Systemic Lupus Erythematosus (SLE): Knowing Symptoms, Causes, Diagnostic Approaches & Management

Systemic Lupus Erythematosus (SLE) is commonly called lupus, and it is a complex chronic autoimmune disease that may involve almost all parts of the body. In this condition, the immune system, which generally defends the body against infection and foreign invaders, mistakenly attacks healthy tissues and organs. It results in a variety of symptoms that almost all people differ in the way they suffer from this disease, which also makes the diagnosis a comparatively difficult task. Knowing about SLE, its various symptoms, the process of diagnosis, and available treatment will help patients face the problem confidently and lead a comfortable life with less suffering.

Systemic Lupus Erythematosus: What It Is

In systemic lupus erythematosus, the immune system attacks its cells and tissue instead of targeting external threats like bacteria and viruses. This altered immune reaction results in inflammation and damages almost any organ in the body, including the skin, joints, kidneys, brain, heart, lungs, and blood cells. “Systemic” indicates that the disease is involving a multitude of organ systems in the body. Lupus is a chronic illness, meaning it lasts for some time and is often characterized by active disease (flares) and periods of remission when symptoms are minimal or absent. This unpredictable presentation of flares and remissions is the unique hallmark of ongoing management of SLE by each person.

Systemic Lupus Erythematosus Symptoms

SLE is characterized by a wide variety of symptoms, and symptoms vary within individuals. No two people with lupus experience the exact same constellation of symptoms, and symptoms can come and go over time in intensity and pattern. This very heterogeneity often presents a challenge for early diagnosis. Some of the most common signs and symptoms of SLE include

• Extreme Fatigue: Extreme fatigue that persists and is not relieved by any kind of rest is perhaps the most common and most debilitating symptom.
• Joint Pain and Stiffness: Pain, swelling, and stiffness in the joints affecting several joints on both sides of the body is a very frequent occurrence. Given the similarities between the symptoms, this may appear to have a presentation of arthritis.
• Skin Rashes: Skin rashes, the most recognizable being the butterfly rash across the cheeks and nose, are one of the classic signs of lupus. Other skin rashes can also occur, including discoid lupus (a circular rash that is raised and scaly). Often, these rashes can be triggered by sunlight.
• Fever: Recurrent fevers are often seen, especially during the flare.
• Weight Loss: Unintentional weight loss can occur due to inflammation and other disease processes.
• Hair Loss: Alopecia can be patchy or generalized; it can be a distressing symptom.
• Mouth or Nose Sores: Painful sores can form, disappear, and form again inside the mouth or nose.
• Sensitivity to Sunlight (Photosensitivity): Skin rashes or other symptoms may worsen in the presence of sunlight.
• Raynaud’s Phenomenon: While under the influence of cold or stress, fingers and toes become white, blue, and painful or numb.
• Swollen Lymph Nodes: Lymph nodes enlarge during a flare.
• Headaches: Headaches are frequent, and at times, severely intense.

Some of the prominent SLE signs include the butterfly rash, which is a distinctive rash across the cheeks and nasal bridge, and discoid lupus, which can cause scarring and permanent hair loss. Lupus arthritis, a non-erosive complication, affects smaller and larger joints. Lupus nephritis, a serious complication, can range from mild urine abnormalities to kidney failure.

Sometimes lupus can also affect the brain and nervous system, leading to neurological symptoms like headaches, dizziness, seizures, cognitive dysfunction, mood disorders, and stroke. It can also affect the lungs, causing pleuritis, pneumonitis, and pulmonary hypertension. Lupus can also affect blood cells, leading to anemia, leukopenia, and thrombocytopenia.

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Systemic Lupus Erythematosus Causes

The exact cause for SLE is not known, but lupus is a dynamic and complex entity formed by the interaction of multiple genetic, environmental, and hormonal factors, and its causes cannot be readily defined in a clear-cut manner. SLE is not contagious. The following causes are believed to be involved in the development of lupus:

• Genetic Factors: An individual with a family history of lupus or other autoimmune diseases is at a higher risk for developing SLE. Certain genetic infections, particularly those of the immune system genes, are thought to confer susceptibility.
• Hormonal Factors: It is more common in women, especially in their reproductive age, indicating some hormone influence, perhaps estrogen.
• Environmental Factors: Environmental factors might be rare causes, but several environmental factors are suspected to provide triggers to the manifestations of lupus in genetically susceptible individuals. These triggers include:
  • Sunlight (Ultraviolet Light): Sun exposure can trigger rashes and systemic lupus flare-ups.
  • Infections: Some individuals have suggested that a viral or bacterial infection could have acted as a trigger.
  • Certain Medications: Certain drugs are known to induce drug-induced lupus, which usually resolves after the offending drug is withdrawn.
  • Stress: Stress, whether physical or emotional, might play a role in triggering flares of lupus.
  • Exposure to Certain Chemicals: Ongoing investigations concerning the environmental chemical exposure that may be contributing toward the development of SLE.

Systemic Lupus Erythematosus Diagnosis

SLE is diagnosed by taking a person’s history and examination and taking specific blood tests and urine tests. Furthermore, it may include complementary tests and imaging in extreme cases.

• Medical and Physical Examination: The doctor will ask detailed questions about the patient’s symptoms regarding onset, symptom duration, and history. A thorough physical examination will tend to find signs of lupus, such as skin rashes, joint inflammation, and other physical findings.
• Blood Tests: Several blood tests are commonly used to help diagnose lupus and monitor disease activity. These blood tests include
  • Antinuclear Antibody (ANA): This is usually the first test ordered. A positive outcome in ANA means that the immune system is producing antibodies against components of the cell nucleus, which is a prevalent finding in lupus but may also occur in other autoimmune diseases.
  • Antibodies to Double-Stranded DNA (anti-dsDNA): These are marked specific antibodies to lupus and correspond often with the active disease, especially in cases where the disease involves the kidney.
  • Antibodies to Smith (anti-Sm): They are also quite specific antibodies for lupus.
  • Antibodies of Other Autoantibodies: Other, for example, anti-Ro (SSA), anti-La (SSB), anti-RNP, and antiphospholipid antibodies tests may also be conducted.
  • Complement Levels (C3 and C4): The complement proteins are part of the immune system and may be low during active lupus as they are being consumed during the inflammatory process.
  • Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP): These are general markers of possible inflammation occurring within the body and may correlate with flare-ups of lupus.
  • Complete Blood Count (CBC): Check for anemia, leukopenia, or thrombocytopenia.
  • Liver Function Tests: To test the health of the liver.
  • Urine Tests (Urinalysis): To check for evidence of protein or blood in the urine, which might indicate kidney involvement.
• Imaging Tests: They may include X-rays, ultrasounds, MRIs, or any other imaging modality depending on the symptoms.
• Biopsy: Sometimes a biopsy of affected tissue, for example, skin or kidney, may be taken for confirmation of diagnosis and assessment of organ damage extent.

The combination of the above clinical findings and diagnostic parameters confirms the presence of SLE in an individual.

Systemic Lupus Erythematosus Treatment

At the moment, there is no permanent cure for SLE, but management and treatment strategies are suggested for reducing inflammation, suppressing immune activity, preventing flares, and managing symptoms. The common treatment strategies for SLE include

• Non-steroidal Anti-inflammatory Agents: These medications serve to alleviate pain and inflammation of the joints and muscles.
• Antimalarial Agents: These are not the direct treatment source, though historically used in the treatment of malaria; those drugs have been found to be efficacious in the management of some lupus symptoms, particularly skin rashes, arthralgia, and fatigue.
• Corticosteroids: These drugs are strong anti-inflammatories and immunosuppressants used to temper active flares and severe symptoms and are an essential part of the treatment.
• Immunosuppressants: These are used to suppress the overactive immune systems and are used to treat the accursed lupus when affecting more serious organs like kidneys or the brain.
• Biologics: This novel targeted therapy blocks certain proteins interfering in the immune response.
• Other Medications: Other medications may be used according to the specific symptoms and complications, such as blood pressure medicines for kidney involvement, anticoagulants for blood clotting disorders, and treatment agents against hyperlipidemia.

In general, treatment strategies differ from person to person based on the symptoms and the severity. Some individuals might need extra alternative therapies regarding their condition and illnesses.

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Systemic Lupus Erythematosus Prevention

Prevention of systemic lupus erythematosus (SLE) is not an option since the direct causes of SLE remain unknown, and it is presumed that there is an intricate interaction between genetics, hormones, and environmental factors. In the case of those who are at risk or already have the disease, however, the following are interventions that may be undertaken to assist in reducing the risk of flares and complications:

• Strict Sun Protection: Limit sun exposure. Apply broad-spectrum sunscreen or always wear protective clothing in order to prevent flares and skin rashes.
• Medication Adherence: Medication prescriptions must be taken as prescribed by the rheumatologist. This is essential to managing disease activity and avoiding flare-ups.
• Regular Medical Follow-Up: Attend all visits with the rheumatologist and other consultants. Regular checkups will enable the prompt diagnosis and management of potential flares or complications.
• Healthy Lifestyle: Follow a good diet. Add fruits and vegetables and whole grains to the diet.
• Gentle Exercises: Moderate exercise, on a regular basis (as tolerated), will prevent fatigue and promote well-being.
• Stress Management: Stress management techniques like yoga, meditation, deep breathing, or any other enjoyable hobbies might be beneficial.
• Adequate Sleep: 7-9 hours of sleep each night might be beneficial to the individuals.
• No Smoking: Smoking causes increased disease activity and complications in lupus. Quitting is therefore highly advised.
• Infection Control: Always use infection-preventive habits (hand hygiene, staying away from ill individuals, receiving recommended vaccinations). Because infection can cause lupus flare-ups, they must be managed. Vaccinations are to be taken as per advice.
• Trigger Awareness: Be aware of possible personal flare triggers such as specific foods, medications, stress, and fatigue.

When to Consult the Rheumatologist?

This would be the advice given to someone seeking a rheumatologist consultation for the following symptoms that could suggest new-onset Systemic Lupus Erythematosus (SLE) or symptoms that suggest a confirmed diagnosis:

• New Multi-Symptom Onset: Prolonged fatigue, joint pain, rash, fever, or mouth ulcers.
• Persistent Joint Pain or Swelling: Lasting duration pain, stiffness, or swelling of multiple joints.
• Unexplained Skin Rashes: Sun sensitive area or butterfly-shaped rash.
• Abnormal Blood Test Results: A positive ANA test, low white cell count and platelet count, along with high ESR or CRP, are a few tests or having the evidence of autoimmune pathology by the primary care physician.
• Suspected Lupus Flare: Sudden worsening or return of usual symptoms or new concerning symptoms.

Conclusion

The complicated autoimmune condition systemic lupus erythematosus (SLE) necessitates meticulous treatment and a thorough comprehension of its many symptoms. Controlling symptoms, avoiding flare-ups, and reducing long-term organ damage all depend on early diagnosis and regular adherence to a customized treatment plan.

Yashoda Hospitals is a top medical facility that can identify and treat systemic lupus erythematosus. Our rheumatology department is comprised of competent rheumatologists who offer complete care, which includes in-depth assessments, cutting-edge diagnostic procedures, and individualized treatment plans. To meet the various needs of SLE patients, Yashoda Hospitals provides a multidisciplinary approach that combines the knowledge of cardiologists, dermatologists, nephrologists, and other specialists. Our dedication to applying the most recent developments in medicine guarantees that people with lupus receive the best care possible with the goal of enhancing their long-term health and well-being.

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REFERENCES

• https://www.ncbi.nlm.nih.gov/books/NBK535405/
• https://my.clevelandclinic.org/health/diseases/4875-lupus