SYSTEMIC LUPUS ERYTHEMATOSUS

General: Systemic lupus erythematosus (SLE), or lupus, is an autoimmune disease where the immune system mistakenly attacks the body’s own tissues.  Lupus causes widespread inflammation that affects several body systems, including the skin, joints, kidneys, heart, lungs, and digestive tract.  Lupus is ten times more common in women, and also more common in African Americans.   The age of onset is commonly between age 15 to 45. 

Causes: The cause of lupus is unknown.  Genetics, environmental triggers, hormones, infections, and stress may play a role in any given individual lupus patient.  Sunlight can trigger skin symptoms. Some medications can cause a lupus-like syndrome that will typically resolve once the medication is discontinued.

Symptoms:  Patients with lupus will usually tend to feel generally unwell.  Many will have vague symptoms like fever, fatigue, weight loss, chest pain, and headaches.  Almost all patients with lupus have joint and muscle pain, with tenderness and swellling.  Also, many patients have vague symptoms of fever, fatigue, and weight loss.  There is a characteristic facial rash that helps confirm a diagnosis of lupus, but the rash is only present in 1/3 of lupus patients. Many patients will have photosensitive skin, where sunlight causes or aggravate rashes. 

Sometimes other autoimmune conditions will coexisit with lupus.  Sjogrens syndrome may produce dry eyes and dry mouth.   Raynauds disease will cause vasospasm, where blood vessels constrict when exposed to cold air or water, causing fingers to turn blue or white.

Dx:  The diagnosis of lupus can be difficult because there is a wide variety of symptoms. Also, there is no single test to confirm the diagnosis in all patients.  The facial “malar” butterfly rash is highly suggestive of lupus.  In patients who have this rash, the skin can be biopsied (remove sample portion of tissue from skin rash and send to lab for analysis).

Blood testing can help diagnose lupus and rule out other conditions.  Testing should include blood cell counts, antibody testing, inflammation markers, kidney tests, and a general rheumatic panel.  There are some antibody test markers in the blood that, when present, can raise suspicion for lupus:  anti- dsDNA, anti-Smith, anti-RNP, and lupus coagulant. Inflammation detectors like erythrocyte sediment rate (ESR) will tend to be extremely elevated.  

Your doctor will gather information from your symptoms, physical examination, and testing and use established criteria to figure out if you have enough features of lupus to confirm the diagnosis.

Treatment:  Hydroxychloroquine is universally helpful for lupus regardless of symptoms and affected body systems.   Corticosteroid tablets or injections may be needed to control inflammation, but always should be minimized.  Immunosuppressant medications can be used, depending on what body systems are showing signs of inflammation.

Medication regimens for lupus are complex because everyone will have a different set of symptoms.  There are specific treatment suggestions for the eyes, heart, lungs, joints.

The medications used for lupus have numerous side effects and must be monitored regularly.  Antibody and inflammatory markers should be tested every few months to check to see if the medications are working.  Regular eye exams are needed for regular use of hydroxychloroquine.  Bone health should be addressed if there is recurrent or long term use of steroid medications. Immunosupressants reduce the function of the immune system, raising infection risk, so immunizations must be kept up to date. 

Self-management:  You can use some specific components  of a clean/healthy lifestyle to help manage lupus.  Eat a healthy diet, get plenty of rest, pace yourself in your physical activities to avoid overuse, and stay out of direct sunlight as much as possible.  Meanwhile, awareness can be very helpful- learn to tell early when a flare-up is coming so that you can prepare to rest and give yourself as much support as possible.