Systemic lupus erythematosus

Common symptoms of SLE

Clearance deficiency

Germinal centres in a person with SLE and controls (schematic

Micrograph of a histology section

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by the production of autoantibodies and widespread inflammation, affecting multiple organ systems.

Signs and Symptoms

SLE presents with a wide range of signs and symptoms, affecting multiple organ systems. The following sections outline the key manifestations in each system.

Skin

Skin manifestations are common in SLE, with malar rash (butterfly rash) being a classic sign. Other skin manifestations include discoid rash, photosensitivity, and mucosal ulcers.

Muscles and Bones

SLE can cause arthralgias, myalgias, and arthritis. Joint pain is typically non-erosive and affects the small joints of the hands and wrists. Osteoporosis and avascular necrosis can occur in advanced cases.

Blood

SLE often affects the blood, leading to anemia, leukopenia, and thrombocytopenia. Antiphospholipid antibodies may lead to an increased risk of blood clots.

Heart

Cardiac manifestations include pericarditis, myocarditis, endocarditis, and coronary artery disease. SLE patients are at an increased risk of developing premature atherosclerosis.

Laboratory tests

Diagnostic tests for SLE include:

• Complete blood count (CBC)
• Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
• Antinuclear antibody (ANA) test
• Anti-double-stranded DNA (anti-dsDNA) antibodies
• Anti-Smith (anti-Sm) antibodies
• Complement levels (C3 and C4)
• Urinalysis

Diagnostic criteria

The American College of Rheumatology (ACR) and Systemic Lupus International Collaborating Clinics (SLICC) have developed criteria to aid in the diagnosis of SLE. A combination of clinical and immunologic criteria is used to make the diagnosis.

Treatment

Medications

SLE treatment varies based on the severity of the disease and the affected organ systems. Common medications include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, antimalarials (e.g., hydroxychloroquine), immunosuppressive agents (e.g., methotrexate, azathioprine), and biologic therapies (e.g., belimumab).

Lifestyle changes

Lifestyle modifications for SLE patients include sun protection, stress reduction, regular exercise, and a balanced diet.

Kidney transplantation

In cases of severe lupus nephritis, kidney transplantation may be necessary.

Antiphospholipid syndrome

Patients with antiphospholipid syndrome require anticoagulation therapy to reduce the risk of blood clots and associated complications.

Management of pregnancy

Pregnancy in SLE patients requires close monitoring and collaboration between rheumatologists and obstetricians. Preconception counseling and risk assessment are crucial. Treatment adjustments may be necessary to ensure a safe pregnancy.

Prognosis

The prognosis for SLE has improved significantly over the past few decades due to advancements in diagnosis and treatment. However, the disease course varies widely among individuals. Factors that may influence prognosis include disease severity, organ involvement, and response to treatment.

Epidemiology

Ethnicity

SLE is more prevalent in certain ethnic groups, including African Americans, Hispanics, Asians, and Native Americans.

Sex

SLE predominantly affects women, with a female-to-male ratio of approximately 9:1. The onset of the disease often occurs during childbearing years.

Changing rate of disease

The incidence and prevalence of SLE have been gradually increasing, likely due to better diagnostic methods and increased awareness of the disease.

Etymology

The term "lupus" is derived from the Latin word for "wolf," possibly due to the characteristic facial rash resembling a wolf's bite.

Classical period

Descriptions of lupus-like symptoms can be traced back to the writings of Hippocrates in ancient Greece.

Neoclassical period

In the 19th century, the first clinical descriptions of lupus emerged, with the characteristic butterfly rash being recognized by Pierre Cazenave.

Modern period

The 20th century saw significant advancements in understanding the immunologic basis of SLE and the development of diagnostic criteria and targeted treatments.

Research

Current research in SLE focuses on identifying novel therapeutic targets, understanding the genetic and environmental factors that contribute to disease development, and improving patient outcomes through personalized medicine.

Famous Cases

Some notable individuals with SLE include singer Selena Gomez, who underwent a kidney transplant due to lupus nephritis, and journalist and television producer Nellie Bly, who was diagnosed with the disease in the early 20th century.

Frequently asked questions

What are 5 questions to ask if you have lupus?

• a. What lifestyle modifications should I make to manage my SLE?
• b. What are the potential side effects of my prescribed medications?
• c. How often should I follow up with my rheumatologist and other specialists?
• d. What steps can I take to reduce the risk of flare-ups?
• e. What resources are available to help me cope with the emotional aspects of living with lupus?

What should patients with SLE avoid?

Patients with SLE should avoid excessive sun exposure, smoking, excessive stress, and certain medications that may trigger lupus flare-ups (e.g., sulfonamides, penicillamine).

What aggravates systemic lupus erythematosus? Factors that can aggravate SLE include sun exposure, infections, stress, hormonal changes, and certain medications.

How do people cope with lupus? Coping strategies for living with lupus include seeking support from friends, family, and support groups; adhering to prescribed medications and medical advice; maintaining a healthy lifestyle; and developing stress management techniques.

What not to tell someone with lupus? Avoid making dismissive or judgmental comments about their symptoms, telling them that it's "all in their head," or suggesting that they are exaggerating their condition. Be empathetic and offer support.

What not to say to someone with lupus? Avoid minimizing their symptoms or comparing their struggles to those of others. Instead, be understanding and supportive.

What are the challenges of living with lupus? Challenges include managing symptoms and flare-ups, dealing with side effects of medications, coping with the emotional impact of a chronic illness, maintaining a balance between work and rest, and navigating relationships.

Is living with lupus hard? Living with lupus can be difficult due to the unpredictable nature of the disease, the need for ongoing medical care, and the potential impact on daily life.

What snacks are lupus-friendly? Lupus-friendly snacks include fresh fruits, vegetables, whole grains, lean proteins, and low-fat dairy products.

Is SLE classed as a disability? SLE may be considered a disability if it significantly impacts a person's ability to perform daily activities or maintain employment.

What is the most serious manifestation of SLE? Kidney involvement, known as lupus nephritis, can be the most serious manifestation of SLE, potentially leading to kidney failure if left untreated.

What body aches do you get with lupus? Lupus can cause aches in joints, muscles, and connective tissues.

What is the most common complication of SLE? The most common complication of SLE is lupus nephritis, which can lead to kidney damage and renal failure.

See also

• Canine discoid lupus erythematosus in dogs
• List of people with lupus

Systemic lupus erythematosus Resources
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Rheumatologic diseases

Arthritis is often used to refer to any disorder that affects the joints. Rheumatic diseases usually affect joints, tendons, ligaments, bones, and muscles. Rheumatologic diseases usually affect joints, tendons, ligaments, bones, and muscles.

Connective Tissue Diseases

Rheumatology and	Connective Tissue Diseases
Ankylosing spondylitis	Arthritis
Arthritis and Rheumatic diseases	Autoimmune diseases
Autoinflammatory diseases	Behçet’s disease
Bursitis	Giant cell arteritis
Gout	Juvenile arthritis
Knee problems	Lupus
Osteoarthritis	Polymyalgia rheumatica
Psoriatic arthritis	Reactive arthritis
Rheumatoid arthritis	Scleroderma
Sjögren’s syndrome	Systemic lupus erythematosus (Lupus)
Tendinitis	Rheumatologic diseases

Lupus nephritis

• Minimal mesangial glomerulonephritis Class I (Minimal mesangial glomerulonephritis Minimal mesangial glomerulonephritis)
• Mesangial proliferative lupus nephritis Class II (Mesangial proliferative lupus nephritis Mesangial proliferative lupus nephritis)
• Focal proliferative nephritis Class III (Focal proliferative nephritis Focal proliferative nephritis)
• Diffuse proliferative nephritis Class IV (Diffuse proliferative nephritis Diffuse proliferative nephritis)
• Membranous glomerulonephritis Class V (Membranous glomerulonephritis Membranous nephritis)
• Glomerulosclerosis Class VI (Glomerulosclerosis Glomerulosclerosis)