Systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a connective tissue disease characterized by a violation of the immune system, in which it begins to perceive its own cells as foreign and destroy them. Because of this pathological process, various substances appear in the body that damage joints, skin, blood vessels, and internal organs.

The content of the article:
Development and causes of systemic lupus erythematosus
Clinical picture of systemic lupus erythematosus
Diagnosis of systemic lupus erythematosus
Treatment of systemic lupus erythematosus
Medical treatment
Systemic lupus erythematosus (SLE)
The disease got its name because of the most pronounced sign – redness of the cheeks and the bridge of the nose. The disease can be accompanied by serious complications that can cause the death of the patient:

myocardial infarction;
cardiosclerosis;
pericarditis;
heart defects;
jade;
liver failure;
pulmonary hypertension;
intestinal gangrene.
Development and causes of systemic lupus erythematosus
The causes of this disease are still the subject of research. There is an opinion that the trigger for the occurrence of this disease is a virus. In the course of research, it was also found that women get sick much more often (ten times more). This is due to the specific properties of their hormonal system (high levels of estrogens in the blood). It is believed that the development of the disease can cause an infection (bacterial or viral) to affect the body.

Systemic lupus erythematosus can be triggered by impaired functioning of immune cells, which leads to the active production of antibodies attacking the body’s own cells. Due to the excessive creation of antibodies in the body, immune complexes are formed, which settle in the kidneys, skin, membrane internal organs and cause an inflammatory reaction.

Clinical picture of systemic lupus erythematosus
The symptoms of systemic lupus erythematosus are very diverse, since it affects almost all systems of the body. As a rule, the disease is accompanied by several common signs: fatigue, fever, weight loss, fatigue and a significant decrease in performance.

Skeletal apparatus. Patients with SLE often experience muscle pain, muscle inflammation and muscle weakness. Due to inflammation or prolonged treatment with hormonal drugs, patients may experience osteoporosis – a change in bone density. A symptom of SLE is also arthritis — inflammation of the joints. This sign of pathology occurs in 90% of all cases. At the same time, arthritis often affects the joints of the wrist, fingers, and knee joints.
Skin and mucous membranes. Various manifestations of the disease on the skin occur in open areas — neck, face, shoulders. Usually there is a red area on the face that resembles a butterfly. In rare cases, the disease is accompanied by hair loss on the temporal areas. Most patients develop sensitivity to the sun, mucosal lesions occur in 25% of cases.
Respiratory system. Many patients with SLE are often concerned about pulmonary pathologies. The most common problem of the respiratory system is considered pleurisy — inflammation of the mucous membrane that covers the lungs. The disease can also provoke lupus pneumonitis, which is characterized by coughing with blood and shortness of breath. Manifestations of the disease are also considered to be damage to the vessels of the lungs, which causes pulmonary hypertension, as well as an infectious process in the lungs.
The cardiovascular system. Systemic lupus erythematosus can disrupt the work of all structures of the heart, its valves, heart muscle, outer shell, coronary vessels. Most often, patients have a lesion of the serous membrane covering the heart muscle (pericarditis). This pathology is accompanied by dull pain in the sternum area, accumulation of fluid in the pericardial cavity. Patients may also develop myocarditis (inflammation of the heart muscle), which is characterized by a violation of the heart rhythm and heart failure.
Kidneys. Kidney damage is considered the most common symptom of SLE. Signs of kidney dysfunction often include mebranous nephritis and proliferative glomerulonephritis.
CNS. Various pathologies of the central nervous system appear due to disorders of the cerebral vessels. The most common manifestations of central nervous system disorders are: migraine and headache, encephalopathy, paranoia, hallucinations, myelopathy, brain stroke, mononeuritis, meningitis.
Digestion. In patients with SLE, there is a violation of swallowing, esophageal lesion, stomach ulcer, pain and discomfort, nausea.
The circulatory system. Manifestations of SLE can be a decrease in red blood cells in the blood (leukopenia), a decrease in blood platelets (thrombocytopenia), an increase in lymph nodes.
Diagnosis of systemic lupus erythematosus
The diagnosis is based on the results of laboratory tests and instrumental studies. Of great importance in the diagnosis of the disease are its leading symptoms. Namely, the diagnosis is made in the presence of at least 4 out of 11 symptoms: arthritis, discoid rashes, mucosal lesions, photosensitization, rash on the cheeks and nose, kidney damage, serous membranes, violation of blood systems, increased levels of specific antibodies, impaired immunity.

Diagnostic tests
To detect systemic lupus erythematosus, the following diagnostic tests are used: Antihistones, ANA, Anti DNA, Anti- Sm, Anti—SSA, Anticardiolipin. A general blood test is also prescribed, which is accompanied by a decrease in leukocytes, platelets and lymphocytes. The presence of the disease may be indicated by the following results of urine analysis: violation of the norm of protein, cylinders, erythrocytes, leukocytes in it. The patient is also prescribed a biochemical blood test. A sudden increase in creatinine in the blood indicates damage to the kidneys, creatine kinase — muscle apparatus, ALAT, ASAT — liver.

Instrumental diagnostic methods
To make a diagnosis, an examination using instrumental methods may be required. In particular, an X-ray of the joints is needed to identify minor changes in them. Computed tomography is prescribed to detect pulmonary embolism and lupus pneumonia. Nuclear magnetic resonance is useful for detecting stroke, vasculitis, CNS lesions. Echocardiography is prescribed to determine the lesion of the heart valves and pericardium, the presence of fluid in the pericardial cavity.

In order for the doctor to be able to make a really accurate diagnosis, additional specific studies may be required. For example, a spinal tap will help to exclude the infectious nature of the disease. A kidney biopsy is prescribed to determine the type of glomerulonephritis, as well as to choose the most appropriate treatment tactics. To differentiate SlE from various dermatological diseases, a skin biopsy is prescribed.

Differential diagnosis
Differential diagnosis of systemic lupus erythematosus is also of great importance. The symptoms of systemic lupus erythematosus are similar to the manifestations of other connective tissue diseases. Namely, SLE must be distinguished from idiopathic dermatomyositis, systemic scleroderma, diffuse fasciitis, Sjogren’s syndrome.

Treatment of systemic lupus erythematosus
Treatment of systemic lupus erythematosus is complex and prolonged. To a greater extent, it is aimed at eliminating the factors provoking it, stopping its development and preventing possible complications. The patient should follow the general recommendations of the doctor: reduce the time spent under the scorching sun, avoid mental and physical overstrain.

Medical treatment
Treatment of systemic lupus erythematosus is medicamental. The treatment program usually provides for the appointment of a whole complex of different drugs. Glucocorticosteroids are considered to be the most effective drugs by right, prolonged use of which significantly extends the patient’s life span and improves its quality.

High efficiency in the treatment of the disease was also shown by drugs from the group of cytostatics:azathioprine, cyclophosphamide, methotrexate. Indications for the appointment of these medications are considered vasculitis, acute lupus nephritis, lightning-fast course of the disease. Complex treatment of the disease also involves the appointment of anti-inflammatory drugs (naklofen, aertal, nimesil, katafast). These drugs are usually prescribed for joint pathologies and high fever.

One of the most innovative methods of treating systemic lupus erythematosus is the appointment of biological drugs. The main advantage of these medications is a limited number of side effects after taking them. They have a targeted effect on the mechanism of pathology formation. The following groups of medications can also be prescribed for the treatment of pathology: anticoagulants (warfarin, heparin), antiplatelet agents (clopidogrel, aspirin), diuretics (hydrochlorothiazide, furosemide), calcium and potassium.

In the case of a very severe course of the disease or ineffectiveness of drug therapy, the doctor may resort to methods of extracorporeal treatment. An effective way to treat SLE is considered plasmapheresis — a method of blood purification, during which part of its plasma is removed along with the antibodies that caused the disease. For the treatment of pathology, hemosorption is also used — blood purification with the help of sorbents.

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