Systemic lupus erythematosus is one of the so-called autoimmune diseases. In them, the immune system attacks the body itself instead of attacking foreign microorganisms that could harm it. In the case of lupus, its main characteristics are the formation of autoantibodies, that is, antibodies against the same body, and the deposition of immune complexes, which are molecular compounds formed by the union of an antibody and an antigen. These deposits accumulate in the tissues of different organs and cause them to stop working gradually. In the following FastlyHealarticle, we will discuss systemic lupus erythematosus: symptoms and treatment.
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Epidemiology of systemic lupus erythematosus
There are approximately 20 to 150 cases per 100,000 inhabitants in the world. It is seen more in women than men, especially in black people. Most patients begin to have symptoms in their reproductive age, around 16, although they can appear as late as age 65.
The severity of symptoms appears to be related to the number of hormones in the body, so symptoms are more likely to be expressed more strongly in young people and milder in older adults.
Etiology of systemic lupus erythematosus
The cause or origin of lupus is not 100% elucidated; it is believed that many factors are involved in its development. Among the factors involved, we find:
- Genetics: mutations have been found in some genes, and lupus has been inherited from parents to children.
- Hormonal: it has been observed that estrogens go hand in hand with a predisposition to develop lupus, which is why women are at greater risk of suffering from it.
- Environmental: these are factors we could modify, such as smoking, diet, exposure to silica, ultraviolet radiation, and some infections like the Epstein-Barr virus.
Symptoms of systemic lupus erythematosus
The initial symptoms of lupus are:
- General discomfort
- Lack of appetite
- Weight loss without doing special diets
These symptoms are very nonspecific and only serve to diagnose when a doctor relates them to laboratory data or specific signs of the disease. There are some more specific signs of lupus that support the diagnosis or suspicion of the disease; these are:
- Arthritis: arthritis manifests itself with inflammation of the joints; the ones that are most affected are those of the fingers, wrists, and knees; although it is not always the same, it is essential to note that this manifestation can be reversed with treatment
- Muscle pain: it is a common manifestation of the disease
- Osteonecrosis: this means that there are bone fragments that die because not enough blood with nutrients reaches them.
Signs on the skin
Up to 80% of patients have systemic lupus erythematosus on the skin. Some of these symptoms are:
- Malar rash or “erythema in butterfly wings “is the appearance of a slightly raised reddish spot on the rest of the skin on the face, precisely that covers the cheeks and the bridge of the nose and can extend to the chin and the ears. This lesion identifies acute cutaneous lupus, a stage of the disease.
- In subacute cutaneous lupus, we can find diffuse plaques, these are small portions of the skin that suffer from redness, the elevation of that area, and that disappear without leaving a scar.
- Chronic discoid lupus; at this stage of the disease, the patient has red spots or plaques that peel off and look like a scab; they can grow and do not disappear quickly; when they disappear, they leave scars in which hair does not grow back and can be lighter or darker than the rest of the skin.
- Other manifestations include alopecia, which is the loss of hair in an area, photosensitivity that reacts very strongly to exposure to the sun’s rays, and something called Raynaud’s phenomenon, specific to autoimmune diseases. In Raynaud’s phenomenon, when people put their hands in cold water, the needles turn blue or pale because they lack blood supply.
Signs in the kidneys
Almost half of the patients with lupus have kidney problems; these occur because immune complexes are deposited in the kidney tissue, making it useless for its functions. The first signs are:
- The proteinuria: urine protein.
- The hematuria: urinating blood, but at the level microscopic, or whether the patient is not going to notice, unless the urine is analyzed in a laboratory, so before the diagnosis of systemic lupus erythematosus, it is essential to test the urine periodically.
There are various neurological manifestations; they may or may not occur; it all depends on the patient and the degree of the disease; among them, we can highlight:
- Cognitive dysfunction: this means that a brain function is altered, among them knowing how to organize, reason, and control our voluntary acts, language, visual recognition and some tasks that allow us to carry out actions are grouped. People with systemic lupus erythematosus often have memory and reasoning problems.
- Acute confusional state: in which the person may be confused suddenly and for a time
- Delirium: it is a symptom in which the person is convinced that something is happening that is not happening
- Psychosis: it is a psychiatric diagnosis that means that the person has lost contact with reality, may have fear, anguish, and irrational obsession with something, and his personality may have significant changes
- We can also observe anxiety, depression, and mania among the psychiatric manifestations.
- Convulsive crisis
- Headache up to migraine
- Movement disorders, such as the inability to hold objects or walk
- Myelitis and myelitis are the inflammation of the spinal cord, and meningitis is the inflammation of the layers that surround the brain; this may be due to the deposit of immune complexes.
- Peripheral neuropathy is due to damage to nerve structures; in peripheral neuropathy caused by systemic lupus erythematosus, patients lose sensation and movement in the fingers and toes.
Part of the pulmonary manifestations is due to the deposition of immune complexes; among them, we find:
- Pleuritis : which is the inflammation of the pleura, the layer that surrounds the lungs,
- Pleural effusion: is the accumulation of fluid in the pleura,
- Interstitial pneumonitis: it is the inflammation of the lung space between one alveolus and another, which are the tiny sacs responsible for passing oxygen from the air to the blood
- Pulmonary hypertension: which is the increase in blood pressure in the vessels of the lungs,
- Alveolar hemorrhage is when the vessels surrounding the alveoli break and fill with blood, which prevents them from getting oxygen from the air into the bloodstream.
All structures of the heart can become inflamed, leading to several diagnoses:
- Pericarditis: if the pericardium, which is the layer that surrounds the heart, becomes inflamed,
- Myocarditis – if the heart muscle becomes inflamed,
- Endocarditis: if the structures inside the heart, such as the valves, become inflamed.
Systemic lupus erythematosus does not usually cause gastrointestinal problems, but medications taken to control systemic lupus erythematosus can cause difficulties; symptoms include:
- Diffuse pain
This is one of the manifestations that remains with the patient of systemic lupus erythematosus for life, and it has several components:
- Cytopenias: it is the decrease in the amount of some blood cells; it can be a low number of platelets (thrombocytopenia), a low number of erythrocytes, or red blood cells (anemia), or a low number of leukocytes (leukopenia). The different types of cytopenias can combine to lead to syndromes.
- Thrombophilia: in this variant, there is something called antiphospholipid antibodies that are a type of antibodies produced with lupus and make the person have a significant predisposition to make clots; they can be due to a small blow or happen out of nowhere, which puts them at risk of having some embolism.
- Adenopathies: it is the growth of the lymph nodes of the body since, in them, the lymphocytes develop and store
- Splenomegaly: it is the growth of the spleen, an essential organ in defense of the body, and that has a lot to do with the development of lymphocytes
There are many other manifestations of systemic lupus erythematosus; it all depends on the organ that has been affected.
Diagnosis of systemic lupus erythematosus
The diagnosis of systemic lupus erythematosus is made by combining the clinic with the laboratory. Among the important laboratory tests is the detection of:
- ANA antibodies or antinuclear antibodies.
- Anti-DNA or anti-DNA antibodies.
ANA antibodies are present in 95% of patients with systemic lupus erythematosus, which helps a lot in making the diagnosis, anti-DNA antibodies are closely linked to the stage of development of the disease, so it is essential to obtain both data. Other antibodies can be searched to complement the diagnosis or define it according to the criterion of the treating physician; these are:
- Extractable core antigens or ENA antigens, such as anti-Sm, anti-RNP, anti-Ro, and anti-La
Other essential elements that are detected in the laboratory are:
- The presence of rheumatoid factor, which is present in almost half of lupus patients,
- Elongated clotting tests, which demonstrate the existence of antiphospholipid antibodies and poor clotting,
- A positive test for syphilis, this test does not mean that the person has syphilis but rather shows the presence of phospholipid antibodies,
- Finding of blood and protein in the urine, indicating kidney damage,
Systemic lupus erythematosus comorbidity
Some conditions are frequently associated with systemic lupus erythematosus; most of them are:
- Infections: it is widespread for patients with systemic lupus erythematosus to develop infections, in part because their immune system does not work as it should, and the other part is due to the medicine, steroids lower the defenses and are an essential component of treatment, in addition to immunosuppressants.
- Premature arteriosclerosis: it occurs at an early age and develops rapidly, so patients should watch their cholesterol levels, should not smoke, and should try to keep their blood pressure levels within normal ranges
- Cardiovascular involvement: especially coronary heart disease, which can even lead to death in advanced stages of the disease
- Osteoporosis: many factors lead to it, illness, medications, and not being able to expose yourself to the sun to synthesize vitamin D and thus fix calcium,
- Cancer: there is an increased risk of developing lymphoma, lung, breast, and cervical cancer, although it does not necessarily mean that because you have systemic lupus erythematosus, you will create one of these carcinomas,
- There are many more pathologies involved, such as fibromyalgia, arterial hypertension, diabetes mellitus, and other added autoimmune diseases.
- Psychological: it is vitally important to add psychological treatment to medical treatment; patients will have to deal with this disease and its consequences for life; part of the disease includes depression and anxiety, which must be treated like all other manifestations of systemic lupus erythematosus.
Treatment of systemic lupus erythematosus
Treatment is highly variable, it should be directed towards the most affected area or that is showing manifestations; in general, some medications remain as a base, and to which more can be added:
- Non-steroidal anti-inflammatory drugs (NSAIDs): paracetamol, acetylsalicylic acid, ibuprofen, naproxen, etc.; these drugs serve as support for most manifestations, fever, inflammation, and pain.
- Corticosteroids: such as prednisone or prednisolone, to lessen symptoms and support anti-inflammatories and immunosuppressants.
- Immunosuppressants: such as methotrexate, azathioprine, cyclophosphamide, or mycophenolate, serve to reduce immune activity, which generates more minor immune complexes, and therefore, organs and tissues function better.
- Synthetic antimalarials: such as hydroxychloroquine, serve to reduce the manifestations in the skin and joints.
- Biological drugs: such as belimumab, which is a monoclonal antibody that reduces the formation of B lymphocytes, or rituximab, which can also help in this regard.
The choice of drugs will be made by the doctor according to the presentation of the disease in each patient and will evaluate their needs and the benefit that can be obtained from each drug; some will be taken for long periods and others only in the seasons in which the disease be very active.
Systemic lupus erythematosus prognosis
The prognosis of the disease depends mainly on the organ that has been most affected, which is also called the target organ; advances in medicine have made life expectancy grow a lot, now, 100% of patients achieve live more than five years, and 90% manage to live more than ten years when the disease is diagnosed and treated in time.
It is usual for the disease to have periods of intense activity and others in which the symptoms are kept very well controlled with the medication; it is scarce for someone to achieve complete remission of the disease; that is, they do not need to take medication and live no symptoms.
However, some risk factors for poor prognosis have been identified :
- Kidney disease, significantly if the glomeruli have been severely affected.
- Arterial hypertension.
- Early-onset age.
- Black race.
- Low socioeconomic status due to the possible lack of access to adequate treatment and a lifestyle that supports health maintenance.
- Presence of antiphospholipid antibodies.
- High disease activity rates.
It is important to remember that the disease can behave differently in each patient and that there are many ways to treat it.
This article is merely informative, at FastlyHeal .com we do not have the power to prescribe medical treatments or make any type of diagnosis. We invite you to see a doctor in the case of presenting any type of condition or discomfort.
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I am a Surgeon with a diploma in comprehensive ultrasound and surgical care residency, an area I am specializing in. During the exercise of my profession, I have realized the need for patients to know the diseases they suffer, and I can tell you that a large part of their complications is due to a lack of information. Being a health web writer allows me to transmit my experience, without borders, to all those readers eager for knowledge, educate them in the prevention of diseases and promote a healthy lifestyle.