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Systemic lupus Erythematosus

 

Systemic lupus Erythematosus
Introduction:
Systemic lupus Erythematosus (SLE) is a chronic inflammatory disease of unknown cause that can affect the skin, joints, kidneys, lungs, eyes, nervous system, serous membranes of lungs, heart, and abdomen, and other organs.
Women, especially in their 20s and 30s, are affected more frequently. Major causes of fatality include cardiovascular, renal, pulmonary & CNS. Heart attack and coronary disease can happen at young ages. The inflammation can affect virtually any organ, and symptoms are either general or organ specific.

Precipitating factors: Some precipitating factors include:

  • Exposure to the sun, fluorescent lights, or tanning beds.
  • Infections can start SLE or cause it to become worse (relapse).
  • Stress can worsen SLE, particularly mild disease.
  • Surgery can increase SLE activity
  • Pregnancy can cause a relapse or can trigger the first signs and symptoms of SLE.
  • Therapeutic abortions can also induce a relapse.

Sign & Symptoms:
Some are related to the effects of inflammation on whole body and some are organ specific. Whole-body symptoms are like fatigue, fever, and weight loss.

Fatigue is the most common complaint, but in most cases, fatigue is not due to SLE but is due to increased work load, depression, unhealthy habits (smoking, unhealthy diet, an inactive lifestyle, drug abuse), stress, anemia, an underactive thyroid [hypothyroidism], use of certain medications (including prednisone or beta-blockers), inflammatory or infectious disease, fibromyalgia, sleep disturbances, and/or lack of exercise. SLE may be associated with both weight loss and weight gain.

Fever and Joint symptoms is also common early sign of SLE. Many may have skin abnormalities, like butterfly (malar) rash, or scaly (discoid) rash. Hair loss (alopecia) is common, but baldness is not. Many could develop painless mouth ulcers. Rash (photosensitivity) after exposure to UV-B radiation found in sunlight or fluorescent lights can occur in 60 to 100 percent of patients with SLE.

More organ specific symptoms could suggest organ involvement which can have devastating consequences. For example, when SLE affect kidneys, lung, heart, eyes, nervous system or when it affects blood counts.

How to diagnose Lupus?
To accurately diagnose SLE, it is important to consider the current symptoms in the context of the previous medical history. Sometimes patient's disease only affects one organ system.
Some important symptoms could provide clues for the diagnosis, for example:

  • History of joint pain arthritis for more than 3 months.
  • Raynaud’s, or when fingers or toes become pale, numb, or uncomfortable in the cold or stress.
  • History of mouth sores for more than 2 weeks.
  • History of having low blood counts (anemia, low WBC, or low platelet count)
  • History of having rash on cheeks.
  • History of skin break out after being in the sun (not sunburn)
  • History of experiencing pain on deep breath for more than a few days (pleurisy)
  • History of having protein in urine
  • History of excessive hair loss.

How to treat SLE?
Diagnosis of SLE is not based on positive ANA alone and the therapy is not limited to use of steroids.
Although there is no cure for SLE, a variety of treatments can reduce symptoms, limit damage to vital organs, and reduce the risk of recurrence.
Diet and nutrition, exercise, and preventive measures are important therapeutic issues.
Some medications such as Sulfonamides and penicillin (but not the synthetic Penicillins) may cause exacerbations of SLE and should be avoided. Oral contraceptives containing high dose estrogens can cause flares of SLE.

A number of medications are used based on specific organ involvement, including NSAID, Antimalaria, Steroids, Mycophenolate, Cyclophosphamide, and azathioprine. Rituxan is showing some promises.
Effective treatment requires ongoing patient-doctor communication to correctly interpret laboratory tests, alleviate symptoms, prevent and treat relapses, and lessen side effects related to drug therapy.

The prognosis for SLE is case dependent. It can be relatively mild or can significantly impair organ function. Some cases may become a rapidly progressive disease causing severe organ failure and death, and most patients experience periods of relapse.

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