SLE / Lupus / Systemic Lupus Erythematosus
Systemic Lupus Erythematosus also known as Lupus or SLE is an autoimmune condition with multisystem inflammation which can affect most organs in the body. Lupus means WOLF in Latin, as the first ever identified feature of this condition was the rash over the nose and cheeks resembling a wolf’s face.
No definitive cause for SLE has been discovered though multiple causes have been found. SLE is caused by defective immune tolerance by the body. Multiple antibodies are produced by the body against its own cells. These antibodies are called anti-nuclear (against cell nucleus) anti-cytoplasmic (against cell cytoplasm). These antibodies attack the healthy cells by producing inflammation causing agents called cytokines and immune complexes. These in turn produce inflammation accounting for the symptoms.
Women are mostly affected and this condition is not common in men. Young women, 15-45 years are affected though older age groups can also be affected. Hormones such as Estrogen and Progesterone are thought to one of the causes for this condition given that women in whom these hormones are present suffer the most. Sun exposure is also thought to worsen this disease as the UV light increases the inflammatory reaction.
The characteristic feature of this condition is the “Relapsing – Remitting” nature of the disease. The disease can exist as a mild or a severe form. There can be sudden worsening of the condition to a severe form and this is called relapse. Once the disease settles down to the mild form, it is called remission. Complications can occur in untreated or poorly treated patients, while the disease
has relapsed.
Most common symptom is the butterfly shaped rash across the cheeks and nose called malar rash along with joint pains and swellings. Hair fall, oral ulcers, low grade fevers, photosensitivity (symptoms getting worse with sun exposure) and fatigue are present. Most organs can be affected like blood with low cell counts, brain and nerves causing seizures, kidney with loss of protein and blood in the urine, heart and lungs with chest pain and shortness of breath. Unfortunately, these complications do not show any outward symptoms and need blood tests and imaging tests for diagnosis.
Diagnosis for SLE would need detailed evaluation with careful history and examination with blood tests. Complete blood picture, urine exam, liver and kidney function tests and chest x ray are the basic tests required. Antibody testing for anti-nuclear antibodies and extra nuclear antibodies is essential for diagnosing the condition. These tests would help to understand the extent of the condition and tailor a target specific treatment approach.
The treatment approach varies depending on the condition of the patient at presentation. Early and appropriate treatment is must. Discontinuing treatment or not taking medication regularly can result in complications and this should be avoided. DMARD’s and biologics are used to treat this condition and these medications should be taken only under the supervision of a Rheumatologists.
