Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that occurs when the body’s immune system attacks its own tissues. It affects the joints, skin, kidneys, heart, lungs, brain and blood cells. It is a disease in which periods of calm intersect with periods of exacerbation, which is often manifested by fever, fatigue and inflammation of the joints. Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other conditions.
The most distinct sign of lupus – a facial rash that resembles the wings of a butterfly stretching on both cheeks – occurs in many, but not all cases of lupus. The exact cause is unknown. Some people are born with a predisposition to develop the disease that can be triggered by certain infections, certain medications or sun exposure. The disease is much more common in women. Although there is no cure for lupus, medications can help control symptoms.
Common Causes of Lupus
No one can say with certainty what causes the immune system to turn on the body’s organ systems, but there are strong clues that define the direction of research. Researchers currently believe that a number of factors are involved: genetic, hormonal and environmental.
- Genetic: Evidence shows that genetic factors play a major part in the development of lupus, which tends to run in families. People whose parents or siblings have a higher risk of developing the disease than people in families that do not have lupus. Much research is now directed toward understanding the genes involved in lupus.
- Hormonal: The higher incidence of the disease in women — especially women of childbearing age — suggests that hormones play a role. But research has not uncovered the link yet. The use of hormones to treat lupus is under investigation.
- Environmental factors: Possible triggers in people susceptible to the disease include viruses, stress, diet, environmental toxins and ultraviolet light, but none have been conclusively shown to cause the disease. Anything that stresses the body is suspect.
Types of lupus
There are 4 types:
- Systemic erythematosus lupus (SLE) – the most common form of lupus
- Cutaneous lupus – a form limited to the skin, often due to sun exposure
- Drug-induced lupus – caused by an overreaction to certain drugs. Frequently, the symptoms disappear when you stop taking the medicine.
- Neonatal lupus – a rare condition in which newborns acquire autoantibodies from the mother who has SLE. While damage to the skin, liver and blood cells resolves in 6 months, heart damage (congenital atrioventricular block) may require pacemaker.
Signs and symptoms
Systemic lupus erythematosus is a chronic disease with periods of exacerbation and remission. Signs and symptoms may appear suddenly or develop slowly, may be mild or severe, and may be temporary or permanent. Most people with lupus have a mild illness characterized by episodes – called outbreaks of the disease – when the signs and symptoms worsen for a while, then improve or even disappear completely for a while.
No two cases are alike – there are different manifestations from one patient to another, or to the same patient, from one stage to another. Signs and symptoms depend on the organ or system affected. The most common manifestations are:
- 95% of patients have systemic manifestations: fever, asthenia, weight loss
- 95% musculoskeletal manifestations: arthralgia / myalgia, arthritis, myositis
- Skin manifestations: malarial rash, discoid rash, alopecia, ulcers. Malarial rash is a rash on the face in butterfly wings that includes the cheekbones and the base of the nose that appears after sun exposure (photosensitivity), sometimes long before the disease occurs. The discoid rash consists of a reddish-purple plaque, with a scaly appearance, most commonly located on the face, scalp, neck, sometimes chest.
- Haematological manifestations: Damage to blood cells may or may not cause symptoms, so it is important to have a regular blood count. Patients may have a decrease in the number of red blood cells (anemia, when the patient may have marked fatigue), white blood cells (with the appearance of serious infections) or platelets (cells that help the blood to clot, with the appearance of bleeding and bruising). Antiphospholipid antibodies can also be produced, which increase the tendency for blood clots (thrombi) to form in the veins in the legs, lungs or brain (stroke).
- Neurological manifestations: are rarer and manifest with confusion, depression, convulsions and stroke (rare)
- Cardiac and pulmonary manifestations: lupus is an independent risk factor for atherosclerosis; in addition, inflammation may occur in the sheets that cover the lungs (pleurisy) or the heart (pericarditis) and the heart muscle (myocarditis).
- Renal manifestations: are among the most important in lupus. Kidney damage can become evident when patients with lupus have arthritis, rash, fever and weight loss. Rarely, it can occur when there are no other symptoms of lupus. Kidney disease usually does not cause symptoms until it is in the advanced stages. Kidney failure is one of the leading causes of death in lupus patients. It is important that kidney damage be diagnosed early and treated properly. Early signs may be evident on urine examination.
- Gastrointestinal manifestations: are rarer and consist of intestinal vasculitis, ascites, pancreatitis
- Secondary antiphospholipid syndrome: venous or arterial thrombosis and repeated abortions
- Eye damage: rare in lupus, most commonly (15%) with secondary Sjogren’s syndrome
How to Treat Lupus Dissorder
The treatment will be done by a multidisciplinary team of doctors. Once the patient is diagnosed, the doctor who will coordinate the care is the internist or rheumatologist, who will treat the joint damage in particular. The team will include the following specialists: nephrologist (kidney damage), hematologist (hematology damage), dermatologist (skin damage), neurologist (nervous system damage), cardiologist (heart damage and blood vessels), endocrinologist (gland damage ), pulmonologist (lung damage), etc.
Treatment depends on the severity of the disease, the organs affected, the stage of disease activity and how much daily activity is affected. The treatment is individualized and may change over time. Currently, there is no cure for lupus. Medications and a proper lifestyle can control the symptoms:
The lifestyle includes first of all the knowledge and understanding of the disease, as well as a balanced diet, regular exercise, avoidance of smoking and stress control. It is also important to minimize sun exposure and use sunscreen.
Medications used to treat lupus include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, antimalarials, immunosuppressants and biologic therapies.
Because this is a condition that can change over time and is not always predictable, a critical part of good care is regular checkups:
If the disease is mild, stable: check every 3-6 months
If the disease is severe or there are complications of the medication: more common
The hemoleukogram, creatinine, urine summary, proteinuria (urinary protein / creatinine ratio) are monitored.
If the patient is taking hydroxychloroquine, an annual eye exam is needed to detect any retinal damage.