Systemic lupus erythematosus
Systemic lupus erythematosus, also known as SLE, is a chronic autoimmune disease in which the immune system attacks the body’s own organs and tissues. The inflammation caused by the condition can affect numerous body systems. Approximately 1.5 million Americans are living with SLE; however, many more may have the condition without realizing it.
Definition & Facts
A number of different autoimmune diseases fall under the broad definition of lupus, but systemic lupus erythematosus is the most common form of the disease. Other types of lupus include cutaneous lupus, discoid lupus, and drug-induced lupus.
Those most at risk for developing lupus include women, African-Americans, people between the ages of 15 and 45, individuals with a family history of the condition, and those taking medications that can cause lupus-type symptoms as a side effect.
Although it is more common in teens and adults, children can develop lupus. Children with the condition are more likely to experience damage to organs such as the kidneys and heart.
The course and progression of SLE can vary widely from person to person. It is common for patients with SLE to experience episodic remissions and flares where symptoms come and go with no apparent cause. Certain environmental factors may trigger lupus flare ups in susceptible individuals.
Symptoms & Complaints
- Low-grade fever
- Hair loss
- Sensitivity to the sun
- Joint pain, joint stiffness, and joint inflammation
- Shortness of breath
- Impaired memory and confusion
- Dry eyes
- Fingers and toes that turn white during times of stress or when exposed to the cold.
If left untreated, SLE can cause blood clots and inflammation of the blood vessels that can lead to a heart attack or stroke and organ damage.
The exact cause of systemic lupus erythematosus is not known. So far, scientists have not identified a gene associated with lupus; however, it is not unusual for individuals with SLE to have other family members with the condition or other autoimmune diseases. This would suggest a possible genetic predisposition for developing the disease when exposed to certain triggers in the environment.
Exposure to sunlight and other forms of ultraviolet light may cause skin lesions in those with the condition. Some individuals with viral infections, such as hepatitis C, parvovirus infection, cytomegalovirus (CMV) infection, or Epstein-Barr virus can go on to develop SLE. Toxic chemicals such as silica dust and trichloroethylene have been linked to lupus. Smokers are more likely to get lupus and have more severe symptoms than non-smokers.
Medications, including certain blood pressure medications, anti-seizure medications, and antibiotics, can cause lupus-type symptoms that typically resolve once the medication is stopped.
Although hormone therapy and birth control do not cause lupus, they can affect the frequency and severity of symptoms. Women with lupus should talk with their doctor before starting hormone replacement therapy or using birth control containing hormones. It is common for individuals with lupus to experience a flare up after trauma or during times of intense physical or psychological stress.
Diagnosis & Tests
Diagnosing lupus can be difficult since the symptoms can vary with time and from person to person and often mimic other autoimmune diseases. The doctor will perform a physical examination to check for the characteristic butterfly rash on the face, ulcers on the mucous membranes of the nose and mouth, joint swelling and tenderness, hair loss, and any irregularities with heart and lung sounds.
There is not a specific laboratory test to screen for SLE, but several blood tests and a urinalysis can help form a diagnosis. In individuals with SLE, a complete blood count will often show decreased red blood cells suggesting anemia. The erythrocyte sedimentation rate, which looks at how fast red blood cells settle to the bottom of a test tube, may be elevated indicating an inflammatory condition. An antinuclear antibody test will normally be positive, which indicates the body’s immune system has been stimulated. Blood tests may also be used to evaluate liver function and kidney function since these organs are often affected by lupus.
An echocardiogram and chest X-rays may be ordered if the doctor suspects heart or lung involvement. Once diagnosed, most patients with lupus are referred to a rheumatologist who specializes in treating autoimmune disorders and conditions affecting the joints and soft tissues.
Treatment & Therapy
There is no cure for lupus. Treatment is aimed at managing symptoms. Over-the-counter and prescription nonsteroidal anti-inflammatory drugs may be used to reduce swelling and alleviate pain. The antimalarial medication, hydroxychloroquine may help control symptoms.
Corticosteroids do a good job of treating the inflammation associated with lupus; however, long-term use of steroids in high doses can cause significant side effects, including osteoporosis, weight gain, high blood pressure, diabetes, frequent bruising, and a weakened immune system.
Immunosuppressive drugs, such as azathioprine, mycophenolate, methotrexate, and leflunomide can counter the action of the immune system that triggers lupus symptoms; however, they do increase the risk of infection.
Prevention & Prophylaxis
As with any chronic condition, it is important to see a doctor regularly to monitor symptoms and the effectiveness of the treatment regimen. Medications may need to be adjusted periodically based on the current symptoms. Individuals with SLE should try to minimize stress, avoid excessive sun exposure, stop smoking, eat a healthy diet, and get regular exercise to minimize the severity and frequency of their symptoms.
Individuals living with lupus should seek out a strong support system to help them cope with the stress of living with a chronic disease. This may include family members, mental health professionals, and support groups of others who are living with the disease who can provide their insight and share coping mechanisms.