Systemic Lupus Erythematosus (SLE)
What is SLE?
SLE is a chronic inflammatory disease that can affect the skin, joints, kidneys, lungs, nervous system, and other organs of the body. Usually, patients have skin rashes and arthritis, as well as fatigue and fever.
Who gets SLE?
SLE affects about 1 in 10,000 people in the world. It is ten times more common in women than men. It most typically develops in women aged between 20 and 40.
What causes SLE?
SLE is a complex disease, and its cause is unknown. In studies of identical twins, when one twin has SLE, the other twin has a 24% chance of developing it. This and other research suggests that genetics plays an important role, but it also shows that genes alone do not determine who gets SLE, and that other factors play a role.
Some of the factors scientists are studying include sunlight, stress, hormones, cigarette smoke, certain drugs, and infectious agents such as viruses. Recent research has confirmed that one virus, Epstein-Barr virus, which causes mononucleosis, is a cause of lupus in genetically susceptible people.
In lupus, the body’s immune system does not work as it should. A healthy immune system produces proteins called antibodies and specific cells called lymphocytes that help fight and destroy viruses, bacteria, and other foreign substances that invade the body. In lupus, the immune system produces antibodies against the body’s healthy cells and tissues. These antibodies, called autoantibodies, contribute to the inflammation of various parts of the body and can cause damage to organs and tissues. The most common type of autoantibody that develops in people with lupus is called an antinuclear antibody (ANA) because it reacts with parts of the cell’s nucleus.
What are the symptoms of SLE?
Patients with SLE can have one or more of the following symptoms:
- Fever, fatigue, and weight loss
- Arthritis lasting for several weeks in multiple joints
- Butterfly-shaped rash over the cheeks or other rashes
- Skin rash appearing in areas exposed to the sun
- Seizures, strokes, and mental disorders
- Blood clots
- Blood or protein in the urine
- Low blood counts (anemia, low white blood cells, or low platelets)
- Sores in the mouth or nose lasting for more than a month
- Loss of hair
How is SLE diagnosed?
Giving the doctor a complete, accurate medical history is critical to the process of diagnosis. This information, along with a physical examination and the results of laboratory tests, helps the doctor consider other diseases that may mimic lupus, or determine if you truly have the disease. No single test can determine whether a person has lupus, but several laboratory tests may help the doctor to confirm a diagnosis of lupus or rule out other causes for a person’s symptoms. Most people with SLE have an antibody called antinuclear antibody in their blood. Another antibody called anti-doubled stranded DNA is a often present in people with SLE.
How can a lupus patient help prevent disease activity?
Periodic increases in disease activity can usually be managed by varying medications. Since ultraviolet light can precipitate and worsen flares, people with systemic lupus should avoid sun exposure. Sunscreens and clothing covering the extremities can be helpful. Abruptly stopping medications, especially corticosteroids, can also cause flares and should be avoided. People with SLE are at increased risk of infections, especially if they are taking corticosteroids or immunosuppressive medications. Therefore, any unexpected fever should be reported and evaluated.
How is SLE treated?
A conservative regimen of physical and emotional rest, protections from direct sunlight, a healthful diet, prompt treatment of infections, and avoidance of aggravating factors are the mainstays of lupus therapy. In addition, for female patients, pregnancy must be planned for times when the disease is under control, and the patient is on allowable medications.
Treatment options include the following:
- Non-steroidal anti-inflammatory drugs (NSAIDs)
NSAID are commonly prescribed to ease joint or muscle pains. Examples of these are ibuprofen, naproxen and diclofenac.
Hydroxychloroquine is often effective at improving skin problems, tiredness and joint pains that are not well controlled by non-steroidal anti-inflammatory drugs.
Steroids reduce inflammation and the dose is usually given as low as possible in order to reduce any side effects from the steroids.
Drugs such as azathioprine, cyclosporine, cyclophosphamide, methotrexate and mycophenolate may be advised if you have severe SLE. These drugs are called immunosuppressive drugs because they work by suppressing the immune system.
What should I do if I have surgery to do?
Surgery may exacerbate the symptoms of SLE. Hospitalization may be required for otherwise minor procedures, and postoperative discharge may be delayed. If it is elective, the surgery should be postponed until lupus activity is under control.
What about immunization in patients with SLE?
Immunizations with killed vaccines have not been shown to exacerbate SLE. Influenza and pneumococcal vaccines are routinely recommended for SLE patients. A patient with lupus should consult her or his doctor before receiving any immunizations, even routine ones.
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