Systemic Lupus Erythematosus (SLE)

SLE is commonly addressed as Lupus. The word Lupus in “Greek” means wolf. This reference is because of the facial rash on the face across the cheeks resembling a wolf. This rash is usually reddish in color. Hence the word “erythematous”. This is a chronic autoimmune disease.

As explained in other sections of this website the word auto means self and immune of course refers to immunity so essentially for unknown reasons our own immune system malfunctions and parts of our own immune system start attacking organs of our own body resulting in inflammation and subsequent damage of the affected organs.

This disease is characterized by a rash over the face and body and inflammation of the various internal organs of the body such as the kidneys, the brain, heart and lungs. Unless treated in time this illness in its systemic form can be life threatening. This illness like many others has a female predominance and the female to male ratio is almost 9:1. The common age of affection is between 20 to 40 years.

Like all other autoimmune diseases this disease can be controlled if treated in time but don’t waste your time looking for a permanent cure you will only land up in further trouble.

Lupus is of three varieties

  1. Discoid Lupus
  2. Systemic Lupus Erythematosus
  3. Drug Induced Lupus

Discoid Lupus (Also Known as DLE or cutaneous Lupus): Here the illness is mainly restricted to the skin there are roundish or Disc like lesions over the face and other parts of the body but mainly those areas which are exposed to Ultraviolet Light, the most common form being sunlight. If not treated well these rashes turn into permanent scars over exposed areas of the body and face and into permanent bald patches over the scalp.

Systemic Lupus Erythematosus (also Known as SLE): In this form of Lupus, any part of the body may be affected such as the joints, Lungs, Kidneys, heart, Brain, Blood etc. it is this form which when uncontrolled can be life threatening.

Drug Induced Lupus: This illness is due to an adverse effect of certain drugs such as Hydralazine for hypertension or Procainamide for cardiac rhythm disturbances or Isoniazid used in tuberculous infections. The use of these drugs has declined over a period of time due to the advent of newer and better drugs though some of them are still used. Drug Induced lupus will occur either equally in both genders and more in men where cardiac drugs tend to be used more often.

Common symptoms of Lupus: These symptoms may be present in various combinations in a particular patient

  1. Arthritis
  2. Fever
  3. Significant Fatigue
  4. Skin Rashes (particularly on sun exposure)
  5. Facial rashes in the shape of Butterfly wings hence also called butterfly rash
  6. Hair loss
  7. Mouth Ulcers
  8. Raynaud’s Phenomenon (Fingers and toes turning blue or white on cold exposure)
  9. Anemia
  10. Kidney Involvement
  11. Seizures (convulsions). Sometimes there may be psychiatric disorders as well
  12. Abnormal blood clots in veins or arteries.

Diagnosing Systemic Lupus Erythematosus:

As with other illness in rheumatology diagnosis of lupus is based on a combination of clinical symptoms and signs. Blood tests in SLE do play a significant role in confirming the diagnosis as well as in monitoring the progress of the disease. For example it is not abnormal to find a low white cell or platelet count or progressively falling hemoglobin despite appropriate treatment. Similarly in case of kidney involvement the urine picture will be abnormal.

Tests for Antibodies are confirmatory and some of them are even important in predicting organ involvement or monitoring disease activity in the particular organ. For example The ANA or the anti-nuclear Antibody test if negative makes the clinical; diagnosis of SLE quite unlikely though it can be positive in a number of other illnesses as well. DsDNA or the double stranded DNA may indicate a tendency towards renal involvement and monitoring of the titers may be helpful in assessing response to treatment. There are many other antibodies that determine affection of various organ systems.

Flare up of Lupus:

Since this is an autoimmune disease the disease can flare up due to any fluctuation in the immune system. Hence some common triggers for a flare are quite predictable. However quite often you may not be able to discern a cause for the flare.

  1. Exposure to sunlight or Ultraviolet rays
  2. Stress physical or emotional
  3. Any Infection whether bacterial or Viral
  4. Certain medications which have been newly introduced.
  5. Recent surgery which again results in stress to the body.

Treatment of systemic Lupus Erythematosus:

Treatment of Lupus will depend on the organ system affected and this requires periodic clinical evaluation coupled with regular monitoring of certain laboratory parameters in order to predict worsening of disease or predict any new organ involvement. However certain drugs are important in the treatment and control of this disease.

  1. Sun – protection measures are extremely important to avoid flares of Lupus. Using Sun protection creams with an SPF (Sun protection Factor) of at least 40. Additionally wearing long sleeve dresses and wide brimmed hats are essential to avoid a flare arising from the harmful Ultraviolet rays of the sun. Avoid going to beaches as the rays hitting the water and reflecting onto the body are the worst.
  2. Antimalarials: Hydroxychloroquin, Chloroquin or Quinacrine are the main drugs used in the treatment of this disease. These drugs help in decreasing the inflammation in various organ systems. Additionally they protect the body from the effect of sunlight and thus prevent lupus flares. They also help in lowering the Cholesterol levels reducing the fatigue levels.
  3. Steroids: The moment the word steroid is uttered, Patients get nervous because steroids are a double edged sword. They are life-saving drugs in an illness like Lupus but themselves have many side effects associated with their chronic usage. There is a separate section in this website which addresses this topic. Suffice to say here that Steroids are extremely important drugs in the treatment of Systemic Lupus Erythematosus unless the disease itself is very mild. In fact in severe disease high doses have to be used.
  4. Immunosuppressant Drugs: These drugs serve as “Steroid sparing” drugs. Since the long term use of steroids is associated with significant side effects, use of these drugs helps in lowering the dose of steroids to a minimum or even stopping steroids altogether. Having said the above use of these drugs itself requires careful monitoring, as they can have their own set of side effects. Additionally If the immunity is over –suppressed than there are chances of infection occurring from outside which needs to be watched for.Commonly used Immunosuppressants are Azathioprine, Ciclosporine, Mycphenolate Mofetil, Methotrexate etc. (All dealt with individually in the drugs section)