Systemic Lupus Erythematosus (SLE): Treatment, symptoms, advice and help

About Systemic Lupus Erythematosus (SLE)

SLE is a chronic inflammatory disorder that involves multiple body systems and exhibits a wide spectrum of clinical manifestations.

Systemic Lupus Erythematosus (SLE): Incidence, age and sex

SLE is one of most common connective tissue diseases. Its prevalence varies according to geographical and racial background from 3/10,000 in Caucasians to 20/10, 000 in Afro-Caribbeans. Around 90% of affected individuals are women, and the peak age at onset in between 20 and 30 years.

Signs & symptoms of SLE: Diagnosis

Patients often have non-specific symptoms such as fever, weight loss fatigue, malaise and fibromyalgia like symptoms. Arthritis, arthralgia and Raynaud’s phenomenon. Raynaud’s is common and may pre-date other symptoms by months or years. Rash is common in SLE and is classically precipitated by exposure to UV light. Mouth ulcers may occur, which may or may not be painful. The diagnosis is based on a combination of clinical features and laboratory abnormalities. Patients should be screened for ANA. Anti-ds DNA antibodies are characteristic of severe active SLE but occur in only around 30% of cases. Similarly, patients with active disease tend to have low levels of C3 and C4. A raised ESR, leucopenia and lymphopenia are typical of active SLE, along with anaemia, haemolytic anaemia and thrombocytopenia.

Causes and prevention of SLE

The cause of SLE is incompletely understood but genetic factors play an important role. The characteristic features of SLE are the production of auto-antibodies, leading to widespread vasculitis and organ damage. Immune complex formation is thought to be an important mechanism of tissue damage in active SLE.

Environmental factors such as ultraviolet (UV) light, pregnancy and infections may often cause flares of lupus.

SLE: Complications

Renal involvement is one of the main determinants of prognosis and regular monitoring of urinalysis and blood pressure is essential. Cardiovascular features such as pericarditis, myocarditis and Libman-Sacks endocarditis may also occur. Neurological features like fatigue, headache and poor concentration are common, and often occur without laboratory evidence of active disease. More specific features of cerebral lupus include visual hallucinations, chorea, organic psychosis, transverse myelitis and lymphocytic meningitis.

Haematological features like neutropenia, lymphopenia, thrombocytopenia and haemolytic anaemia are common. Mesenteric vasculitis is a serious complication which can present with abdominal pain, bowel infarction or perforation.

SLE: Treatment

Patients should be advised to avoid sun and UV light exposure and to employ sun blocks. Patients with mild disease restricted to skin and joints can be managed satisfactorily with analgesics and/or NSAIDs and if necessary hydroxychloroquine (200- 400mg daily). Life threatening disease affecting the kidney, CNS or cardiovascular system required high – dose steroids and immunosuppressives. Mycophenolate mofetil (MMF) has been used successfully in combination with high-dose steroids for renal involvement in SLE. Lupus patients with the antiphospholipid-antibody syndrome, who have had previous thrombosis, require life-long warfarin.