What is systemic lupus erythematosis?
Systemic lupus erythematosus is a very long name for a very complicated autoimmune disease that is more commonly known as SLE or lupus. SLE can affect nearly every organ system in the body. The skin is no exception, and in fact, may be involved in 70-80% of cases, causing sores, ulcers and/or rashes. Because lupus is a multi-symptom disease, it can take years to properly diagnose. Lupus is considered a connective tissue disease and will often “overlap” with other such connective tissue diseases such as scleroderma, now called Progressive Systemic Sclerosis, dermatomyositis, rheumatoid arthritis, and Sjogren’s syndrome. This makes diagnosing lupus very complex. It is common that patients will be diagnosed with some of the above connective tissue diseases or other conditions such as fibromyalgia or chronic fatigue syndrome before being properly diagnosed with lupus.
No definitive test for SLE exists. That being said, the ANA test is one commonly used to identify whether lupus could be a proper diagnosis. Antinuclear antibodies (ANA) are eventually found in more than 98 percent of people with lupus. However, some patients test positive for ANA and do not have lupus, while others who test negative for ANA still may have lupus. There is not one test that will determine a lupus diagnosis, rather the physician will take into account 11 different criteria when making this determination. These are the following:
- Rash on the bridge of the nose and cheeks, often called a butterfly rash
- Raised red patches on the skin, called a discoid rash
- Sensitivity to sunlight or Photosensitivity
- Mouth or nose ulcers
- Heart or lung changes
- Nervous system changes
- Kidney changes
- Blood changes
- Antibodies in DNA
- ANA present in the blood
Lupus often affects many different systems in the body, and therefore, if you do have lupus, the symptoms and signs that you may experience will depend heavily on which part of the body is being affected by the disease, but here is a thorough yet abbreviated list;
- Brain and Nervous System: Persistent and unusual headaches, memory loss, or confusion.
- Ophthalmologic-Eyes: Lupus can damage nerves and blood vessels in the eye, leading to dry or puffy eyes, and increasing sensitivity to light.
- Oral-Mouth: Sores inside the mouth are a common symptom of lupus.
- Dermatologic-Skin: Lupus may cause skin rashes, and is known for its distinctive “butterfly” rash on the face usually over the cheeks and bridge of the nose. These rashes can be exacerbated by sun exposure (photo-sensitivity). You may also experience hives or sores which would also worsen with sun exposure. Sudden and unexplained hair loss could also signify lupus.
- Cardiopulmonary-Lungs: Lupus can damage the lungs through pleurisy and pneumonitis (inflammation), or pulmonary emboli, resulting in shortness of breath and pain in the chest from deep breathing.
- Renal System- Kidneys: About half of systemic lupus erythematosus (SLE) patients will develop some form of kidney inflammation, called lupus nephritis. This inflammation can lead to kidney failure, but like most lupus symptoms the effect on the kidneys is quite variable and hard to predict. Increased protein (showing as blood) in the urine, swelling of the feet and legs, and high blood pressure can be indicators that the kidneys may be affected.
- Gastrointestinal-Stomach & Digestion: Lupus can cause or exacerbate ulcerative colitis, pancreatitis, and liver conditions, resulting in nausea, vomiting, recurring and persistent abdominal pain, bladder infections, and blood in urine.
- Reproductive: Lupus or SLE can cause fertility issues.
- Hematologic-Circulation in the Fingers, Toes, and Tip of the Nose: If your fingers turn white or blue with exposure to cold or during stressful situations, it can be caused by a constricting of the small blood vessels in those areas. This is called Raynaud’s phenomenon, a condition closely associated with lupus.
- Musculoskeletal-Legs, Joints, and Feet: Persistent joint pain and swelling is a common lupus symptom. Legs and feet may also swell.
What are the treatments for SLE?
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Anti-inflammatory medications may relieve some lupus symptoms by reducing the inflammation responsible for the stiffness and discomfort in your muscle, joints, and other tissues.
- Antimalarial drugs-Plaquenil (hydroxychloroquine): Medications commonly used to treat malaria can help control lupus. Side effects can include stomach upset and, very rarely, damage to the retina of the eye. *
- Corticosteroids: Prednisone and other types of corticosteroids can counter the inflammation of lupus. Corticosteroids often produce several long-term side effects — including weight gain, bruising easily, thinning of the bones (osteoporosis), high blood pressure, diabetes and increased risk of infection.
- Immune suppressants: Such as: Belimumab(Benlysta), CellCept (mycophenolate mofetil), Cyclosporine, Cytoxan(cyclophosphamide), Imuran(azathioprine), Methotrexate(Trexall): Drugs that suppress the immune system may be helpful in more serious cases of lupus or cases where the lupus is very active. Potential side effects may include an increased risk of infection, liver damage, decreased fertility and an increased risk of cancer. *
- Various medications for skin conditions related to lupus