Systemic lupus erythematosus(SLE) / Lupus

OverviewSystemic lupus erythematosus is a condition of unknown cause that can affect virtually any organ of the body. Systemic lupus erythematosus occurs when the immune system attacks the body because it confuses it for something foreign.

Systemic lupus erythematosus occurs in people with an inherited predisposition when they come into contact with environmental triggers. The potential triggers could be sunlight, infections, and medications (blood pressure medications, anti-seizure medications, antibiotics).

Some of the risk factors for lupus are gender (women), race (African Americans, Hispanics, and Asian-Americans), and age (between 15 and 45).


Symptoms and signs –

  • Fatigue
  • Fever
  • Muscle weakness
  • Weight changes
  • Joint pain
  • Rash on the on cheeks and nose, photosensitivity
  • Raynaud phenomenon – Color changes of the skin of the digits. This change is due to a vascular response to cold temperature or emotional stress.
  • Superficial painless oral and nasal ulcers
  • High blood pressure
  • Chest pain
  • Abdominal pain or food-provoked abdominal discomfort and fullness
  • Early satiety
  • Nausea
  • Cough
  • Shortness of breath
  • Delirium
  • Seizures
  • Psychosis
  • Headache
  • Recurrent miscarriages


Diagnosis of systemic lupus erythematosus –

  • The initial evaluation is based on a careful history and physical exam.
  • The laboratory tests, which may provide diagnostically useful information are a complete blood count and differential, serum creatinine levels, urinalysis, serum protein electrophoresis.
  • The other laboratory tests, which support the diagnosis of SLE if abnormal: Erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) levels, urine protein-to-creatinine ratio, C3 and C4 or CH50 complement levels, antinuclear antibodies, anti-double-stranded DNA (anti-dsDNA), antiphospholipid antibodies.


Disease activity and severity of systemic lupus erythematosus –

  • Raynaud phenomenon.
  • The involvement of blood and blood vessels may lead to anemia and an increased risk of bleeding or blood clotting.
  • Kidney involvement causing kidney damage and kidney failure.
  • Gastrointestinal involvement causing esophagitis, intestinal obstruction, protein-losing enteropathy, hepatitis, acute pancreatitis.
  • Lung involvement leading to inflammation of the chest cavity lining (pleuritis), pneumonia.
  • Inflammation of heart, arteries or heart membrane (pericarditis).
  • Other complications are infections, increased risk of cancer, bone tissue death, and pregnancy complications such as the increased risk of miscarriage, preeclampsia.


Lifestyle management of SLE –

  • Follow a healthy diet and exercise as recommended by your doctor. Exercise helps keep your bones strong and reduces the risk of a heart attack.
  • Ultraviolet light can trigger a flare. Make sure you wear protective clothing, use sunscreen.
  • Do not smoke. Smoking can worsen the effects of lupus.
  • Your doctor may prescribe you vitamin D and calcium which may help keep your bones healthy.


Medical management –

  • Pain, swelling, and fever are treated with over-the-counter nonsteroidal anti-inflammatory drugs such as naproxen, ibuprofen.
  • Hydroxychloroquine to decrease the risk of lupus flares.
  • Prednisone, methylprednisone are often used to control serious disease involvement.
  • Immunosuppressants such as azathioprine, mycophenolate, and methotrexate may be helpful in serious cases of lupus.
  • Biologics such as belimumab may be used to reduce lupus symptoms in some people.
  • Rituximab can be used in resistant cases.

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