Lupus - Systemic Lupus Erythematosus (SLE)
- What is Lupus - Systemic Lupus Erythematosus?
- Statistics on Lupus - Systemic Lupus Erythematosus
- Risk Factors for Lupus - Systemic Lupus Erythematosus
- Progression of Lupus - Systemic Lupus Erythematosus
- Symptoms of Lupus - Systemic Lupus Erythematosus
- How is Lupus - Systemic Lupus Erythematosus Diagnosed?
- Prognosis of Lupus - Systemic Lupus Erythematosus
- How is Lupus - Systemic Lupus Erythematosus Treated?
- Lupus - Systemic Lupus Erythematosus References
- Drugs/Products Associated with Lupus - Systemic Lupus Erythematosus
What is Lupus - Systemic Lupus Erythematosus?
Systemic lupus erythematosus (SLE) is an autoimmune disorder that may affect many organ systems within the body. In particular it is associated with a distinctive rash and joint pain, however the most potentially serious problems are due to effects on the brain and kidneys.
Statistics on Lupus - Systemic Lupus Erythematosus
SLE occurs worldwide, but racial differences are seen. It is estimated to affect 1 in every 250 African-American women.
There is a female predominance (9:1), and peak age of onset is between 20-40 years.
The disease affects 0.1-0.2% of the population, and is much more common in Africans.
Risk Factors for Lupus - Systemic Lupus Erythematosus
Cause unknown but probably multi-factorial. Factors thought to be involved:
- Genetic: 70% concordance between identical twins and increased incidence of HLA-B8 and HLA-DR3.
- Immunological: antinuclear antibodies are present which are thought to result from polyclonal activation of B cells by an antigenic stimulus (possibly viral). May be associated with impaired T cell regulation and deficiencies in complement.
- Drugs: hydralazine, isoniazid, anticonvulsants and procainamide may cause a mild lupus like syndrome which often resolves with withdrawal of the drug.
- Infection: viral infections may be responsible.
- Hormonal factors: high incidence in women suggest female hormones may modify the immune system.
- Sunlight is an exacerbating factor for the cutaneous (affecting the skin) manifestations in most cases.
Progression of Lupus - Systemic Lupus Erythematosus
SLE usually occurs in episodes, with flares and remissions that may last for long periods of time. In some patients, it may persist as a chronic illness. Generally speaking, if serious complications have not developed by the first few years, they are unlikely to do so.
Symptoms of Lupus - Systemic Lupus Erythematosus
Features typical of SLE include:
- joint pains
- rash that worsens with sun exposure
- mouth ulcers
- hair loss
- urticaria (hives)
There may have been previous problems with pregnancy (multiple miscarriages), or a family history of autoimmune disease such as rheumatoid arthritis.
Other features may include:
- raised blood pressure.
- mouth ulcers.
- dry eyes
- hair loss.
- joint tenderness or swelling.
- signs of fluid in the lungs.
- signs of inflammation of the fibrous sac surrounding the heart (pericarditis).
- protein in the urine.
- scaly red rash in a 'butterfly' distribution over the face and other sun exposed areas.
How is Lupus - Systemic Lupus Erythematosus Diagnosed?
A combination of clinical and physical findings, plus appropriate tests are needed to make a diagnosis of SLE.
Tests may include:
- Blood tests
- Immunological tests
- Urine testing (protein in the urine suggests kidney involvement)
- Biopsy (taking a sample of the skin or kidney to look for abnormalities)
- MRI scan to look for involvement of the brain.
Prognosis of Lupus - Systemic Lupus Erythematosus
With current treatments, prognosis is good. Survival rates have increased from 50% at five years during the 1950s, to approximately 90% at 10 years presently.
How is Lupus - Systemic Lupus Erythematosus Treated?
Treatment depends on symptoms and severity of the disease.
- NSAIDs - useful for mild disease with arthralgia
- Hydroxychloroquine - mild disease when symptoms cannot be controlled with NSAIDS or for cutaneous disease.
- Corticosteroids - mainstay of treatment. Particularly for moderate to severe disease. Aim is to control disease activity before gradually reducing the dose.
- Immunosuppressives (azathioprine, cyclophosphamide) - usually in combination with corticosteroids for severe disease (e.g. renal or cerebral disease).
- Topical steroids - for discoid lupus. Should also avoid excessive sunlight (suncream and clothing).
Lupus - Systemic Lupus Erythematosus References
- Braunwald, Fauci, Kasper, Hauser, Longo, Jameson. Harrison's Principles of Internal Medicine. 15th Edition. McGraw-Hill. 2001
- Cotran, Kumar, Collins 6th edition. Robbins Pathologic Basis of Disease. WB Saunders Company. 1999.
- Hurst JW (Editor-in-chief). Medicine for the practicing physician. 4th edition Appleton and Lange 1996.
- Kumar P, Clark M. CLINICAL MEDICINE. WB Saunders 2002 Pg 427-430.
- Longmore M, Wilkinson I, Torok E. OXFORD HANDBOOK OF CLINICAL MEDICINE. Oxford Universtiy Press. 2001
Symptoms of This Disease:
Drugs/Products Used in the Treatment of This Disease:
- Azahexal (Azathioprine)
- Endoxan (Cyclophosphamide)
- Methotrexate Injection and Tablets (DBL) (Methotrexate)
- Plaquenil (Hydroxychloroquine)
- Solone (Prednisolone 5mg, 25mg)
|Modified: 7/5/2009||Created: 11/9/2003|
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