Systemic lupus erythematosus
Medical condition description
This is a polyetiologic, autoimmune (antibodies are produced against the body itself) rheumatic disease that affects many organs and systems: kidneys, lungs, heart, brain, reproductive system, skin and mucosa, joints, muscles, etc. SLE affects 100-500 people per 1 million inhabitants. In Lithuania, the prevalence is 16.2 / 100,000 adults. Women are 10 times more likely to be affected than men, often experiencing the disease during pregnancy or immediately after childbirth. The peak age is 15-45 years.
The leading cause of SLE development is not yet clear. It is believed that viral infections (Epstein-Barr, cytomegalovirus) and genetic predisposition play a significant role. Since women are more affected, an endocrine cause is likely. It has also been observed that intense exposure to ultraviolet radiation (insolation) and constant contact with chemicals can trigger the disease.
Symptoms
60-80% of those affected have a fever above 38°C at some point. The fever can rise several times a day or persist constantly at a high level. This fever cannot be attributed to an infection. Common symptoms also include general weakness, muscle pain, insomnia, depressive mood, and weight loss.
Skin damage can occur suddenly or gradually.
a) Suddenly appearing redness, not extending beyond the lip border but involving the bridge of the nose and cheeks (“butterfly rash”) lasts for several days or weeks and then disappears without scarring. This acute dermatitis is often triggered by sunlight or exacerbation of the disease itself.
b) In cases of subacute skin damage, the rash not only affects the face but also spreads to the chest, arms, and other areas. These rashes appear in different places, often resembling psoriatic rashes.
c) Chronic skin lupus, also known as discoid lupus, can be the only manifestation for some individuals. In these cases, raised reddish patches with a central depression and scales are visible on the skin.
Patients also commonly experience Raynaud’s syndrome – temporary whitening of the fingers and toes, less frequently of the nose or ears when exposed to cold or (very rarely) strong emotions. After whitening, the skin turns pale, later becoming red and painful, with a burning sensation.
Sometimes small blood vessel ruptures and focal lesions around the nail bed are visible on the palms. Patients also often develop painless mouth ulcers, with noticeable hair loss. Muscle or recurrent, migrating, or persistent joint pain, especially in the fingers, can also occur. These joint inflammations usually do not cause destruction, but in very rare cases, minor changes in the hand joints may develop – known as Jaccoud’s syndrome.
Due to changes in the mucosa, respiratory tract disorders, various infections, as well as cardiac and vascular changes are common, leading to a condition called lupus nephritis – kidney damage that can result in renal failure. The nervous system is also often affected – mood, memory, cognitive impairments, epilepsy seizures, signs of stroke, etc., may occur.
Diagnosis
Laboratory tests are performed: a decrease in blood cells is detected, inflammatory markers increase, protein is observed in the urine, blood cells (erythrocytes), and other characteristic signs. Immunological tests are also carried out to facilitate the diagnosis of this disease – ANA, Lupus cells, etc.
Treatment
Patients are advised to avoid heavy work, exposure to cold, intense sunlight, and contact with chemicals.
Treatment involves the use of steroid hormones, Plaquenil, immunosuppressants such as azathioprine, methotrexate, cyclophosphamide, etc.
Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology