Systemic Lupus Erythematosus is an inflammatory condition that affects many systems including joints, skin, brain, lungs, kidneys, and blood vessels. An autoimmune reaction that attacks the own body causes damage and inflammation in the above-mentioned organs.
Causes for Systemic Lupus
- Hereditary predisposition
- Genetic mutations
- Effects of sex hormones- females in premenopausal period are more prone to get the disease
- Drugs – some drugs given for illnesses as Procainamide, Isoniazid, Hydralazine
- Ultraviolet Light
- Exposure
Signs and Symptoms of SLE
Clinical manifestations of SLE vary among patients, while fatigue, skin manifestations and arthralgia are the commonest symptoms among all patients.
- Fever
- Malaise and tiredness
- Symmetrical small joint bone pain
- Soft tissue swelling around joints
- Deformities in joints
- Muscle pain
- Malar rash which manifests as a red discoloration distributed in a shape of a butterfly in face over cheeks and nasal ridge
- Lesions over finger tips and around nail folds
- Pigmentation
- Loss of hair
- Hypersensitivity to sunlight
- Can affect lungs and cause lung diseases
- Abnormal heart rhythms
- Eye manifestations as exudates and hemorrhages
- Psychiatric disorders as depression
- Fits
- Migraines
- Epilepsy
- Kidney failure
- Mouth ulcers
Complications of SLE
- Joint deformities
- Kidney failure
- Stroke
- Heart failure due to myocardial infarctions or abnormal rhythm
- Negative pregnancy outcomes
- Hip destruction
- Cataract formation in eyes
- Scarring in skin
Who is at Risk of Getting SLE?
- Women of childbearing age between 15 years to 44 years
- Women are affected than men
- Some ethnic groups are also more prone including African Americans and Asians
- People with a positive family history
Diagnosis of Systemic Lupus
Diagnosis is difficult as the signs and symptoms can mimic other diseases as they are not specific. Main investigations used to diagnose SLE include blood investigations as antinuclear antibodies, high ESR and reduced serum complements. Skin and kidney biopsies can be investigated histological and immunofluorescent abnormalities. Imaging as CT / MRI can also be used for diagnosis.
Management
- It is very important to educate the patient about the disease and the course of treatment.
- Steps for life style modification must also be taken as patients may experience fatigue and malaise.
- Exposure to sunlight must be avoided as hypersensitivity to sunlight can cause skin manifestations.
Pharmacological Management
- Fever, muscle pain, bone pain and such mild symptoms can be managed by NSAIDs.
- Topical corticosteroids and antimalarial drugs can be used for skin manifestations.
- Sever exacerbations of disease can be treated with long-acting intramuscular corticosteroid injections or oral short acting corticosteroids.
Lifestyle Changes in SLE Patients
- Quit smoking as it can cause stress in lungs, kidney and lungs.
- Limit time under the sun.
- Due to the immunosuppressive drugs these patients can be more exposed to infections. Hence it is important to practice health habits that reduce catching infections as staying up to date on vaccines, avoid spending time around people who are sick and practicing proper hand hygiene.
- As stress can worsen the disease it is important to avoid mental stress and practice mental relaxation techniques. Counselors and support groups can help these patients cope up with the stress caused due to disease.
- Exercise programs planned under exercise physiologists can help to increase physical well-being of these patients.
Pregnancy and Systemic Lupus
Pregnancy is not contra indicated in SLE unless in severe disease. Recurrent miscarriages and frequent exacerbations of disease can occur in SLE patients who are pregnant. Some drugs also should be avoided during pregnancy. Hence the drugs must be reviewed by a doctor in pregnancy.
References
- Kumar and Clerk’s Clinical Medicine -8th Edition- Parveen Kumar, Michael Clark
- Oxford Handbook of Clinical Medicine – 10th Edition
