Systemic Lupus Erythematosus

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What is Systemic Lupus Erythematosus

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Chronic autoimmune disease
As occurs in other autoimmune diseases, the immune system attacks the body’s cells and tissue, resulting in inflammation and tissue damage

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What systems can SLE affect?

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Inflammation caused by lupus can affect many different body systems, including joints, skin, kidneys, blood cells, heart and lungs

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Predominant age of SLE development

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Female to Male Ratio: 7:1
Predominant Age: 20-45 (childbearing years

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Four Types of Lupus

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Systemic lupus erythematosus
Discoid lupus erythematosus
Drug-induced lupus erythematosus
Neonatal lupus

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Systemic lupus erythematosus

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can affect nearly any part of the body. Body systems most commonly involved include the skin, joints, lungs, kidneys and blood. When people talk about lupus, they're usually referring to systemic lupus erythematosus

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Discoid lupus erythematosus

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affects only the skin. People with discoid lupus, also called cutaneous lupus, experience a circular rash on the face, neck and scalp. A small number of people with discoid lupus may develop systemic lupus erythematosus, though it isn't possible to predict who will develop the more serious form of lupus.

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Drug-induced lupus erythematosus

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occurs after taking certain prescription medications. Not everyone who takes these medications develops lupus. Drug-induced lupus affects a wide variety of body systems. Signs and symptoms usually go away when the medication is stopped

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Neonatal lupus

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is a rare form of lupus that affects newborn babies. A mother with certain antibodies that are linked to autoimmune diseases can pass them to the developing fetus — even if the mother has no signs or symptoms of an autoimmune disease. The antibodies can cause neonatal lupus. A baby with neonatal lupus may experience a rash in the weeks following birth. Neonatal lupus may last about six months before disappearing

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Risk Factors for SLE

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Sex: more common in women
Age: most often diagnosed between 20-45
Race: more common in African Americans and Asians
Sunlight Exposure
Certain Medications: chlorpromazine, hydralazine, isoniazid, procainimide
EBV
Exposure to Chemicals: mercury and silica

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Symptoms of SLE

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No two cases of lupus are exactly alike
Signs and symptoms may come on suddenly or develop slowly, may be mild or severe, and may be temporary or permanent
Most people with lupus experience episodes called "flares" of worsening signs and symptoms that eventually improve or even disappear completely for a time

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Skin Symptoms of SLE

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Erythematous rash over the malar eminences, generally with sparing of the nasolabial folds (butterfly rash)
Alopecia
Skin lesions that appear or worsen with sun exposure
Raised erythematous patches with subsequent edematous plaques and adherent scales (discoid lupus)
Leg, nasal or oropharyngeal ulcerations
Livedo reticularis: pallor from anemia
Petechiae (from thrombocytopenia)

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Joint Symptoms of SLE

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Tenderness
Swelling
Effusions, generally involving the peripheral joints

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Cardiac Symptoms in SLE

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Pericardial rub (in patients with pericarditis)
Heart murmurs (if endocarditis or valvular thickening or dysfunction)
Chest pain

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Generalized symptoms of SLE

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Fever
Conjunctivitis
Dry eyes
Dry mouth (sicca syndrome)
Oral ulcers
Abdominal tenderness
Decreased breath sounds (from pleural effusions)
Weight loss or gain
Raynaud’s syndrome
Shortness of breath
Easy bruising
Anxiety
Depression
Memory loss

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Diagnosis of Lupus according to the American Rheumatism Association

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Diagnosis can be made by the presence of any four of the following criteria:
Butterfly rash
Discoid rash
Photosensitivity
Oral ulcers
Arthritis
Serositis (pleuritis, pericarditis)
Renal disorder
Neurologic disorder (seizures, psychosis)
Hematologic disorders (hemolytic anemia; leukopenia; lymphopenia; thrombocytopenia)
Immunologic disorder (positive SLE cell preparation; Anti-DNA; Anti-SM; false positive STS known to be positive for 6 months
Abnormal ANA

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Laboratory Tests for dx SLE

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Immunologic: ANA; Anti-DNA antibody; anti-SM antibody; ESR
CBC with diff
Platelet Count (Coomb’s Test if anemia detected)
Urinalysis (24 hour for protein if proteinuria detected)
PTT and anticardiolipin antibodies in patients with thrombotic events
Renal panel to evaluate function

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Imaging Studies for SLE

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CXR: for evaluation of pulmonary involvement like pleural effusions or infiltrates
EKG: eval causes of chest pain
Echocardiogram: screen for significant valvular heart disease (present in 18% of SLE patients); can pick up valvular thickening and dysfunction

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Leading cause of death in persons with SLE

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Infection and
kidney failure