Systemic Lupus Erythematosus (SLE)

Lupus, which means “wolf” in Latin, refers to the destructiveness of wounds on the skin. Systemic lupus erythematosus (SLE) or generalized lupus rash, with its full name, is the most common type of butterfly disease-related disease. It can affect the entire organism. The main structures damaged; are serous membranes with skin, joints, kidneys, and two layers of the mesothelium (parietal and visceral membranes). It can be described as a war waged by the body against itself1,2,3.

There are two types of lupus:

  • Systemic Lupus Erythematosus (SLE)
  • Discoid Lupus Erythematosus (DLE)

Discoid Lupus Erythematosus (DLE) does not affect the internal organs, but there is sensitivity to the sun. Discoid (round) skin lesions are found. Its treatment is the same as for SLE3.

Table: Systemic lupus erythematosus (SLE) classes for classification.

To be classified as a lupus patient (not a diagnostic criterion), it must have at least four of the above criteria4.

The Cause of the Disease

The main cause of the disease is CRP (C reactive protein). CRP is a protein produced in the liver. In the case of inflammatory reactions, the amount of the body increases. The DNA histone stimulates the path of the immune system that adheres to the residues of the cell membrane. Macrophages and lymphocytes recognize CRP, and antigens are recognized. Since the immune system recognizes its antigen, it develops tolerance against its antigens. It can be seen as a war that the body opens against itself. It means that high CRP levels are an infection in the body, and the decrease in the CRP level is reduced. Normal CRP level is below 4.9 mg/L.

It is more common in women, blacks, Hispanics, East Asia, and the Americas. Environmental factors also include the causes of the disease. Viruses (Epstein Barr virus (EBV)), ultraviolet light, and drugs are important risk factors1,2,3,5,6.

Figure: Butterfly-shaped rashes on the cheeks and nose are one of the symptoms of lupus.

Disease Symptoms

Symptoms include fatigue, joint swelling, fever, weight loss, boil-like sores, hair loss, photosensitivity, and butterfly-shaped rashes covering the cheeks and nose. The severity of the disease can vary from individual to individual. In some, it is quite mild, while in others it has a lethal effect. Blood cell destruction and heart valve disease are also seen in a small proportion of patients. Kidney failure is a major cause of death. Glomerulonephritis, vasculitis, and interstitial nephritis may be encountered in 3/4 of the patients6.

Treatment of the Disease

Antinuclear antibody (main) test, anti-DSDNA, and anti-ENA tests are performed. It is a multisystemic autoimmune disease that cannot be treated completely, flaming and extinguishing in certain periods. Therefore, immunosuppressive drugs are used to suppress the effects and prevent the onset of organ damage. Hydroxychloroquine (HCQ) is a lysomotropic drug. It can reduce organ damage and prevent the thrombotic effects of antiphospholipid antibodies3,6.

Conclusion

Lupus is an autoimmune disease that can have serious consequences but has no definitive cure. These patients should not forget to use medication and sunscreens with SPF 50 and above. In addition, psychological treatment is recommended for the patient.

References

  1. SLE Kumar V, Abbas AK, Aster JC. Robbins and Cotran Pathologic Basis of Disease. 9th edt., Elsevier Saunders, Philadelphia, 2015 23.01.2023 – 22.00
  2. Systemic lupus erythematosus Virella G. Medical Immunology, 7th Edition. CRC Press, Boca Raton (FL), 2020 23.01.2023 – 21.33
  3. Lupus Anonymous https://www.avrasyahospital.com.tr/bagisiklik-sisteminin-gardini-dusuren-hastalik-lupus/ 24.01.2023 – 22.05
  4. Assessment of patients with systemic lupus erythematosus and the use of lupus disease activity indices Griffiths B, Mosca M, Gordon C, Best Practice & Research Clinical Rheumatology (2005) 19(5) 685-708 23.01.2023 – 21.22
  5. The Role Of Viruses In Etiopathogenesis Of Systemic Lupus Erythematosus Artim-Esen B. The relationship between systemic lupus erythematosus and Epstein-Barr virus infection. Specialization Thesis 2004. 23.01.2023 – 21.29
  6. Lupus Acıbadem Web and Editorial Board https://www.acibadem.com.tr/ilgi-alani/lupus/#tani-yontemleri 24.01.2023 – 21.11

Figure Reference: https://www.cnnturk.com/saglik/lupuskelebek-hastaligi-nedir-belirtileri-nelerdir-nasil-bulasir-lupus-hastaligi-tedavisi-var-mi

Inspector: Ayşenur DURU

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