Systemic Lupus Erythematosus

 

What is Systemic Lupus Erythematosus (SLE)?

Systemic Lupus Erythematosus (SLE) is the name given to a chronic multisystem inflammatory disease. It can also be known as Lupus. SLE can affect many organs, causing a wide variety of symptoms. The severity of symptoms can be mild or severe.

Inflammation is a response of the body to injury or infection. It is driven by the immune system. In SLE proteins called antibodies from the immune system become activated inappropriately and target healthy tissue, SLE is known as an autoimmune disease.

 

Causes of SLE

In the UK, approximately 20,000 people are estimated to be living with SLE with females being up to 12 times more likely to be affected than males. SLE is more common in individuals of African/Caribbean and Chinese origin. Most cases of SLE are diagnosed before the age of 50.

SLE is thought to result from a number of different factors. These are genetic, hormonal and environmental factors that result in the loss of the normal immune system functioning and results in the immune system targeting healthy tissues. The immune system focuses its attack on dying (or apoptotic) cells. In patients with SLE, dying cells, that are usually considered harmless, start to look dangerous. The immune system responds by making small proteins (called antibodies) that bind to the dying cells leading to them accumulating. Over time, antibodies bound to dying cells form immune complexes that activate other immune cells, leading to inflammation. The immune complexes can form in many organs.

Genetic factors:

Hormonal factors:

Environmental factors:

 

Symptoms of SLE

Patients may have a few or several of the following symptoms. They may come and go, and can be precipitated by an infection, which causes a flare of disease activity.

 

Symptoms can include:

 

SLE can also affect the following parts of the body:

 

What are the Possible Complications of SLE?

Flares of SLE can occur at any time but particularly following infection. SLE or its treatment can also increase the risk of:

Untreated, SLE may lead to irreversible organ damage, which may be life threatening. However, regular medication and careful monitoring can reduce the risk of this. It is important to consult your doctor if you have noticed worsening or changes in your symptoms.

 

How do we diagnose SLE?

The doctor will take a detailed history and examine the patient. This will be followed by blood tests and other investigations.

General Blood tests:

Antibody tests:

The doctor may arrange other tests to check the function of the heart, lungs and liver:

 

Treatment

At present, there is no cure for SLE, but many patients can be managed so that organ damage is prevented or minimised, especially if this treatment is initiated in the early stages of the disease.

The outlook for people with SLE has greatly improved due to modern treatments. However, its unpredictable and variable nature can make it difficult to tell how it will affect different individuals. Close monitoring is therefore needed especially during periods of flare.

The aims of treatment are to minimise symptoms, reduce inflammation and prevent organ damage. The drugs may be changed or adjusted as symptoms flare.

 

The following drugs may be used:

 

Lifestyle Measures

 

Disease activity of SLE is monitored using symptoms and blood tests. The most common way to monitor this is using a score such as the SLE disease activity index (SLEDAI).

 

Useful Links

Versus Arthritis:  http://www.versusarthritis.org

Lupus UK: http://www.lupusuk.org.uk

NHS: http://www.nhs.uk/conditions/Lupus/Pages/Introduction.aspx