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Understanding Systemic Lupus Erythematosus (SLE)


Systemic Lupus Erythematosus (SLE), also known as lupus, is an autoimmune disease that can cause joint inflammation and pain, skin rashes, fever, and damage to several vital organs, including the heart, lungs, brain, and kidneys.

What causes SLE?

SLE is an autoimmune disease, meaning a person's body attacks itself. In other words, the person's immune system mistakes his or her own tissues for a foreign pathogen (an organism that causes disease like a bacteria or virus), however, why the body mistakenly does this is currently unknown.

What are the symptoms of SLE?

Each person with lupus has different symptoms, thus, no two lupus cases are alike. In addition, the signs and symptoms may come on suddenly or develop slowly over time, can be mild or severe, and can be temporary or permanent.

Even though the symptoms can vary, the most common symptoms include skin rashes, fatigue, fever, and pain/swelling of the joints. The most serious symptoms occur when there is damage to the vital organs such as the heart, lungs, brain, and kidneys.

Lupus has been defined by the characteristic rash on the facial cheeks and bridge of the nose. It was first described by the thirteenth-century physician Rogerius, who felt the pattern of this rash resembled that of a wolf's bite, thus, the name lupus, the Latin word for wolf.

In addition, the facial rash is also called the "butterfly rash" since it looks like a butterfly with four open wings.

As a direct result of sunlight, a rash can develop in other areas, including the neck, chest, and upper extremities.

Other symptoms of SLE include the following:

  • Malaise (a feeling of uneasiness and discomfort)
  • Chest pain
  • Shortness of breath
  • Dry eyes
  • Mouth ulcers
  • Weight loss (with or without abdominal pain)
  • Swollen lymph nodes
  • Headache
  • Memory loss and confusion

What are the risk factors for developing SLE?

  • Female gender. SLE occurs in females nine times more often than in males. In addition, it most often affects people 15 to 44 years old, so females of childbearing years are at the highest risk.
  • Certain racial and ethnic groups. People of certain racial and ethnic groups have a higher risk of developing lupus, including African Americans, Hispanics/Latinos, Asians, and Native Americans.
  • Genetics. SLE appears to have a genetic component since it has been known to run in families. In addition, people who have a family member with SLE are more likely to develop it, compared to the general population.

How is SLE diagnosed?

Your physician or medical provider will start by taking a history (with emphasis on family history of SLE) and performing a physical exam. However, as every person with SLE has different symptoms, it could prove challenging to make the diagnosis.

Full laboratory tests should be done on a person suspected of having SLE. For example, 50% of people with SLE have coexisting anemia, a condition with a low hemoglobin level in the blood.

An Erythrocyte sedimentation rate or ESR is a good general marker for general inflammatory diseases and is elevated in cases of SLE.

An antinuclear antibody test (ANA) test is the best test for SLE since it is positive in 97% of SLE cases; however, a positive ANA test does not always indicate pathology (disease). Healthy people will have a positive ANA 3% to 15% of the time, while 10 to 37% of healthy people over age 65 will also have a positive ANA.

If the kidney has been affected, a urinalysis will show the presence of proteins or red blood cells.

Imaging studies, including a chest x-ray (CXR), can demonstrate pulmonary damage from infection, inflammation, or fluid in the lung.

Occasionally, an enlarged heart can be visualized on the CXR, and if further evaluation is needed, a special ultrasound of the heart can be ordered, called an echocardiogram. This ultrasound allows the evaluator to see the functioning of the heart since it shows movement in "real-time."

A renal ultrasound can evaluate for any kidney damage.

If more detailed information is needed, other tests can be obtained, such as a computed tomography (CT or CAT) scan or a magnetic resonance imaging (MRI) scan. These scans use computerized images to create three-dimensional viewing.

Can SLE be cured?

As there is no cure for lupus, the treatment involves managing the symptoms and preventing the complications like joint deterioration and vital organ damage.

What medicines can be used to treat SLE?

Nonsteroidal anti-inflammatory drugs (NSAIDs) help with pain and inflammation. They can be taken as over the counter (OTC) or by prescription.

Over the counter NSAIDs include aspirin, ibuprofen (Advil), and naproxen (Aleve). In addition, many prescription NSAIDs are being used today, including Celebrex, Voltaren (diclofenac), Ansaid, Meloxicam, and others. However, use NSAIDs with caution as they can cause ulcers and gastrointestinal bleeding.

Antimalarial medications are used to treat SLE since they reduce the immune system response. They include medicines such as hydroxychloroquine (Plaquenil) and chloroquine (Aralen).

Corticosteroids, such as oral prednisone, are used to treat SLE. However, corticosteroids produce long-term side effects like weight gain, diabetes, high blood pressure, and mental status changes like loss of memory and confusion.

For those that do not respond to meds like hydroxychloroquine or steroids, immunosuppressants such as Methotrexate can help.

Are there lifestyle changes you can make to help prevent complications from SLE?

Yes, there are several lifestyle changes to prevent and treat SLE:

  • Limit sun exposure
  • Use a high SPF sunblock
  • See your physician regularly
  • Exercise
  • Eat healthy
  • Quit smoking cigarettes
  • Get plenty of rest and sleep

Is SLE contagious?

SLE is not contagious. It cannot be passed from one person to another by touch, body fluid, sweat, or aerosol.

Conclusion

SLE is an autoimmune disease, meaning a person's body attacks itself. Unfortunately, there is no cure for lupus, and instead, the symptoms must be managed through medication and lifestyle changes.

Key takeaways

Systemic Lupus Erythematosus is an autoimmune disease, meaning a person's body attacks itself.

Each person with lupus has different symptoms, thus no two cases are alike.

SLE occurs in females nine times more often than in males. Genetics and race also play a role.

Medications including nonsteroidal anti-inflammatory drugs, antimalarial drugs, corticosteroids and immunosuppressants are used to treat the symptoms.

Lupus is not contagious.

References:

Gianoulli, S., Voulgarelis, M., Ziakis, P.D., Tsioufas, A.G. (2006). Anaemia in Systemic Lupus Erythematosus: From Pathophysiology to Clinical Assessment. Ann Rheum Dis.

American College of Rheumatology. Antinuclear Antibodies (ANA).

Cleveland Clinic. Lupus: Symptoms, Causes, Types and Treatments.

Lupus Foundation of America. The History of Lupus.

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