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SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
What
is SLE?
SLE or lupus is a chronic autoimmune disease affecting various organs of the
body including skin, heart, lungs, kidneys, joints and nervous system. When
only the skin is involved, the condition is called discoid lupus. When internal
organs are involved, the condition is called systemic lupus erythematosus (SLE).
Autoimmune diseases are conditions in which the body’s immune system attacks
the body’s own body systems and tissues.
What
is the cause of lupus?
Why the immune system attacks one’s own body systems is still not known.
However, SLE is more common in women (8 times more common then in men). It is
also commonly seen in adults from 20 to 45 years but can affect any age. Genetic
factors, exposure to sunlight in genetically susceptible individuals and even
infection is known to activate the autoimmune disturbance that causes lupus.
Some drugs (drugs such as hydralazine used to treat high blood pressure and
antiepileptic drugs such as phenytoin) are known to cause drug-induced lupus
that usually resolves when the medications are discontinued.
How
does a patient with lupus present?
In patients with discoid lupus, only the skin is involved. The rash usually
is seen on the face and scalp, is red with raised borders and does not itch
or cause pain but scarring may occur leading to permanent hair loss.
Patients with SLE may have low-grade fever, loss of appetite, fatigue, arthritis,
ulcers of the mouth and nose, hypersensitivity of skin on exposure to sunlight.
Serious organ involvement can lead to hepatitis, kidney involvement leading
to leakage of protein in the urine-fluid retention and even kidney failure.
Linings of the lungs and heart may be involved leading to sharp chest pain.
Brain may be involved causing personality changes, thought disorders, weakness
of limbs and even tremors.
A facial rash may develop area the bridge of the nose and affecting the checks
called the “butterfly rash” of lupus. There may be poor circulation
in the fingers and toes with exposure to cold leading to bluish discoloration
and pain.
All these various symptoms may not occur together in a patient but variable
presentations may be seen at different intervals.
How
is lupus diagnosed?
In addition to above clinical presentations, certain blood tests may be done
to diagnose SLE. However, these blood tests always have to be interpreted in
the context of clinical symptoms as no single test establishes the diagnosis
of SLE. In patients with SLE certain abnormal antibodies may be produced (antibodies
are substances that are produced by the immune system of the body to fight infection.
When antibodies attack one’s own body system and tissue, they are known
as autoantibodies). Antinuclear antibodies (ANA), Anti double stranded DNA (ds
DNA) or anti-sm (Smith) antibodies may be present.
In addition, your doctor would advise certain tests to determine the severity
of organ involvement. The doctor selects the appropriate tests individually.
What
is the treatment of SLE?
There is no curative treatment available. The goal of therapy is to decrease
the autoimmune activity in the body and severity of organ damage – Therapy
consists of a combination of medications, rest and patient education.
Those patients with mild symptoms need no treatment or only short courses of
anti-inflammatory medications. Those with severe illness involving internal
organs require high doses of steroids and other medications to suppress body
immune system.
Anti-inflammatory drugs commonly used are NSAIDs such as aspirin, ibuprofen,
etc. Sometimes individual response to NSAIDS may vary and different NSAIDs may
be tried to find the most effective one for the patient. The most common side
effects of the NSAIDs (non-steroidal anti-inflammatory drugs) are gastritis
and stomach ulcers. Hence, they are usually taken with food.
Corticosteroids are helpful when internal organs are involved. However, they
have several side effects and hence are given under a doctor’s guidance
with regular monitoring.
Immuno-suppressive drugs are medicines that suppress the immunity. They are
used in severe diseases. All these medications can seriously depress blood cell
counts and can increase risk of infection and bleeding.
Certain precautions should be taken to prevent flare or aggravation of the disease.
Since UV light may precipitate flare, patients with SLE should avoid sun exposure.
Sunscreen agents and full-sleeved clothing may be useful. Patients with active
disease need rest during periods of active disease. Passive and prescribed exercise
is important during the flares to maintain muscle tone and joint mobility.
Patients with SLE during pregnancy require close observation, as there is increased
risk of miscarriages and flaring up of the disease activity. Patients who have
cardiolipin antibodies or lupus anticoagulant in the blood are at increased
risk of miscarriages and may require blood-thinning medications.
Thus for successful management of SLE, it requires close co-operation between the doctor and the patient.
Last created on 15-12-03
Last updated on18-11-2006