Skip to content

Systemic Lupus Erythematosus

July 29, 2008

Systemic Lupus Erythematosus

This disease (SLE) is an autoimmune disease affecting women 10 times more often than men. It is often called the great “imitator” because it can appear in multiple forms and is difficult clinically to detect. Because SLE is an autoimmune disease it is manifested as chronic inflammation(Think ‘inflammatory response’ for those of you who have taken pathophysiology or another biological-life science.) The primary areas of the body that are affected include, but are not limited to: bone, joint, skin, hair, kidneys, lungs, and nervous system. First symptoms are often fever, fatigue, weight loss and a change of skin color of the face (or characteristic butter-fly rash).

Pathophysiology

In a brief and well written statement by the American College of Rheumatology (2004) briefly reviews what happens in a more complex nature in the body, so I will refer to their excellent definition through quotation.
“SLE is an autoimmune disorder which develops when the body’s own immune system, which normally protects against cancers and invading infections, begins to attack the patient’s own tissues (known medically as a “loss of self-tolerance”). This occurs first through the production of “auto-antibodies” (antibodies are immune system cells that attack foreign microbes; auto-antibodies attack a person’s own cells). As the attack continues, other immune system cells join the fight. This leads to inflammation, blood vessel abnormalities (vasculitis) and deposition of immune system cells in organs which causes tissue damage.”

Symptoms
Symptoms vary widely. Most common symptoms include; fever, facial rash, fatigue, weight loss, arthritis symptoms such as joint swelling either bilaterally or unilaterally, myalgia, hair loss, mouth sores, anemia, heat intolerance or easily sunburned, blood clots, pain in the chest muscles or cough, or neurological symptoms like headache, stroke, or seizure.

How it is Diagnosed
It is often diagnosed based on a combination of presenting symptoms and laboratory testing. A blood test called an ANA (Anti-Nuclear Antibody) is done and if positive with symptoms is often considered diagnostic. Blood counts (CBC), SED rates (Erythrocyte sedimentation rate) which is often elevated in inflammation, Rheumatoid factors can be drawn to rule out Rheumatoid arthritis, and specific antibody tests called anti-double strand DNA and anti-smith antibodies can also be drawn. Kidney function (Renal function) is often tested at time of diagnosis and monitored throughout the course of the illness.

Treatment
There is currently no cure for SLE. Treatment course depends on disease severity. For example, mild patients are treated with daily medication called NSAIDS (or non-steroidal anti inflammatory drugs that include high dose naprosyn, Motrin, mobic, etc…). Facial rashes are often treated with steroid creams and sun restriction is encouraged. Patients are also encouraged to avoid increased stress, in all aspects of their lives, as stress can trigger worsening symptoms. As the disease progresses, treatment moves to steroids or oral chemotherapeutic medications. The risks of all medications should be noted. For instance NSAIDS increase the risk of ulcers and gastric bleeding in patients because they interfere with prostaglandin synthesis, which also is a mechanism for creating mucus lining in the gut (actually this risk is drastically increased when antidepressant medication, SSRI’s in particular, are added to NSAIDS… chronically ill patients often have depression with their primary illness). Steroids also bring risk of decreased immune system function (stops the inflammation), which increases the risk of infection or acquiring communicable disease, increase the risk of diabetes and high blood pressure (hypertension).

Support
The news for Lupus is not all bad. The 10 year survival rate is 85%. The rate of survival decreases based on severity of major organ involvement. There are good support groups out there for Lupus. Below are some sights and groups that support SLE patients:

1. S.L.E. Lupus Foundation – An organization that supports research and offers resources to patients. They have an excellent website at: http://www.lupusny.org/.

2. Lupus Foundation of America – A non-profit organization that supports education, research, and support to SLE patients. They also have an excellent website at: http://www.lupus.org/newsite/index.html.

3. The Lupus Research Institute – A non-profit organization supporting SLE research. They can be found at: http://www.lupusresearchinstitute.org/

4. WeHaveLupus.com – An internet website and blog dedicated to patients with SLE. This site is not professional but is quite good at giving the patient perspective of this illness. It can be found at: http://www.wehavelupus.com/

5. American College of Rheumatology – Webpage on Lupus that provides facts and information. It can be found at: http://www.rheumatology.org/public/factsheets/sle_new.asp

6. MedlinePlus Page on Lupus – Information webpage by the NIH on SLE found at: http://www.nlm.nih.gov/medlineplus/ency/article/000435.htm

7. National Institute of Arthritis and Musculoskeletal and Skin disorders – They have a really good Webpage on Lupus with information and links at: http://www.niams.nih.gov/Health_Info/Lupus/default.asp

Advertisements
No comments yet

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: