Systemic Lupus Erythematosus (SLE)

What is SLE?

Systemic lupus erythematosus (SLE) is a in which the immune system wrongly identifies the normal tissues as being “foreign” and attacks it. It is more common in women compared to men. The disease mainly involves the skin, joints and kidneys though involvement of other organs such as lungs, heart and CNS is also seen. If not properly treated and managed, the complications of systemic lupus erythematosus is life threatening.

What are the symptoms of SLE?

The signs and symptoms may vary depending on which organs and systems are most prominently affected. The generalized symptoms includes :

  • Fatigue.
  • Fever.
  • Weight loss.
  • Malaise and lethargy.
  • Hair loss.
  • Mouth sores.
  • Butterfly-shaped skin rash on the face.
  • Lymph node swelling.
  • Joint aches.

Other associated symptoms depending on the organ of involvement includes :

  • Gastrointestinal symptoms: Abdominal pain, nausea and vomiting.
  • Cardiovascular: Cardiac arrhythmias or irregular heart beats, tachycardia.
  • Lung: Difficulty in breathing and coughing up blood, pleuritis.
  • Kidneys: Hypertension and glomerulonephritis.
  • Central nervous system: Headaches, numbness and tingling, personality changes, problems with vision, paralysis.

What causes SLE?

SLE is a disease of the immune system. Since the immune system attacks the body’s own tissues, it is known as an autoimmune disease. The cause of SLE is not known although certain genetic factors are seen to predispose an individual to the condition. Such susceptible individual are seen to develop SLE on interactions with certain environmental factors such as certain foods, chemicals, medicines or ultraviolet light or after certain infections or hormonal changes. Therefore genetics are a predisposing factor and one of the events mentioned above is the trigger. A person is at a higher risk of developing SLE if any person in his family has the disease and women tend to be at a higher risk.

How is SLE treated?

Antinuclear antibody (ANA) testing, CBC, kidney biopsy, chest x-ray and urinalysis help in the diagnosis of SLE. Antithyroid microsomal antibody, antithyroglobulin antibody, direct Coombs’ test, cryoglobulins, ESR, kidney and liver function tests are also of significance. SLE is not a curable disease. Patients with SLE are treated symptomatically and the degree of immune activity is controlled and even suppressed at times.

  • Nonsteroidal antiinflammatory drugs (NSAIDs) are used for symptomatic treatment.
  • Skin rashes can be treated with creams corticosteroid containing creams.
  • Antiemetics such as metoclopramide and anticonvulsant drugs may be necessary in certain patients.
  • Hypertension, kidney problems, heart failure or other manifestations also need to be managed appropriately.

Specific treatment of SLE includes the use of three types of drugs, hydroxychloroquine, corticosteroids and cytotoxic drugs.

  • Mild SLE with no major joint involvement can be treated with hydroxychloroquine and NSAIDs and shows good improvement of symptoms.
  • More severe cases with symptoms such as fever, oral ulcers, muscle pain or anemia may require addition of a low to moderate dose of oral corticosteroids such as methylprednisolone. Patient with severe involvement of heart, lungs, CNS and kidney and during life-threatening situations higher doses of corticosteroids and cytotoxic drugs such as azathioprine are used.
  • Higher doses of corticosteroids may develop severe side effects and the patient requires close monitoring.
  • Use of cytotoxic drugs causes side effects on the bone marrow and hence blood counts are carefully monitored during their use.

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