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What You Need To Know About Systemic Lupus Erythematosus (SLE)


What is SLE

SLE is a chronic autoimmune disorder where the body attacks itself and leads to a lot of problems. In SLE, there are antibodies produced against the cells of the body and this leads to multi systemic inflammation and organ damage.

It does not exactly always show on the face but interestingly, there are symptoms that may show up on the face. So here are a couple of presentations of SLE:

  1. Skin: Let's start with the common presentations. In about 50% of cases, the patients have courageous features such as butterfly rash, discoid lupus or photosensitivity. SLE is commonly associated with the butterfly rash (also called Lupus as the pattern resembles that on a wolf's face - 'lupus' is Latin for 'wolf') 
  2. Kidneys: The antibodies in SLE can attack the kidney and cause lupus nephropathy. This will come with symptoms of kidney disease like swelling in certain body parts (oedema), reduced urination, lower back pain and signs like proteins in the urine (proteinuria). Kidney disease is the most common cause of death in SLE.
  3. Digestive Tract: Mouth ulcers, nausea, abdominal pain, difficulty digesting food (dyspepsia)
  4. Respiratory System: Pleuritis (Inflammation of the coverings of the lungs), pleural effusion, pneumonitis, pulmonary hypertension, interstitial lung disease
  5. Cardiovascular System: Pericarditis (inflammation of the covering of the heart), myocarditis
  6. Central Nervous System: Seizures, Psychosis
    SLE can also cause anaemia, reduced platelets, reduced white blood cells in the blood. It can present with fever, fatigue as well as weight changes. 

What causes SLE?

The cause is not well known but it is theorized that factors contributing to it are a genetic disposition and environmental triggers.

Possible environmental triggers include:

  • Stress

  • Sun exposure

  • Infection

  • Smoking

  • Surgery

  • Hormones

  • Pregnancy

  • Drugs like isoniazid, phenytoin, procainamide, quinidine, etc.

  • Studies have shown that lupus is more common in women of childbearing age and in people of African origin. Interestingly, it is more common in African-Americans but not so much in Africans. 

Diagnosis

The diagnosis relies on following clinical diagnostic criteria. It must be based on the combination of clinical findings and lab evidence. What is used nowadays is the European League Against Rheumatism and the American College of Rheumatology criteria (EULAR/ACR Criteria). The criteria use a point system. Patients with at least 1 clinical criterion and a total of 10 and above have SLE. The clinical criteria include fever, leukopenia, thrombocytopenia, autoimmune haemolysis, delirium, psychosis, seizures, acute cutaneous lupus, oral ulcers, renal biopsy showing lupus nephritis, etc.

Other diagnostic tests include antinuclear antibody (ANA), direct Coombs test, lupus anticoagulation, etc

Management:

Management of SLE really depends on the severity. Make sure to see a doctor if you notice any symptoms. Drugs can be administered to prevent and control complications. The drugs include corticosteroids, NSAIDs, disease-modifying anti rheumatoid drugs like cyclophosphamide, etc


Article By: Bola Owate

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