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Lupus – Systemic Lupus Erythematosus (SLE)

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What is Lupus – Systemic Lupus Erythematosus (SLE)

Systemic lupus erythematosus (SLE) is an autoimmune disorder that may affect many organ systems within the body. In particular it is associated with a distinctive rash and joint pain, however the most potentially serious problems are due to effects on the brain and kidneys.

Statistics on Lupus – Systemic Lupus Erythematosus (SLE)

SLE occurs worldwide, but racial differences are seen. It is estimated to affect 1 in every 250 African-American women.

There is a female predominance (9:1), and peak age of onset is between 20-40 years.

The disease affects 0.1-0.2% of the population, and is much more common in Africans.

Risk Factors for Lupus – Systemic Lupus Erythematosus (SLE)

Cause unknown but probably multi-factorial. Factors thought to be involved:

  • Genetic: 70% concordance between identical twins and increased incidence of HLA-B8 and HLA-DR3.
  • Immunological: antinuclear antibodies are present which are thought to result from polyclonal activation of B cells by an antigenic stimulus (possibly viral). May be associated with impaired T cell regulation and deficiencies in complement.
  • Drugs: hydralazine, isoniazid, anticonvulsants and procainamide may cause a mild lupus like syndrome which often resolves with withdrawal of the drug.
  • Infection: viral infections may be responsible.
  • Hormonal factors: high incidence in women suggest female hormones may modify the immune system.
  • Sunlight is an exacerbating factor for the cutaneous (affecting the skin) manifestations in most cases.

Progression of Lupus – Systemic Lupus Erythematosus (SLE)

SLE usually occurs in episodes, with flares and remissions that may last for long periods of time. In some patients, it may persist as a chronic illness. Generally speaking, if serious complications have not developed by the first few years, they are unlikely to do so.

Symptoms of Lupus – Systemic Lupus Erythematosus (SLE)

Features typical of SLE include:

There may have been previous problems with pregnancy (multiple miscarriages), or a family history of autoimmune disease such as rheumatoid arthritis.

Other features may include:

  • raised blood pressure.
  • mouth ulcers.
  • dry eyes
  • hair loss.
  • joint tenderness or swelling.
  • signs of fluid in the lungs.
  • signs of inflammation of the fibrous sac surrounding the heart (pericarditis).
  • protein in the urine.
  • scaly red rash in a ‘butterfly’ distribution over the face and other sun exposed areas.

How is Lupus – Systemic Lupus Erythematosus (SLE) Diagnosed?

A combination of clinical and physical findings, plus appropriate tests are needed to make a diagnosis of SLE.

Tests may include:

  • Blood tests
  • Immunological tests
  • Urine testing (protein in the urine suggests kidney involvement)
  • Biopsy (taking a sample of the skin or kidney to look for abnormalities)
  • MRI scan to look for involvement of the brain.

Prognosis of Lupus – Systemic Lupus Erythematosus (SLE)

With current treatments, prognosis is good. Survival rates have increased from 50% at five years during the 1950s, to approximately 90% at 10 years presently.

How is Lupus – Systemic Lupus Erythematosus (SLE) Treated?

Treatment depends on symptoms and severity of the disease.

  • NSAIDs – useful for mild disease with arthralgia
  • Hydroxychloroquine – mild disease when symptoms cannot be controlled with NSAIDS or for cutaneous disease.
  • Corticosteroids – mainstay of treatment. Particularly for moderate to severe disease. Aim is to control disease activity before gradually reducing the dose.
  • Immunosuppressives (azathioprine, cyclophosphamide) – usually in combination with corticosteroids for severe disease (e.g. renal or cerebral disease).
  • Topical steroids – for discoid lupus. Should also avoid excessive sunlight (suncream and clothing).

Lupus – Systemic Lupus Erythematosus (SLE) References

  1. Braunwald, Fauci, Kasper, Hauser, Longo, Jameson. Harrison’s Principles of Internal Medicine. 15th Edition. McGraw-Hill. 2001
  2. Cotran, Kumar, Collins 6th edition. Robbins Pathologic Basis of Disease. WB Saunders Company. 1999.
  3. Hurst JW (Editor-in-chief). Medicine for the practicing physician. 4th edition Appleton and Lange 1996.
  4. Kumar P, Clark M. CLINICAL MEDICINE. WB Saunders 2002 Pg 427-430.
  5. Longmore M, Wilkinson I, Torok E. OXFORD HANDBOOK OF CLINICAL MEDICINE. Oxford Universtiy Press. 2001


Posted On: 11 September, 2003
Modified On: 30 September, 2015


Created by: myVMC