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VERIFIED CONTENTAuthor: lek. Katarzyna Banaszczyk

Systemic lupus erythematosus is an autoimmune disease, classified as a rheumatic disease. Its treatment is typically performed by a rheumatologist. This disease can have a diverse clinical picture, which results from the fact that this disease can affect virtually all systems of our body. What are the symptoms of systemic lupus and how is it treated? Do we have other medical conditions known as lupus?

Systemic lupus erythematosus (SLE)is an autoimmune disease associated with the development of chronic inflammation in the body. The essence of the disease is the formation of immune complexes (complexes) that accumulate in the skin and other organs of the body. Systemic lupus erythematosus can affect many organs of our body - for example, the heart, lungs and kidneys. This disease occurs even 10 times more often in women, and the age of onset is usually 16-55. year of life. The course of the disease is believed to be somewhat milder in the elderly.

Lupus - causes of the disease

The causes of systemic lupus erythematosus are still not fully understood and it is impossible to identify one specific factor responsible for the development of this disease.

The pathogenesis of this disease consists of both genetic factors (including various mutations) and environmental factors (e.g. exposure to UV radiation) and exposure to infectious agents (Epstein-Barr virus, bacterial antigens) .

Systemic lupus erythematosus - skin symptoms of lupus

The most characteristic symptoms of systemic lupus are skin. Skin eruptions occur in up to 80% of patients with systemic lupus. The following may occur in the course of SLE:

  • erythema on the face, taking the shape of a butterfly - erythematous eruptions mainly affecting the cheeks and nose, skin lesions exacerbated by exposure to sunlight. Importantly, other parts of the body that are exposed to the sun may also be involved,
  • skin changes in the form of blisters, lumps - skin eruptions in the course of lupus are not onlyerythematous changes, i.e. intense redness, may also appear lumps above the skin surface or blisters filled with fluid,
  • reticular cyanosis,
  • erosions of the mucosa - they can be located in the oral cavity or nasal cavity,
  • urticarial lesions - typically in the form of blisters,
  • petechiae under the nail plate - it resembles a splinter stuck under the nail, these changes result from the formation of microclots in the blood vessels,
  • psoriasis-like lesions, primarily on the shoulders, neck and chest. These are typically papular changes with a tendency to exfoliate,
  • hair loss, even leading to baldness,
  • skin atrophy, scars, discoloration and discoloration after skin eruptions.

Systemic lupus erythematosus - changes in the locomotor system

This disease can also be associated with the appearance of symptoms and abnormalities on the part of the locomotor system, which include:

  • joint pain and arthritis - most often these are hand joints, wrist joints and knee joints - the joints are most often involved symmetrically and typically there is no damage to the articular cartilage and joint destruction. However, we can deal with a subluxation in the metacarpophalangeal joints and with a characteristic elbow deviation in the wrist joints - such deviations are called Jaccoud's arthropathy,
  • myalgia, myositis,
  • inflammation of tendons and other periarticular tissues,
  • osteoporosis,
  • sterile bone necrosis - most often affects the femoral head.

Systemic lupus erythematosus - changes in the kidneys

Systemic lupus is a multi-organ disease that can also be associated with kidney involvement. Up to half of SLE patients are involved in kidney involvement.

Kidney damage, called lupus nephropathy in this case, results from a build-up of immune complexes and usually develops in the first two years of the disease. Kidney involvement in this disease may lead to kidney failure.

Systemic lupus erythematosus - changes in the lungs

The respiratory system could be another busy system. In the course of SLE, the following may develop:

  • lupus pneumonia - in its acute form, it can be manifested by shortness of breath, fever, cough, and even hemoptysis. We also distinguish a chronic form of lupus pneumonia, which manifests itself with less severe clinical symptoms - mainly dyspnoea manifested by exercise and a dry cough,
  • lupus pleurisy -most often it is mild and affects the elderly significantly more often,
  • contracted lung syndrome - this abnormality results from the accompanying SLE significant weakening of the respiratory muscles. It manifests itself as a feeling of shortness of breath, and on an X-ray of the lungs it is visible as an elevation of the diaphragm.

Systemic lupus erythematosus - heart and circulatory system

SLE can also affect the cardiovascular system. The most common changes to this layout are:

  • pericarditis and myocarditis - usually asymptomatic,
  • coronary artery disease and myocardial infarction - you should be aware that these diseases are more common in people suffering from systemic lupus erythematosus, atherosclerosis develops earlier than in other people, which results, among others, from from the treatment (steroids), hormonal disorders accompanying the disease, as well as from abnormalities in the kidneys.

Systemic lupus erythematosus - neuropsychiatric disorders

Unfortunately, systemic lupus erythematosus does not spare the nervous system and the psyche of patients. Symptoms and neuropsychiatric disorders that may occur in the course of SLE include:

  • transient ischemic attacks,
  • stroke, both ischemic and haemorrhagic,
  • epileptic seizures,
  • depression,
  • memory and concentration disorders,
  • damage to the peripheral nervous system,
  • rare: psychosis, sterile meningitis, damage to the optic nerve or chorea.

Systemic lupus erythematosus and abnormalities in the digestive tract

In patients with SLE, the disease also does not bypass the gastrointestinal tract. We can deal with the occurrence:

  • swallowing disorders,
  • liver enlargement - which may result from its inflammation caused by immunological reasons,
  • peritonitis,
  • thrombosis of the mesenteric or pancreatic vessels (vascular thrombosis can even lead to necrosis of the intestinal wall due to ischemia).

Systemic lupus erythematosus - diagnosis

The diagnosis of systemic lupus erythematosus is based on the presence of typical clinical symptoms and the results of additional tests, which include:

  • designation of anti-dsDNA antibodies,
  • anti-Sm antibodies,
  • antiphospholipid antibodies,
  • abnormal ANA titre.

These are specialized immunological tests to which a specialist rheumatologist can refer us, but unfortunatelywe will not obtain them from your GP, as they are not included in your primary care basket.

Systemic lupus erythematosus - other laboratory tests

Other laboratory tests that play an auxiliary role are:

  • increase in ESR- Biernacki's reaction - this indicator was once used in the diagnosis of inflammation, but now its importance in this topic has decreased - in the diagnosis of inflammation, the CRP protein is more often used , however, in the diagnosis of rheumatological diseases, OB still plays an important role,
  • peripheral blood count , in which we can notice anemia, decrease in the number of white blood cells (leukopenia), decrease in the number of lymphocytes, i.e. lymphopenia, as well as decrease in the number of platelets,
  • increased serum creatinine and urea levels- may accompany lupus nephropathy and indicate kidney damage,
  • general urine test- the presence of protein in the urine sediment, as well as the presence of erythrocytes (i.e. red blood cells) may indicate kidney damage in the course of systemic lupus.

Systemic lupus erythematosus - treatment

Treatment of systemic lupus erythematosus depends primarily on the form of the disease, its severity, and the body systems involved. The most commonly used medications in SLE are:

  • steroids- basic substances used in the treatment of lupus. They should be used in the smallest effective doses, which allows you to avoid side effects;
  • antimalarial drugs- such as, for example, chloroquine. They can be used together with steroids,
  • immunomodulating drugs- these include cyclophosphamide, azathioprine, mycophenolate mofetil, and cyclosporine. These drugs suppress the activity of the immune system, thanks to which they also reduce autoimmune reaction, i.e. a reaction against your own body, which allows you to reduce the symptoms of the disease,
  • non-steroidal anti-inflammatory drugs (NSAIDs)- they are used in the symptomatic treatment of arthritis and myositis - their action helps reduce inflammation.

Lupus - preventing exacerbations and complications

The course of systemic lupus erythematosus is such that episodes of disease remission (i.e. its silencing) are interspersed with periods of exacerbation. It is worth following a few rules thanks to which we reduce the risk of an exacerbation of this disease. First of all, remember about:

  • avoiding radiation exposuresunny,
  • avoiding drugs that can cause drug-induced lupus - these include, among others:
    • procainamide - anti-arrhythmic drug,
    • hydralazine,
    • penicillamine,
    • dihydralazine,
    • diltiazem,
    • methyldopa - the basic treatment for hypertension in pregnancy,
    • infliximab - a biological drug used, inter alia, in in the treatment of ulcerative enteritis.
  • avoiding infections - the use of steroids and immunomodulating drugs make the lupus patient more likely to develop serious infections. To avoid them, it is worth vaccinating, among others, against influenza, against pneumococci, tetanus and against Haemophilus influenzae type B,
  • leading a he althy lifestyle - avoiding smoking, maintaining a he althy body weight and following a varied, he althy diet.

Systemic lupus erythematosus and pregnancy

It should be emphasized at the outset that systemic lupus itself does not affect fertility, however, it may be associated with he alth risks for the mother and the fetus. Conception should not be planned during the exacerbation of the disease. It happens that pregnancy aggravates the symptoms of the disease.

Drugs that can be continued during pregnancy include:

  • steroids,
  • azathioprine,
  • cyclosporine,
  • chloroquine.

It should be emphasized that the use of cyclophosphamide and mycophenolate mofetil is contraindicated during pregnancy. Importantly, in a situation where the mother has anti-Ro and anti-La antibodies, this may lead to the development of the so-called neonatal lupus in the newborn, which is manifested, among others, by disturbances of the child's heart rhythm in the form of heart blocks.

Breastfeeding in the course of the disease is not contraindicated, however, during lactation, only steroids, chloroquine and non-steroidal anti-inflammatory drugs (NSAIDs) are allowed.

Newborn lupus erythematosus - what is it?

It is worth mentioning that lupus can affect even children from the first day of life. As mentioned earlier, neonatal lupus develops in babies of mothers who have anti-Ro and anti-La antibodies.

These antibodies have the ability to cross the placenta and cause symptoms in newborns. In addition to the heart blocks mentioned above, other neonatal lupus symptoms include:

  • skin lesions of annular erythema,
  • decrease in the number of platelets, leukocytes (white blood cells), anemia,
  • enlargement of the liver and spleen (hepatosplenomegaly).

It should be emphasized that all these symptoms except disordersthe heart-block rhythm passes without treatment. Anti-Ro / anti-La antibodies can also be detected in the serum of the newborn. A child with neonatal lupus erythematosus requires a thorough cardiological diagnosis.

To sum up, systemic lupus erythematosus is a chronic disease that can significantly reduce the quality of life. However, with proper treatment and a he althy lifestyle, the clinical symptoms of this condition can be satisfactorily controlled.

If you develop symptoms that may indicate lupus, it is worth going to your family doctor who, after talking with us and carrying out an examination, will decide whether it is necessary to extend the diagnosis and possibly consult a rheumatologist.

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Immune system