Systemic Lupus Erythematosus (SLE), commonly known as lupus, is a chronic autoimmune disease that can affect multiple organ systems in the body. It is characterised by periods of flares and remissions and can range from mild to life-threatening. Understanding lupus involves exploring its symptoms, causes, diagnosis, treatment, and impact on patients’ lives.
Symptoms of Systemic Lupus Erythematosus
The symptoms of SLE can vary widely among individuals and can affect many different parts of the body. Common symptoms include:
General Symptoms
- Fatigue – A profound and persistent tiredness not relieved by rest.
- Fever – Low-grade fever without any apparent cause.
- Weight Loss – Unintentional weight loss.
Musculoskeletal Symptoms
- Joint Pain and Swelling – Often affecting the small joints of the hands, wrists, and knees.
- Muscle Pain – Generalized muscle aches and weakness.
Dermatological Symptoms
- Butterfly Rash – A distinctive rash across the cheeks and nose.
- Photosensitivity – Sensitivity to sunlight, causing rashes or worsening of symptoms.
- Discoid Rash – Circular, scaly rashes on the face, neck, and scalp.
Renal Symptoms
- Lupus Nephritis – Inflammation of the kidneys, leading to blood in the urine, proteinuria, and sometimes kidney failure.
Cardiovascular and Pulmonary Symptoms
- Pleuritis – Inflammation of the lining of the lungs, causing chest pain with deep breathing.
- Pericarditis – Inflammation of the lining around the heart, causing chest pain.
- Raynaud’s Phenomenon – Reduced blood flow to fingers and toes, leading to color changes, numbness, and pain.
Neurological Symptoms
- Headaches – Severe and persistent headaches.
- Seizures – Uncontrolled electrical activity in the brain.
- Psychosis – Severe mental disturbances.
Hematological Symptoms
- Anaemia – Low red blood cell count.
- Leukopenia – Low white blood cell count.
- Thrombocytopenia – Low platelet count, leading to easy bruising and bleeding.
Causes and Risk Factors of Systemic Lupus Erythematosus
The exact cause of SLE is unknown, but it is believed to be the result of a combination of genetic, environmental, hormonal, and immunological factors.
Genetic Factors
- Family History – A higher risk if a relative has lupus or another autoimmune disease.
- Genetic Predisposition – Certain genetic markers are associated with an increased risk of developing lupus.
Environmental Factors
- Infections – Certain viral and bacterial infections can trigger lupus in susceptible individuals.
- Medications – Some drugs can induce lupus-like symptoms, known as drug-induced lupus.
- Exposure to Sunlight – Ultraviolet light can trigger skin rashes and flares.
Hormonal Factors
- Gender – Women are more commonly affected than men, suggesting hormonal involvement.
- Estrogen – Fluctuations in estrogen levels are thought to influence disease activity.
Diagnosis
Diagnosing SLE can be challenging due to its wide range of symptoms that mimic other conditions. A combination of clinical evaluation, laboratory tests, and imaging studies is used to diagnose lupus.
Clinical Evaluation
- Medical History – Detailed questions about symptoms, their duration, and family history.
- Physical Examination – Comprehensive examination to identify characteristic signs such as rashes, joint swelling, and other organ involvement.
Laboratory Tests
- Antinuclear Antibody (ANA) Test – A positive ANA test is found in almost all patients with lupus.
- Autoantibodies – Tests for specific autoantibodies such as anti-dsDNA, anti-Smith, and antiphospholipid antibodies.
- Blood Tests – To assess kidney and liver function, complete blood count, and inflammation markers like ESR and CRP.
- Urine Tests – To detect proteinuria and blood, indicating kidney involvement.
Imaging Studies
- X-Rays – To assess joint and lung involvement.
- Echocardiogram – To evaluate heart function and check for pericarditis.
- Kidney Biopsy – In cases of suspected lupus nephritis to determine the extent of kidney damage.
Systemic Lupus Erythematosus Treatment
There is no cure for SLE, but treatment focuses on managing symptoms, preventing flares, and minimising organ damage. A multidisciplinary approach is often necessary.
Medications
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) – For pain and inflammation management.
- Antimalarials – These medications are commonly used to control mild symptoms and prevent flares.
- Corticosteroids – To reduce inflammation and control severe symptoms.
- Immunosuppressants – These drugs are used to suppress the immune system.
- Biologics – Targeted therapies for patients with refractory lupus.
Lifestyle Modifications
- Regular Exercise – To maintain joint function and overall health.
- Healthy Diet – Balanced diet to support immune function and manage weight.
- Sun Protection – Using sunscreen and protective clothing to prevent photosensitivity reactions.
Monitoring and Follow-Up
- Regular Check-Ups – Frequent organ function and disease activity monitoring.
- Patient Education – Understanding the disease, recognising early signs of flares, and adherence to treatment plans.
Systemic Lupus Erythematosus is a complex and multifaceted autoimmune disease that requires a comprehensive and individualised approach to management. Early diagnosis, effective treatment strategies, and ongoing monitoring are essential to controlling symptoms, preventing flares, and minimising organ damage. While there is no cure, advancements in research and treatment offer hope for better outcomes and improved quality of life for those living with lupus. Education, support, and multidisciplinary care are crucial in managing this challenging disease.
