SLE (SYSTEMIC LUPUS ERYTHEMATOSUS)/LUPUS

INTRODUCTION

Systemic lupus erythematosus (SLE) also known simply as lupus, is an autoimmune disease in which the body’s immune system mistakenly attacks healthy tissue in many parts of the body. It can affect almost any organ systems although it mainly involves the skin, joints, kidneys, blood cells and nervous system.

More than 90% of cases of SLE occur in women frequently starting at child bearing age (15 to 45 years).

SIGNS & SYMPTOMS

Patients may present with any of the following signs and symptoms.

Systemic: Weakness, poor sleep quality, poor physical fitness, fever, weight loss, etc.
Muscles & bones: Joints pain, muscles pain, joints inflammation.
Skin: Red or purplish facial rash with a butterfly pattern, skin rashes, or itchiness when exposed to direct sunlight.
Kidneys: Presence of protein in urine, acute kidney diseases, kidney failure due to lupus nephritis.
Neuropathy: Headache, changes in behavior or feelings, abnormal movements, altered levels of consciousness, anxiety, and depression.
Lungs: Excess collection of fluids in lungs, inflammation of lungs tissues, high blood pressure in the arteries of lungs, scarring (fibrosis) of lung tissue.
Heart: Inflammation of heart muscles (myocarditis), inflammation of the lining around the heart (pericarditis), or fluid accumulation around the heart (pericardial effusion).
Blood: Low white blood cell count, low hemoglobin, low platelets count.
Reproductive (pregnancy): It can cause an increased rate of fetal death & miscarriage in pregnancy whose diseases flares up during pregnancy.

CAUSES

SLE is an autoimmune disease which is caused by genetic and environmental factors which results in a defective immune response. It produces antibodies which mistakenly attack our own body cells (auto-antibodies) leading to a situation called auto-immunity.

Drug induced SLE (mimics SLE) generally disappears once the medicine that causes the episodes are stopped. (E.g. isoniazid, phenytoin)

TREATMENTS

Main aims of treatment are:

– to decrease the pain

– to improve the functional status of patients

-to protect the vital organs like kidney, skin, lungs, heart, and brain

– to decrease the chances of miscarriage during pregnancy.

Treatment includes

NSAIDS & Corticosteroids: etoricoxib, naproxen, methylprednisolone, prednisolone for short periods of time only.
Non biological DMARDs: hydroxychloroquine, azathioprine, mycophenolate, cyclosporine, cyclophosphamide.
Biological DMARDs: Rituximab, Belimumab, IV immunoglobulin
Kidney transplantation: treatment of choice for end-stage kidney disease due to complications of lupus nephritis.

DIAGNOSIS

Diagnosis is based on clinical history & blood tests.

Blood test includes: Complete blood count with differential counts, CRP(C-reactive protein), kidney function test, liver function test, erythrocyte sedimentation rate, urine routine examination, spot protein spot creatinine ratio, complement levels.

Autoantibodies test: ANA (Antinuclear antibody), Anti ENA panel (anti extractable nuclear antibodies), Anti dsDNA (anti double stranded DNA) antibodies.

Before planning for pregnancy: Lupus anticoagulant & Anti cardiolipin antibodies (IgG, IgM) is done to rule out the risk of fetal death & miscarriage during pregnancy.

FOLLOW UP

Patients with lupus have to come for follow up as per the doctor’s advice to monitor their disease activity and to monitor the side effects of the medicines. So that doctors can prescribe the medicines according to their disease activities & in case of side effects.

Lifestyle changes: Avoiding direct sunlight as it can worsen the skin symptoms and precipitate flares.

Avoiding activities that can cause fatigue & tiredness.