Systemic Lupus Erythematosus (SLE): Symptoms, Diagnosis, And Treatment
Systemic Lupus Disorder is a complex disorder of the immune system which can affect many parts of the body. This disorder is caused due to an error in the immune system which leads to the body targeting and attacking itself, in the process causing a lot of damage.
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SLE is usually a disorder that occurs in young women, often during or immediately after pregnancy. It is rare in men, but can be severe. It is also found among the elderly, but predominantly found among young women between 20-30 years of age.
What are the symptoms of Lupus?
Patients with SLE do not have a set pattern of presentation; all patients present with different symptoms. This contributes to the difficulty in diagnosis and the delay in appropriate referral to a specialist.
SLE can result in damage to the skin, which presents as a rash, often seen over the cheeks and sometimes on other areas as well. Patients often report itching on sun exposure and repeated painful mouth ulcers. Joint pains, usually involving the small joints, are noted frequently. Unlike rheumatoid arthritis, it does not result in deformity. However, the findings can be non-specific, and the patient could happen to be evaluated for an unexplained fever.
Although the disease can involve almost every organ of the human body, there are some organs or parts/areas of the body which are commonly affected. It can cause a fall in all the blood cell counts- the red cells, the white cells and the platelets. The can majorly affect the kidney, and if uncontrolled, can result in severe damage, leading on to dialysis. For some patients the disease can affect the brain presenting as fits (seizures), psychiatric disturbances and as a stroke (brain attack). The disease can damage other organs such as heart, lung, eye, and liver; less commonly, but this may be seen.
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How can Lupus be diagnosed?
It is difficult to diagnose Lupus disorder, as the symptoms vary from person-to-person. Testing for this involves detailed blood testing for the presence of “auto-antibodies” like ANA (Antinuclear Antibody) and others, in addition to testing to establish which organs have been affected. The diagnosis is made by a combination of findings based on the clinical interview, examination, and blood testing. Sometimes, kidney biopsy is needed to assess the situation correctly. It is important to note that there are other conditions which may mimic SLE, and can cause confusion, like some viral infections, cancers, especially of the blood system.
How is Lupus treated?
‘Lupus treatment’ has undergone many changes over the years, and is now much better managed. The choice of medicines depends on the organs affected. It can be pretty simple for the ones facing skin and joint problems. Aggressive treatment is required to prevent and arrest the worsening of kidney function in patients who are suffering from Kidney problems. Other organ involvement has to be managed as per guidelines, under the supervision of a qualified rheumatologist.
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It is crucial to note that frequent follow up is required to ensure that the medications give the desired results, and that the patient is not facing any untoward side effects. Some patients’ condition may worsen in spite of treatment, and they may need additional measures. It should also be noted that some patients may have other immune-related disorders co-existing with SLE, which must be assessed and treated immediately.
What are the risk factors associated with Lupus?
Patients with SLE are at risk of suffering because of complications created by disease and their medications. Many of these medications work by weakening the immune system, and the patient is at a higher risk of infection; appropriate steps, including vaccination, may be required. They will also need to be monitored for the development of drug induced complications like diabetes and high blood pressure.
With professional supervision under a rheumatologist, proper follow-up and monitoring with appropriate medical therapy, patients with SLE can expect to have a significant benefit in disease control and quality of life.
Dr Subramanian Swaminathan is a senior consultant- infectious diseases at Gleneagles Global Hospital, Bangalore and Chennai.