Systemic Lupus Erythematosus
Donald Aulds, M.D.
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. Autoimmune diseases are conditions in which the body builds antibodies against its own tissues. The body fails to recognize its own tissues and considers them foreign. Seventy-five percent of all autoimmune diseases occur in women, but when an autoimmune disorder occurs in men, the disease is usually more severe. It is believed that women’s bodies mount more of an immune response when triggered, and the fluctuation of sex hormones with menstrual cycles, pregnancy and use of oral contraception may increase the risk of autoimmune response. The risk can also be increased by environmental factors such as exposure to glutens in wheat and other foods, grass allergies, aspirin sensitivity, and chronic exposure to yeast. Autoimmune diseases include SLE, Sjogren’s syndrome, scleroderma, rheumatoid arthritis, dermatomyositis, diabetes mellitus type I, Hashimoto’s thyroiditis, Addison’s disease, pernicious anemia, vitiligo, autoimmune hemolytic anemia, idiopathic thrombocytopenia purpura, myasthenia gravis, and psoriasis.
SLE can affect any part of the body, but most commonly affected are the heart, joints, skin, lungs, liver, kidneys and nervous system. The course of the disease varies between active disease and remissions. There are several types of lupus which include:
- Drug-induced lupus erythematosus – a form brought on by certain medications
- Lupus nephritis – an inflammation of the kidney caused by SLE
- Subacute cutaneous lupus – a non-scarring form aggravated by exposure to sunlight
- Discoid lupus erythematosus – a skin disorder of red, raised lesions
- Neonatal lupus – a rare disease affecting babies born to women with lupus. It is believed to be caused by the crossing of maternal antibodies across the placenta.
What are the symptoms of lupus?
SLE has often been referred to as “the great imitator” since its symptoms are often mistaken for other illnesses and because the symptoms come and go very unpredictably. The common symptoms can include:
- Skin changes – occur in over thirty percent of patients with common patterns including malar rash (butterfly rash on face), and discoid lupus (a thick, red scaly patch) and alopecia (loss of hair).
- Musculoskeletal changes – joint pain usually in the small joints of the hands and feet, muscle pain, and tendon pain. It usually does not cause destruction of the joint and only a small number of patients have deformities of the hands or feet.
- Heart patterns – may produce an inflammation of the heart called pericarditis, inflammation of the valves, and atherosclerosis.
- Hematological changes – chronic anemia and iron deficiency, a rise in anticardiolipin antibody, and decreased platelets which are necessary in clotting.
- Kidney and bladder changes – loss of blood and protein in the urine, an inflammation of the kidney called nephritis, renal failure and lupus cystitis.
- Pulmonary changes – inflammation of the lung tissue and pleura (the lining of the chest wall) resulting in pneumonia, pleuritis, pulmonary hypertension, pleural effusion (collection of fluid between the lungs and the chest wall) and bleeding in the lungs.
- Liver – autoimmune hepatitis
- Neurological changes – seizures and psychosis
- Intestinal changes – gastroenteritis, pancreatitis
What tests can be done to help diagnose SLE?
The American College of Rheumatology has established a diagnosis of lupus:
- Anti-nuclear antibody positive (ANA test) – the mainstay of blood test for lupus
- Pleuritis and/or pericarditis present
- Arthritis in two or more joints of the hands and/or feet
- Mouth ulcers or nasopharyngeal ulcers
- Sensitivity to sunlight or UV light
- Kidneys – loss of more than 0.5 grams of protein daily
- Blood – low red blood cell count, low white blood cell count or clotting disorder
- Seizures or psychosis
- Immunologic markers in blood – positive anti-Sm, anti-phospholipid antibody, and a false positive test for syphilis
- Skin rashes – malar rash or discoid lupus patterns
What treatments are available for SLE?
Lupus is a chronic disease with no known cure, so therapy concentrates on control with medications. Common medications can include disease-modifying antirheumatic drugs such as Methotrexate or Plaquenil, immunosuppressant medications such as steroids, pain medications, and non-steriodal anti-inflammatory agents. Avoiding sunlight or using sun protective agents may help with photosensitivity. Weight loss may help in the joint pain.
If you feel that you may have problems with symptoms that are part of the lupus disorder, talk to you doctor for evaluation and testing.