Systemic Lupus Erythematosus – Causes, Symptoms and Treatment

Lupus (sometimes known as systemic lupus erythematosis or SLE) is an autoimmune disease that can attack many different parts of the body and produces a great variety of different symptoms. Because the effects of lupus are so variable, this disorder can be tough to diagnose. Although few people have heard of lupus, worldwide it’s far more common than leukaemia, muscular dystrophy and multiple sclerosis, which, after extensive publicity, have become household names.

Lupus mainly attacks women during their child-bearing years, but sometimes men and even young children are affected. It’s estimated that 1 in 730 women suffers from lupus in the UK and, for reasons we don’t understand, it is more common in some races than in others. For instance, the frequency in white women is 1 in 1000 compared with that in black women of 1 in 250.

Causes of Systemic Lupus Erythematosus

The cause of SLE is an attack by the body against its own tissues. The fundamental attack is against the DNA and RNA molecules, which are at the very heart of the cell’s structure. (DNA carries genetic information, and RNA is involved in protein synthesis.) This explains why SLE affects organs all over the body. It is not known what triggers this autoimmune attack.

Lupus can be triggered:

• At puberty
• After childbirth
• Through sunlight
• By some medications
• During the menopause
• After a viral infection
• As a result of an injury.

Research is looking at whether a viral infection could trigger the body to react first against the virus and by extension against its own proteins, but this has not been established. There is a strong hereditary element; if you have an affected sibling your chances of SLE are about 5% as opposed to one in a thousand of the general population. There are certain racial groups in which it is much more widespread, for example, Afro-Americans. In a few cases, SLE follows drug treatment with hydralazine, used for high blood pressure.

Women are affected far more than men – about nine to one. The disease is very rare in children and adolescents,

Symptoms of Systemic Lupus Erythematosus

Any body system could be affected, but the most common early symptoms are pains in the joints or a butterfly-like facial rash so-called because of its symmetrical spread across the cheeks. Pain in the joints is of sudden onset and without blood tests could be thought due to rheumatoid arthritis.

There may be a sensitivity to sunlight, fever, odd tender patches on the fingers and Raynaud’s phenomenon (see RAYNAUD’S DISEASE). Many other organs are affected, for example, the lungs, kidneys and heart, but these rarely cause symptoms at the time of presentation.

Lupus is a disease that can present many different facets. Rarely do two people have exactly the same symptoms, and they can vary from just one to many:

• Joint and muscle aches and pains
• Permanent rash, which may be raised and scaly over the nose and cheeks
• extreme fatigue and weakness rashes from sunlight recurring flu-like and/or night sweats
• poor blood circulation causing the tips of the fingers and toes to turn white then blue on exposure to cold -Raynaud’s phenomenon
• Headaches, Migraine
• Increased Risk of Miscarriage
• Kidney Problem
• Oral ulcers
• Hair loss
• Depression.
• Some drugs, such as certain antihypertensive drugs, may cause similar symptoms.

The diagnosis is established by showing a certain number of symptoms plus blood tests that reveal antibodies to DNA. If the disease progresses, there is a risk of stroke, personality change and kidney damage. However, these represent the most severe end of the spectrum, at the other end of which there are many people with a relatively benign form of SLE.

Treatment of Systemic Lupus Erythematosus

People with SLE who become tired and have frequent rashes but otherwise well need only anti-inflammatory drugs for flare-ups of pain in the joints; for much of the time they require no medication at all. In more severe disease, with increasing kidney damage, steroids are necessary by mouth in a dosage enough to bring things under control. If this is not sufficient chemotherapy is used with drugs such as cyclophosphamide or azathioprine — drugs used to treat cancer that works by reducing the activity of the immune system.

Lupus is usually treated with four main groups of drugs, depending on the severity of the disease.

Aspirin and non-steroidals

Non-steroidal anti-inflammatory drugs (NSAIDs) are used for patients with mainly joint and muscle pain, In the case of patients with sticky blood, aspirin in low dosage, 75—150mg daily, is used to thin the blood.

Antimalarials

These drugs are of help in patients with skin and joint disease. They may be sufficient for patients with moderately active lupus to avoid using steroids. Hydroxychloroquine And mepacrine are most commonly used.

Steroids

Drugs such as prednisone have been vital in the improvement in lupus and for some people can be life-saving: They have a Profound effect on inflammation and can suppress tile disease. Once lupus is under control, you can be weaned Off steroids gradually under your doctor’s supervision.

Immunosuppressants

These drugs are used in more severe disease. The most commonly used are azathioprine, methotrexate and Cyclophosphamide. You’ll have regular blood tests to check on your bone marrow and liver You may also have physiotherapy to help improve mobility in affected joints. It’s important to remain as physically active as the condition will allow, so try to take moderate exercise regularly. With treatment, most people with lupus can lead normal, productive lives.

Typically, with SLE there are fluctuations in its severity. Doctors need to recognise a deterioration early enough to
begin appropriate treatment while balancing the side effects of the treatment against the damage done by the illness.

Commonly Asked Questions

1. What is the outlook for SLE?
   The liberal use of steroids has improved the five-year survival to at least 95%. There is evidence that if serious problems are going to occur it will be in the first few years of the illness, which after that takes a more benign course.
2. Can I still get pregnant?
   Pregnancy can go ahead but with an increased risk of high blood pressure and miscarriage. Taking aspirin reduces the risks of miscarriage. The outcome is good in four out of five pregnancies.

Complementary Treatment

Maintaining conventional treatment alongside complementary approaches is important.

• Nutritional therapy tries switching to a diet rich in fish oil and supplementing with vitamin E and selenium. 
• Chinese approaches (herbs, acupuncture, tai chi/chi kung) and Western herbalism can help by your immune system.
• Ayurveda might advise detoxification, oil massage and specific yoga practices.

Mesures You Can Take

• Become well educated on lupus.
• Try to prepare for the up and down nature of the disease. Plan for alternatives. Allow for rest when the disease is active but try to maintain general fitness.
• Reduce fatigue by developing priorities and learning to pace yourself. Break down big, long-term goals into
  small, manageable steps that can be easily accomplished.
• Be open with family and friends about the unpredictable pattern of lupus, and how the disease affects you.
• By listening to your pain, you can begin to control it.
• Try to accept the things you cannot change, rather than constantly feeling frustrated and upset over situations beyond your control. Remember that stress, depression and pain are all closely connected, and each affects the other. Reduce one and you reduce them all.
• Approximately one-third of lupus patients are sensitive to light, so avoid direct and prolonged sun exposure and
  ultraviolet light from artificial sources (such as fluorescent lights). Wear broad-brimmed hats and cover other exposed parts of the body when out in sunlight and use sunblock creams. Ask for help from Family, friends and
  health-care professionals.