Systemic Lupus Erythematosus

Lupus is an autoimmune disease characterized by acute and chronic inflammation of various tissues of the body.  Patients with lupus produce abnormal antibodies in their blood that target tissues within their own body rather than foreign infectious agents. Because the antibodies and accompanying cells of inflammation can affect tissues anywhere in the body, lupus has the potential to affect a variety of areas. Sometimes lupus can cause disease of the skin, heart, lungs, kidneys, joints, and/or nervous system. When only the skin is involved, the condition is called lupus dermatitis or cutaneous lupus erythematosus. A form of lupus dermatitis that can be isolated to the skin, without internal disease, is called discoid lupus When internal organs are involved, the condition is referred to as systemic lupus erythematosus (SLE).  The systemic version of Lupus is considered an Autoimmune Arthritis.

Systemic lupus is more common in women than men (about eight times more common). The disease can affect all ages but most commonly begins from 20 to 45 years of age.

Symptoms of systemic lupus erythematosus

The signs and symptoms of lupus that you experience will depend on which body systems are affected by the disease. But, in general, lupus signs and symptoms may include:

·         Fatigue

·         Fever

·         Weight loss or gain

·         Joint pain, stiffness and swelling

·         Butterfly-shaped rash (malar rash) on the face that covers the cheeks and bridge of the nose

·         Skin lesions that appear or worsen with sun exposure

·         Mouth sores

·         Hair loss (alopecia)

·         Fingers and toes that turn white or blue when exposed to cold or during stressful periods (Raynaud's phenomenon)

·         Shortness of breath

·         Chest pain

·         Dry eyes

·         Easy bruising

·         Anxiety

·         Depression

·         Memory loss

Patients with SLE can develop different combinations of symptoms and organ involvement. Common complaints and symptoms include fatigue, low-grade fever, loss of appetite, muscle aches, arthritis, ulcers of the mouth and nose, facial rash, unusual sensitivity to sunlight, inflammation of the lining that surrounds the lungs and the heart, and poor circulation to the fingers and toes with cold exposure (Raynaud's phenomenon). Complications of organ involvement can lead to further symptoms that depend on the organ affected and severity of the disease.

Most patients with SLE will develop arthritis during the course of their illness. Arthritis in SLE commonly involves swelling, pain, stiffness, and even deformity of the small joints of the hands, wrists, and feet. Sometimes, the arthritis of SLE can mimic that of rheumatoid arthritis.

More serious organ involvement with inflammation occurs in the brain, liver, and kidneys. White blood cells and blood-clotting factors also can be characteristically decreased in SLE.  Inflammation of muscles can cause muscle pain and weakness.   Inflammation of blood vessels that supply oxygen to tissues can cause isolated injury to a nerve, the skin, or an internal organ. The damage blocks the circulation of blood through the vessels and can cause injury to the tissues that are supplied with oxygen by these vessels.

Kidney inflammation in SLE can cause leakage of protein into the urine, fluid retention, high blood pressure, and even kidney failure. This can lead to further fatigue and swelling of the legs and feet.

Involvement of the brain can cause personality changes, thought disorders, seizures, and even coma. Damage to nerves can cause numbness, tingling, and weakness of the involved body parts or extremities. Brain involvement is referred to as lupus cerebritis.

Diagnosing systemic lupus erythematosus
The 11 criteria used for diagnosing systemic lupus erythematosus are:

·         malar (over the cheeks of the face) "butterfly" rash

·         discoid skin rash (patchy redness with hyperpigmentation and hypopigmentation that can cause scarring)

·         photosensitivity (skin rash in reaction to sunlight [ultraviolet light] exposure

·         mucous membrane ulcers (spontaneous ulcers of the lining of the mouth, nose, or throat)

·         arthritis (two or more swollen, tender joints of the extremities)

·         pleuritis or pericarditis (inflammation of the lining tissue around the heart or lungs, usually associated with chest pain upon breathing or changes of body position)

·         kidney abnormalities

·         brain irritation (manifested by seizures and/or psychosis)

·         blood-count abnormalities (low counts of white or red blood cells, or platelets, on routine blood testing)

·         immunologic disorder (abnormal immune tests include anti-DNA or anti-Sm [Smith] antibodies, falsely positive blood test for syphilis, anticardiolipin antibodies, lupus anticoagulant, or positive LE prep test)

·         antinuclear antibody (positive ANA antibody testing) in the blood

In addition to the 11 criteria, other tests can be helpful in evaluating patients with SLE to determine the severity of organ involvement.