Systemic Lupus Erythematosus (SLE)

Definition

Systemic lupus erythematosus  (SLE) or lupus for short refers to a long term autoimmune inflammatory disease that may affect the skin, kidneys, joints, brain, lungs, and other organs. In SLE, the body’s immune system attacks its own tissues and organs and causes inflammation. SLE affects women more than men. It can affect people of any age, but is more commonly seen in young women.

Symptoms

Symptoms of SLE may come and go. The symptoms may also vary from person to person and largely depend on the body part affected. The generalized and non-specific symptoms include :

  • Swelling and joint pain in joints of the fingers, wrists, hands, and knees
  • Arthritis
  • A ‘butterfly’ skin rash over the cheeks and bridge of the nose
  • Skin rash worsening in sunlight
  • Chest pain upon deep inhalation
  • Tiredness
  • Anemia
  • Nausea
  • Vomiting
  • Hair loss
  • Unexplained fever
  • Sensitivity to sunlight
  • General discomfort or uneasiness
  • Mouth sores
  • Swollen lymph nodes
  • Enlargement of spleen

Symptoms involving the brain and nerves include headache, seizures, numbness, tingling, vision problems and personality changes. When the lungs are affected, there is difficulty breathing and coughing up of blood. Heart symptoms may include abnormal heartbeat rhythms. The digestive symptoms include stomach pain, nausea, and vomiting. Discolored patches of skin and change of skin color in fingers when cold (Raynaud’s phenomenon) are the main skin symptoms. Kidney problems with SLE may present as protein or blood in the urine, high blood pressure, and swelling of the kidneys. SLE can lead to miscarriages in pregnant women.

Causes

In systemic lupus erythematosus, the body’s immune system mistakenly attacks its own healthy tissues. This is a constant process and results in long term inflammation. The underlying cause of SLE is not fully known but there may be a genetic predisposition. In some cases, SLE-like symptoms may come upon after taking some drugs (likeprocainamide, hydralazine, and isoniazid). The symptoms may go away after stopping the drugs. It is an immune mediated drug reaction and not SLE as such. In few cases, however, SLE can be triggered by unknown environmental factors that triggers the disruption of the immune system which remains for life.

Treatment

There is no cure for systemic lupus erythematosus. Treatment aims at controlling the symptoms, avoiding complications and improving the quality of life.

Mild SLE

  • Non-steroidal anti-inflammatory drugs (NSAIDs) are given for arthritis and inflammation of lungs and chest (pleurisy).
  • Corticosteroid ointments or creams are recommended for skin rashes.
  • Anti-malaria drugs (like hydroxychloroquine, chloroquine or quinacine) and low-dose corticosteroids may be given to control skin and arthritis-related complaints.
  • Wearing protective clothing, sunglasses, and applying sunscreen is recommended when in the sun.

Severe SLE

  • Immunosupressants (like azathioprine or oral cyclophosphamide) or cytotoxic drugs (drugs that stop cell growth) or high doses of corticosteroids (prednisone) are recommended to decrease responses of the immune system against the body cells.
  • Preventive heart care, regular osteoporosis screening, and up-to-date immunizations are recommended to patients.

Other SLE cases

  • Pregnant SLE patients are given corticosteroids (prednisone), aspirin, or heparin throughout the second and third trimesters.
  • In SLE affecting the central nervous system, intravenous methylprednisolone and cyclophosphamide is recommended.
  • Mycophenolate mofetil is given to patients with kidney problems.

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