Gu Yueying, Internal Medicine, Professor, Former Director of the Department of Rheumatology at Renji Hospital,Former Deputy Director of the Shanghai Institute of Rheumatology and Immunology

Introduction

Everyone has a melody in their heart, a song that lets them look up at the stars and shine. For some diseases, healing is a long, arduous song.

Dr. Gu Yueying is one of China’s earliest pioneers in the clinical practice and research of rheumatic diseases, a field for which she received the Lifetime Achievement Award from the Rheumatology Branch of the Chinese Medical Association. She has always believed that patients could live better, healthier lives.

“The proudest achievement in my life is saving many patients,” Dr. Gu says, reflecting on her career.

Throughout her life, she has explored, persisted, and broken new ground in rheumatology and immunology, all for a simple dream: “To help more patients escape the torment of rheumatic diseases and reignite the flame of their lives.”

The Path to Medicine

Changzhou, a historic city in Jiangsu province, is where Gu Yueying was born.

“My mother always wanted me to be a doctor,” she recalls. “During the national college entrance exam, I chose medicine without hesitation. I listed Nanjing Medical College as my first choice, was admitted, and embarked on my path in medicine.”

Studying at Nanjing Medical College was challenging. Gu constantly motivated herself, knowing that a strong foundation was crucial. She also valued hands-on clinical practice and was brave enough to attempt any procedure.

“I remember during my fifth-year internship, I was observing an appendectomy. The chief surgeon failed four times to successfully administer the lumbar anesthesia. I noticed his needle placement was incorrect, so I raised my hand and said, ‘Let me try.’ I succeeded on the first attempt, which greatly boosted my confidence.”

After graduating, she began her clinical career, guided by a philosophy of being a capable doctor with noble medical ethics, dedicated to treating patients and saving lives.

“Early in my career, I had the opportunity to help establish the Department of Rheumatology and Immunology.”

Rheumatology and immunology was a new field, pioneered in the West in the 1950s. In China, Professor Huang Mingxin, a renowned internist at Renji Hospital, had the foresight to prepare for its establishment. It wasn’t until early 1980 that Renji Hospital officially founded its Clinical Immunology Research Laboratory, with Huang as consultant, Jiang Shaoji as director, and Chen Shunle as executive deputy director. Around the same time, Professor Zhang Naizheng was also establishing a rheumatology department at Peking Union Medical College.

In early 1980, Gu Yueying joined the new laboratory at Renji Hospital, working on the clinical care and research of rheumatic diseases. Under the leadership of Director Chen Shunle, she worked tirelessly to advance the field of autoimmune diseases in China.

The pioneering stage of a new discipline was arduous. “At that time, there were only three of us: Director Chen, a lab technician, and me. We didn’t have an independent office; we borrowed a corner of the cardiology lab, where we put a desk and a cabinet. This was the origin of our early saying: ‘three people, one table.’ After outpatient services and ward rounds, I would take visiting doctors to the library to work on research. Our first paper, on 50 cases of systemic lupus erythematosus, was written at a long library table in October 1980.”

Throughout the 1980s, she was the department’s only full-time clinician. Occasionally, one or two visiting doctors would rotate through, but when they didn’t, Gu shouldered the responsibilities of a resident, attending, and chief physician. When facing critically ill patients, she made quick decisions and often consulted senior physicians like Zhang Qingyi, Chen Shuxia, and Ouyang Renrong for emergency advice. “Their noble medical ethics, profound knowledge, and rich experience inspired my growth and were models for me to learn from,” Gu says.

“From 1980 to 1997, the department never had dedicated wards,” she explains. “Our patients were housed in beds borrowed from cardiology and gastroenterology. We often had critically ill patients but no on-call doctors. I would manage them before my shift ended and then hand them over to the cardiology on-call team. When a patient was critical, I would stay voluntarily. For the first ten years, I often went home when the night-shift nurses finished. My home phone number was posted on the wall in the cardiology office for emergencies at any time.”

During this decade, Gu sacrificed weekends and holidays with her family, dedicating herself entirely to patient care, research, and education. She continuously enhanced the reputation of Renji’s rheumatology department while forging her own legacy as a leader in the field.

Her Unwavering Mission: Conquering Lupus

The primary research focus at Renji Hospital’s rheumatology department, and for Dr. Gu Yueying herself, has always been systemic lupus erythematosus (SLE).

SLE is an autoimmune disease that can cause severe complications when it affects major organs.

“Lupus disproportionately affects young women,” Dr. Gu explains. “Before the 1990s, a devastating myth persisted: that lupus was a form of ‘blood cancer,’ an incurable disease requiring massive doses of hormones. The stigma was so severe that some young women chose death over treatment. Even in an advanced city like Shanghai, there were two to three suicides by female lupus patients each year.”

Shortly after the department’s founding, Dr. Gu quickly mastered the clinical diagnosis and treatment of SLE and other major rheumatic diseases like rheumatoid arthritis, systemic sclerosis, and Sjögren’s syndrome. To better understand SLE in Chinese patients, she summarized her findings in a 1980 paper, “Clinical and Immunological Manifestations in 50 Cases of SLE.” She followed these patients for 5, 10, and 17 years, and their survival rates were similar to those published internationally, proving that China’s SLE treatment was on par with the West. This research shattered the “blood cancer” myth, giving patients hope and inspiring Chinese rheumatologists to advance the field.

In 1983, to determine SLE’s prevalence in China, the Renji team conducted an epidemiological survey of over 30,000 textile workers in Shanghai. The prevalence rate of 70 per 100,000 matched international figures and remains the only large-scale SLE epidemiological survey of its kind in China. This study was led by Director Chen Shunle and Dr. Lu Guanghua.

Chinese rheumatologists long sought to develop their own diagnostic criteria for SLE. The task was entrusted to Professor Chen Shunle by the national rheumatology society.

In 1986, under Dr. Chen’s direction, Gu Yueying and Dr. Xu Yihua undertook this challenge. They analyzed over 200 SLE patients and 140 patients with other rheumatic diseases, evaluating 70 clinical and immunological indicators. Using computer analysis and expert clinical experience, they formulated 13 diagnostic criteria. The Chinese Medical Association distributed these to 27 top-tier hospitals for verification. The results showed their sensitivity and specificity met or even exceeded the American College of Rheumatology (ACR) criteria. Crucially, the new criteria were more effective for early diagnosis. “The establishment of the Chinese Diagnostic Criteria for SLE, later known as the Shanghai Criteria, solidified Renji Hospital’s leading position in SLE research in China,” Dr. Gu said.

As early as the 1980s, Dr. Gu collaborated with Professor Hong Suying from the obstetrics and gynecology department to manage SLE pregnancies. They guided patients through pre-conception, pregnancy, and delivery, ensuring disease remission. In the 1980s alone, their joint efforts led to the successful births of more than 100 babies, including a pair of twins, with all mothers and infants safe. This broke the taboo that SLE patients could not have children.

For this series of achievements in SLE research, the team of Chen Shunle and Gu Yueying won the Second Prize of the Shanghai Science and Technology Progress Award in 1994 and the Third Prize of the National Science and Technology Progress Award in 1995. Since 1994, she has received a special government allowance from the State Council, a prestigious national honor.

“Later, our department grew systematically, with more and more talent emerging,” Dr. Gu recalls. “For example, Professor Shen Nan studied and worked at UCLA for many years, initially researching the genetics of SLE and later the role of interferons. These became key research directions for us thereafter.”

After 2000, Dr. Gu, using molecular biology and genetics, led graduate students and collaborated with Professor Shen Nan’s team to explore the pathogenesis of SLE, opening new avenues for treatment. In 2002, her team studied lupus susceptibility gene loci on human chromosome 1, a significant step in understanding the genetic mechanisms of SLE. Subsequently, their work on abnormal T-helper cell differentiation in SLE patients won the Shanghai Medical Science and Technology Second Prize in 2003. Furthermore, their research on the genetic pathogenesis and treatment of SLE earned the Second Prize of the Chinese Medical Science and Technology Award and the First Prize of the Shanghai Science and Technology Progress Award in 2005.

“These research achievements are the result of our department’s collective effort and represent significant progress in our basic research capabilities as our team grew,” Dr. Gu said.

Drawing on her extensive clinical experience, Dr. Gu realized early on that SLE treatment required two distinct phases: induction of remission and consolidation maintenance therapy. While the international community had proposed this for other diseases, it had not been widely applied to SLE. Dr. Gu believed it was critical for SLE, allowing patients to achieve remission and then maintain it with low-dose medication, enabling them to live normal lives—studying, working, and having children.

Glucocorticoids, or hormones, are a life-saving treatment for SLE. However, their use was highly controversial. One school of thought, wary of side effects, opposed high-dose pulse therapy for critically ill patients, believing a 1000mg dose was no more effective than 100mg but far riskier. Dr. Gu knew from clinical experience this was false. She argued that in severe lupus crises, such as lupus encephalopathy, a 1-gram, three-day pulse therapy was necessary to save lives.

To convince the wider medical community, Dr. Gu, in 2006, led a national clinical study. She designed the study and led rheumatology departments in 12 top-tier hospitals to observe the efficacy of different hormone doses for lupus encephalopathy. The conclusion was clear: high-dose hormones were highly effective at inducing remission without a significantly increased risk of infection. This large-scale study transformed the understanding of high-dose therapy, reducing fear and establishing a new standard for treating severe SLE in China.

Through years of practice, Dr. Gu became exceptionally skilled in hormone therapy, confidently managing doses from 5mg to 1000mg. At the time, the decision to use high-dose hormones to rescue a critically ill patient in her department rested largely on her shoulders.

Overcoming Cross-Cultural Challenges and Advancing Rheumatology

This research revealed racial differences in the progression and prognosis of Rheumatoid Arthritis (RA) between Eastern and Western patients. Dr. Gu was a key beneficiary of this project, becoming one of the first in China to master the internationally standardized joint assessment system for RA.

Dr. Gu also held unique insights into treating Sjögren’s Syndrome. At a time when the global standard of care was primarily symptomatic management, she argued that a significant portion of cases were progressive. She championed early diagnosis and aggressive treatment with corticosteroids and immunosuppressants to induce remission and prevent deterioration, offering a viable alternative treatment plan.

Dr. Gu also expanded her work into rare immune-mediated diseases. In 2005, she and Ye Shuang published “A Study on Adult-Onset Still’s Disease.” “We now know it’s an autoinflammatory disease,” Dr. Gu remarked, “but in the 80s and 90s, we were unclear what this persistent high fever of unknown origin was. It was only after seeing many cases that we grasped its characteristics.” Her research summarized the disease’s factors, explained its diverse symptoms, and clarified diagnostic criteria.

“My department and I were among the first to research this field,” Dr. Gu stated. She highlighted the dangers of its complications, such as life-threatening hemophagocytic syndrome (HPS) caused by cytokine storms. “Today,” she noted, “the entire rheumatology community has extensive experience in treating it, and poor prognoses are now rare. However, research into its pathogenesis continues.”

Dr. Gu innovatively applied conventional drugs, finding new uses for them and turning them into “miracle drugs” for complex diseases. In her hands, cyclophosphamide (CTX) was a “miracle drug.” Just one month after the U.S. National Institutes of Health (NIH) published a new CTX regimen for lupus nephritis in June 1986, she began applying it in her practice with excellent results. She applied similar pulse therapy to treat systemic sclerosis, leading to softer skin and fading pigmentation. Recognizing its efficacy against vasculitis, she used it to treat Takayasu’s arteritis. In the late 1980s, she even treated three patients with pulmonary arterial hypertension (PAH), a complication of SLE, achieving complete remission.

Dr. Gu also prioritized trialing new drugs, constantly staying abreast of the latest developments. After learning the nephrology department at Huashan Hospital was successfully using “CellCept” (mycophenolate mofetil) for chronic nephritis, she analyzed its pharmacology and became the first in China’s rheumatology community to use it for SLE nephritis. Because it lacks the gonadal toxicity of cyclophosphamide, CellCept has become a frontline treatment for lupus nephritis and is now widely used for other autoimmune diseases.

When the 21st century brought the landmark innovation of biologic agents for targeted RA therapy, Dr. Gu was quick to learn, adopt, and apply the new approach. Working with experts nationwide, she helped develop application guidelines and proposed a crucial viewpoint: “Biologics require deep induction of remission, typically for 1-2 years, before transitioning to a maintenance phase. Premature dose reduction can lead to relapse.” This approach has proven highly effective in clinical practice.

Throughout her career, Dr. Gu’s impact extended beyond her own research. She published numerous academic papers and significantly promoted the clinical application of new knowledge in SLE, helping doctors improve their skills and giving medical students a deeper understanding of autoimmune diseases. She served as editor-in-chief for the rheumatology section of the national “Internal Medicine” textbook for elite medical programs and authored the first edition of the Chinese Medical Association’s guidelines for diagnosing and treating lupus, making profound contributions to medical education in China.