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Systemic Lupus Erythematosus
What is Systemic Lupus Erythematosus?
Systemic lupus erythematosus (also called SLE or lupus) causes a variety of problems. It may cause skin rashes, arthritis, anemia, seizures or psychiatric illness, and often affects internal organs including the kidneys, lungs and heart. Once a disease with high mortality, SLE is now considered a chronic disease. In 1954, survival after 4 years was 50%; today it is more than 97%.
SLE is a chronic inflammatory disorder resulting from an abnormality of the immune system, which normally functions to protect the body against cancers and invading infections. In SLE, the immune system is over-active and produces too many abnormal antibodies that react with the patient's own tissues. The exact cause of lupus is not known, but heredity, environment and hormonal changes may be involved.
- Prevalence of SLE is 40 to 50 per 100,000.
- It is more common in certain ethnic groups, particularly among blacks.
- More than 85 percent of lupus patients are women.
Because of its wide variety of symptoms, diagnosis is often difficult and requires a high degree of awareness among physicians. Typical features of SLE include:
- A butterfly-shaped rash over the cheeks
- A skin rash appearing in areas exposed to the sun
- Sores in the mouth and nose
- Arthritis involving one or more joints
- Kidney inflammation
- Nervous system disorders including seizures, mental disorders and strokes
Fever, weight loss, hair loss, poor circulation in the fingers and toes, chest pain when taking deep breaths (pleurisy) and abdominal pain are often seen. Laboratory studies are crucial to diagnosing SLE. In particular, the antinuclear antibody (ANA) test is almost always positive in SLE. A precise diagnosis is often appropriately delayed because the disease may evolve gradually.
Treatment for SLE depends on the clinical problems present and whether the disease is active or not at a given time. Earlier and more accurate diagnosis, better understanding of the immune abnormalities in SLE, and treatment studies have all contributed to improved treatment of patients with SLE.
Regular medical evaluation is important to monitor SLE. Drug treatment must be individualized for each patient, depending on the particular problems and their severity. For mild inflammation, nonsterodial anti-inflammatory medications are helpful. Corticosteroids, the single most important drugs to treat SLE, must be used judiciously. Bone protection is important when steroids are used. Anti-malarials such as hydroxychloroquine reduce SLE activity and ar