Lupus

What is Systemic Lupus Erythematosus (SLE)?

Lupus, or systemic lupus erythematosus, is a chronic autoimmune disease in which cells and immunoglobulins of the immune system mistakenly attack normal parts of the body. What causes this disease is not known exactly, and almost any organ can be involved, although there is a predisposition for the skin, joints, lungs, and kidneys.  

This disease has a strong tendency to affect women. The management of this illness has been revolutionized over the last 20 years with much better outcomes, and therapies are continuously being studied.

People who have SLE can suffer from chronic fatigue, fever, weight loss, skin rashes, and other distressing symptoms that vary among patients. One potential complication of SLE is vasculitis, an inflammation of the blood vessels. It can cause thickening or narrowing, weakening, and scarring of blood vessels that support all organs. This can lead to tissue and organ damage. 

Raynaud’s phenomenon can also affect people who have SLE. With Raynaud’s, the arteries are predisposed to spasm. This generally occurs on exposure to cold, but stress and some medications may trigger episodes of Raynaud’s as well. 

The arterial spasms can lead to decreased circulation predominantly in the hands and feet where there is a classic color change: pale, purple followed by bright red. Treatment involves careful protection from the cold, medications that relax blood vessel spasm and if needed, immunosuppression.

Raynaud’s can also be associated with scleroderma and CREST Syndrome. In the past, the treatment for this group of illnesses was predominantly based on the symptoms and dependent on the specific organs involved; now, for the first time, therapies specifically approved for scleroderma have become available.

SLE can be mild or become serious. Patients are likely to have flare-ups when the symptoms worsen, with periods of remission in between when symptoms lessen.

What causes SLE?

SLE is an autoimmune disease. That means that the immune system is not working as it should. Autoimmunity is a general term that refers to the condition when the body's immune system becomes overactive. The immune system is the part of the body that fights infection and plays an important role in keeping the body healthy.  With autoimmune diseases, the immune system mistakenly attacks the body and, depending on which organ is affected, results in a unique set of symptoms. Autoimmune diseases include a wide range of conditions and are generally treated by rheumatologists.

The reasons why some people get SLE are not clear. Research shows that there could be genetic, environmental, and biological influences that make some people more prone to developing lupus.

How is SLE treated?

SLE is incurable, but well-managed treatment regimes can be highly effective in preventing organ damage and reducing symptoms. Suppressing the overactive immune response is key to managing SLE, and there are a variety of medications available to achieve this.

Anti-malarial drugs like hydroxychloroquine are usually given to help reduce the effects of SLE symptoms such as:

• Arthritis
• Fatigue
• Rashes
• Mouth sores

Hydroxychloroquine also helps prevent flare-ups of SLE symptoms.

corticosteroids and immune suppressant medications are also utilized particularly if SLE affects specific organs.  Kidney, lung, central nervous system, and heart problems are all potentially serious issues.

In addition to hydroxychloroquine and corticosteroids, patients may benefit from taking the biologic medication belimumab, which can be particularly effective in treating mild but active cases of lupus. Another biologic therapy not infrequently used is Rituximab. Methotrexate and mycophenolate are immunomodulators that can be used in SLE as well.

To learn more about lupus and how to manage the condition, call Sergio Schwartzman, MD, today.