Systemic Lupus Erythematosus (SLE)
Systemic Lupus Erythematosus (SLE) is a type of systemic autoimmune disease that happens when your body’s immune system begins to attack your healthy tissues and organs. SLE causes inflammation in many different parts of the body, such as joints, skin, kidneys, blood cells, brain, heart, and lungs. It can be hard to diagnose SLE because the disease symptoms are sometimes similar to those of other diseases. One particular sign that could refer to SLE are rashes that appear in the face. The rash will look like butterfly wings that spread across both sides of the cheeks. However, the rash only occurs in many cases of SLE, but not all SLE cases will have the wings of butterfly rashes.
Some people are born with a tendency for SLE, which means they have more tendency to develop SLE than others. The SLE could be triggered by infections, some drug usage, or sunlight. Although there is no current cure for SLE, there are treatments that help manage the symptoms.
Symptoms of SLE may vary depending on case by case. It may come suddenly or develop over time. SLE symptoms can be mild, or it can be severe. It also can occur temporarily or permanently. Most of the patients with SLE will also have flares, a mild disease that occurs by episodes. Sometimes it will worsen, while other times, it may improve or disappear altogether for a while.
The signs and symptoms will most likely depend on the body systems that are affected by SLE. These are the most common signs and symptoms:
- Pain around the joint, stiffness, and swelling
- Facial rashes with butterfly wings shaped that cover the area of cheeks and nasal bridge, and sometimes rashes may appear elsewhere on the body
- Lesions spread across the skin that tends to worsen with sun exposure
- Raynaud’s phenomenon which is a discoloration of fingers and toes, especially with exposure to cold temperature or from stress
- Difficulty breathing
- Chest pain
- Dry eyes
- Headaches, confusion, and loss of memory
When to consult a doctor
You should seek medical care if there are any symptoms of unexplained rashes, ongoing fever, aches, or fatigue.
SLE is a type of autoimmune disease that occurs when the body’s immune system attacks its healthy tissue. There is a possibility that SLE may result from both genetics and the surrounding environment; however, no one knows for sure what causes SLE. Those people who come with inherited SLE will have a higher tendency to develop the disease when the environment is triggering them. These are some possible triggers of SLE:
- Sunlight – Sun exposure could cause skin lesions for SLE; it sometimes could trigger internal reactions to those who are prone to illness.
- Infections – Infections can trigger SLE or could worsen SLE in some other cases.
- Types of medications – Some types of medications, such as those used to treat blood pressure, anti-seizure, and antibiotics, can trigger SLE symptoms. Those who receive drugs to treat SLE will often get better after they stop with the medication. Sometimes symptoms may continue to appear even if the doctor stops giving the drug treatment; thus, it rarely happens.
Factors that could increase the risks of developing SLE:
- Gender – SLE tends to occur more in women.
- Ages – SLE can affect people of all ages, but will commonly occur with people between the ages of 15 to 45.
It can be challenging to diagnose SLE as each case shows signs and symptoms that will vary. Sometimes, signs and symptoms appear to have some similarities with other diseases. There is not a single specific test that can directly be used with the diagnosis of SLE. Doctors need to use the combination of the blood test, urine test, physical examinations and examine signs and symptoms to help with the diagnosis.
Types of blood and urine tests conducted at the laboratory:
- Full blood count – This is a blood test that measures the red blood cells, white blood cells and platelets, and the amount of hemoglobin, which is a protein in red blood cells. Test results might be able to point out about anemia, which is also common among SLE patients. Additionally, low amounts of white blood cells or platelet might also occur in those with SLE.
- Erythrocyte sedimentation rate – This test helps measure how red blood cells can reach the bottom of a tube in an hour. If red blood cells can settle down to the bottom of a tube faster, it could indicate an SLE. However, the sedimentation rate is not a specific test for only SLE; it could also suggest that you may have other infections, inflammatory conditions, or cancer.
- Kidney and liver test – Since SLE can affect kidneys and liver; blood tests are essential to help determine how kidneys and livers can function.
- Urinalysis – This is a type of urine test that will examine the urine sample and see if the protein level or red blood cells in the urine have been increased or not. If the level increases, it could be because of the effect of SLE on the kidneys.
- Antinuclear antibody test (ANA) – This is a positive test that points out the number of antibodies that your immune system produced. Generally, people with SLE will tend to have positive ANA test results; however, that is not always the case as some people with a positive ANA also do not have SLE. In case your test result shows positive ANA, the doctor may recommend you take another specific type of antibody testing.
Your doctor will recommend these imaging tests if they suspect that SLE starts to affect your lungs or heart.
- Chest X-ray – By undergoing an x-ray of your chest, shadows that show some abnormality may appear. This could indicate fluid or lung inflammation.
- Echocardiogram – The Echocardiogram produces real-time images of the beating heart by using sound waves. The test can also determine if there are other problems with valves or other heart portions.
The use of biopsy to find suitable SLE treatments
The treatments of SLE may vary depending on cases or damages that occur with the body systems. SLE can also cause harm to kidneys. Depending on cases and severity, sometimes it is vital to test kidney sample tissue and use it to determine the most appropriate treatment for you. The sample of kidney tissue can be obtained by using a small incision or with a needle. Sometimes your doctor will use skin biopsy to help confirm the SLE diagnosis that affects the skin.
There are different types of treatments, and each type will vary based on signs and symptoms.
Discuss with your doctor the benefits and risks of each treatment and medication type to find the most suitable treatment for you.
When signs and symptoms of flare begin to subside, there may be a need for you to change medications or medication dosages. These are commonly used drugs to manage symptoms of SLE:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) – Over-the-counter medications can sometimes treat pain, swelling, or fever caused by SLE. Examples of these drugs are naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others). Other stronger NSAIDs require a prescription from the doctor. NSAIDs’ common side effects include bleeding in the stomach, problems with the kidneys, and it is also associated with the risk of heart problems.
- Antimalarial drugs – Hydroxychloroquine (Plaquenil) is a type of medication known to treat malaria. It causes an effect on the immune system, and it can help reduce the risk of developing SLE flares. Common side effects can include discomfort in the stomach area and eye retina damage; however, this is an infrequent side effect. Doctors will recommend regular eye exams when prescribing these medications.
- Corticosteroids – Medicines such as Prednisone and other corticosteroids can help with the inflammation caused by SLE. Steroids such as methylprednisolone (A-Methapred, Medrol) are most likely used to manage severe disease involving the kidneys and brain when given in high doses. Side effects of corticosteroids include weight gain, bruising easily, osteoporosis (or bone thinning), high blood pressure, diabetes, and increased risk of infection. These side effects will increase when corticosteroids are given in higher doses and used in long term therapy.
- Immunosuppressants – Azathioprine (Imuran, Azasan), mycophenolate mofetil (CellCept), and methotrexate (Trexall) are examples of drugs that help repress the immune system. It is often useful for severe SLE cases. Higher risk of infection, liver damage, decreased chance of fertility, and increased cancer risk are the potential side effects of using immunosuppressants.
- Biologics – Belimumab (Benlysta) is a different type of medication that will be administered intravenously. It helps reduce SLE symptoms in some cases. Side effects of biologics may include feelings of nausea, diarrhea, and infections. In rare cases, it could worsen depression.