of immense personal integrity and inspiration.

Editor: Chen Qing @ ShanghaiDoctor.cn

Note: Chinese Sources from “The Path of Benevolent Medicine” which was published in 2024. It records 90 important medical figures in the history of Renji Hospital. Yewen Renyi (ShanghaiDoctor.cn) team was one of the major writers of the book and is authorized by Renji hospital to create English version on the website of ShanghaiDoctor.cn