Systemic Lupus Erythematosus: Diagnosis and Treatment
lupus SLE, systemic lupus erythematosus The disease usually begins at 20 or 40 years of age and is more common in women than men. The Dra. Silvana Meineri Melina, a member of Rheumatology, brings us information about symptoms to consider, diagnosis and treatment of this disease. Do not hide, inform yourself.
The Lupus Erythematosus (SLE) is a disease autoimmune. That is, it is generated by our own organism. The immune system is our defense system that will produce antibodies against viruses, bacteria, and other foreign substances that are called antigens. In autoimmune diseases, the immune system is unable to differentiate antigens (foreign substances) from our own cells or tissues. The result is the production of antibodies that attack the patient’s own tissues causing inflammation and tissue damage.
Lupus is a chronic inflammatory disease, that is, it produces inflammation of the affected organs and persists for a long period of time, which could mean all of life. However, Lupus manifests alternating periods of increased activity or more symptoms (exacerbation) with others of inactivity (remission).
Each person has a different pattern of the disease, which sometimes makes diagnosis difficult. This pathology can occur at any age, but most often it begins in youth, so early diagnosis is extremely important.
It begins in people between 20 and 40 years old approximately. It is 10 times more frequent in women than in men. The disease is more common in some ethnic groups, mainly black and Asian individuals, and tends to be worse in these groups.
How is Lupus diagnosed?
Lupus can be difficult to detect because it has many symptoms that can appear slowly over years.
People with lupus usually present characteristics that are not specific to it. These include: fever, fatigue, weight loss, blood clots and hair loss. Pregnant women can suffer spontaneous abortions.
To diagnose Lupus, 4 or more of the following 11 criteria are required, either serially or simultaneously during any interval:
- Rash malar: butterfly-shaped rash on the cheeks.
- Rash discoid red eruption with oval or elevated round areas.
- Photosensitivity: rash on the skin exposed to the sun.
- Ulcers in the mouth: sores in the mouth or nose usually painless that remain for a few days or even more than a month.
- Arthritis: pain and inflammation that lasts for a few weeks in two or more joints.
- Lung or heart involvement: inflammation of the tissue lining the lungs (pleuritis) or the heart (pericarditis), which can cause chest pain by breathing deeply.
- Kidney involvement: blood or protein in the urine, or tests that suggest poor kidney function.
- Neurological problem: convulsions, strokes or psychosis.
- Abnormal blood tests: low number of red blood cells (anemia), white blood cells or platelets.
- Positive antinuclear antibodies: known as ANA, are present in almost all patients with lupus.
disorders:anti-DNA, anti-Sm antibodies or blood tests to detect syphilis with a false-positive result (which means that, in reality, you do not have this infection).
SLE, systemic lupus erythematosus Treatment
There is no curative treatment for Lupus. The treatment depends on the type of symptoms the patient has and its severity.
Non-steroidal anti-inflammatory drugs. NSAIDs decrease swelling, pain, and fever. These medications include ibuprofen and naproxen.
Medications against Malaria. Patients with Lupus can also receive an anti-Malaria medication such as Hydroxychloroquine. Although these medications prevent and treat Malaria, they also help relieve some symptoms of Lupus, such as fatigue, rashes, joint pain, or mouth sores. Also, they can help prevent abnormal blood clotting.
Corticosteroids and immunosuppressants. Patients with serious problems, such as renal involvement, pulmonary or cardiac involvement and symptoms related to the central nervous system, need a more “aggressive” treatment. This can include high doses of corticosteroids, such as prednisone and medications that suppress the immune system. Immunosuppressants include azathioprine, cyclophosphamide, and cyclosporin. Recently, mycophenolate has been used to treat severe kidney disease derived from Lupus, known as Lupus Nephritis.
Biologics. New treatment options include so-called biological drugs such as rituximab and abatacept. These two medications are not approved for the treatment of lupus. In 2011, a biological medicine called belimumab was approved for the treatment of SLE from mild to moderate.