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Systemic lupus erythematosus (SLE)

 Systemic lupus erythematosus (SLE)



Systemic lupus erythematosus (SLE) is a chronic autoimmune disease in which the body's immune system mistakenly attacks healthy tissue, causing widespread inflammation. This inflammation can damage multiple organ systems, including the joints, skin, kidneys, brain, heart, and lungs

No two cases of SLE are identical, with the disease course fluctuating between periods of mild or no symptoms (remission) and periods of increased symptoms (flares).

Symptoms

The symptoms of SLE can vary widely, depending on which part of the body is affected. 

Common symptoms include:

Constitutional: Persistent fatigue, unexplained fever, and weight loss.

Joint and Muscle: Pain, stiffness, and swelling, often in the fingers, hands, wrists, and knees. In most cases, it does not cause permanent joint damage.

Skin:

Butterfly rash: A characteristic rash across the cheeks and bridge of the nose, occurring in about half of all people with SLE.

Photosensitivity: Skin lesions or rashes that appear or worsen with sun exposure.

Discoid rash: Raised, red patches that can cause scarring.

Oral ulcers: Sores in the mouth or nose that are typically painless.

Neurological: Headaches, confusion, memory loss, dizziness, and, in severe cases, seizures.

Renal (Kidney): Swelling in the legs, feet, or ankles due to lupus nephritis, an inflammation of the kidneys.

Cardiovascular: Chest pain due to inflammation of the heart's lining (pericarditis), heart muscle (myocarditis), or arteries.

Pulmonary (Lungs): Chest pain and shortness of breath due to inflammation of the lining surrounding the lungs (pleurisy).

Circulatory: Fingers and toes turning white or blue in response to cold or stress (Raynaud's phenomenon) and an increased risk of blood clots.

Blood abnormalities: Anemia and low white blood cell or platelet counts. 

Causes and risk factors

The exact cause of SLE is unknown, but it is believed to result from a combination of genetic, hormonal, and environmental factors. 

Genetics: Certain gene mutations may increase the likelihood of developing lupus. It can run in families, but having a family member with lupus does not guarantee you will develop it.

Hormones: The disease disproportionately affects women, especially during their childbearing years, suggesting a hormonal link, particularly with estrogen.

Environmental triggers: Factors that can trigger lupus flares include:

Sunlight exposure

Infections

Certain medications, including some blood pressure medications, anti-seizure drugs, and antibiotics

Cigarette smoking 

Diagnosis

Because its symptoms often mimic other diseases, diagnosing SLE can be challenging. A rheumatologist will use a combination of physical examination, clinical history, and laboratory tests to make a diagnosis. 

Antinuclear antibody (ANA) test: Most people with lupus have a positive ANA test. However, a positive result alone is not enough for a diagnosis, as healthy people can also test positive.

Anti-double-stranded DNA (anti-dsDNA) test: This specific antibody is highly predictive of SLE.

Other blood tests: These check for specific antibodies, such as anti-Smith (anti-Sm) and antiphospholipid antibodies, and can also measure inflammation (e.g., erythrocyte sedimentation rate) and complement protein levels, which are often low in active lupus.

Urine tests: These check for kidney involvement, such as excess protein or blood in the urine.

Biopsies: A kidney or skin biopsy may be performed to confirm a diagnosis and assess the extent of organ damage. 

Treatment and management

There is no cure for SLE, so treatment focuses on managing symptoms, reducing flares, and minimizing organ damage. 

Medications:

Nonsteroidal anti-inflammatory drugs (NSAIDs): For pain and swelling in mild cases.

Antimalarials: Hydroxychloroquine (Plaquenil) is a cornerstone of treatment that helps control symptoms and prevent flares.

Corticosteroids: For serious inflammation and disease activity.

Immunosuppressants: Used for severe cases involving major organs to suppress the immune system.

Biologics: Medications like belimumab and anifrolumab specifically target parts of the immune system to reduce lupus symptoms.

Lifestyle management:

Sun protection: Avoid excessive sunlight and use high-SPF sunscreen, as UV light can trigger flares.

Regular exercise: Activities like walking, swimming, and yoga can help with joint pain and fatigue.

Diet: Eating a healthy, balanced diet is recommended.

Stress management: Relaxation techniques can help reduce stress, a known trigger for flares.

Avoid smoking: Smoking can worsen lupus symptoms, particularly affecting the heart and blood vessels.

Pregnancy planning: Women with SLE who wish to become pregnant should consult their doctor to plan for pregnancy during periods of low disease activity to reduce risks.

Type of Doctor Department : A Rheumatologist


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