Systemic lupus erythematosus
Systemic lupus erythematosus (SLE) is an autoimmune disease in which the body’s immune system mistakenly attacks healthy tissue. It can affect the skin, joints, kidneys, brain, and other organs.
SLE is much more common in women than men. It may occur at any age, but appears most often in people between the ages of 10 and 50. Symptoms vary from person to person, and may come and go. Almost everyone with SLE has joint pain and swelling. Some develop arthritis. The joints of the fingers, hands, wrists, and knees are often affected.
Other common symptoms include:
- Chest pain when taking a deep breath
- Fever with no other cause
- General discomfort, uneasiness, or ill feeling (malaise)
- Hair loss
- Mouth sores
- Sensitivity to sunlight
- Skin rash. A “butterfly” rash in about half people with SLE. The rash is most often seen over the cheeks and bridge of the nose, but can be widespread. It gets worse in sunlight.
- Swollen lymph nodes
Other symptoms depend on which part of the body is affected:
- Brain and nervous system: headaches, numbness, tingling, seizures, vision problems, personality changes
- Digestive tract: abdominal pain, nausea, and vomiting
- Heart: abnormal heart rhythms (arrhythmias)
- Lung: coughing up blood and difficulty breathing
- Skin: patchy skin color, fingers that change color when cold (Raynaud phenomenon)
- Kidney: swelling in the legs, weight gain
Exams and Tests
To be diagnosed with lupus, you must have 4 out of 11 common signs of the disease. Nearly all people with lupus have a positive test for antinuclear antibody (ANA). However, having a positive ANA alone does not mean you have lupus in most cases.
The health care provider will do a physical exam and listen to your chest. An abnormal sound called a heart friction rub or pleural friction rub may be heard. A nervous system exam will also be done.
Tests used to diagnose SLE may include:
You may also have other tests to learn more about your condition. Some of these are:
- Antinuclear antibody (ANA) panel
- Complement components (C3 and C4)
- Coombs’ test – direct
- Kidney function blood tests
- Liver function blood tests
- Rheumatoid factor
- Antiphospholipid antibodies
- Kidney biopsy
There is no cure for SLE. The goal of treatment is to control symptoms. Severe symptoms that involve the heart, lungs, kidneys, and other organs often need treatment from specialists.
Mild forms of the disease may be treated with:
- NSAIDs for joint symptoms and pleurisy (Talk to your provider before taking these drugs.),
- Low doses of corticosteroids such as prednisone
- Corticosteroid creams for skin rashes
- A drug also used to treat malaria (hydroxychloroquine) and low-dose corticosteroids for skin and arthritis symptoms
- A biologic drug named belimumab may be helpful in some people.
Treatments for more severe SLE may include:
- High-dose corticosteroids
- Immunosuppressive drugs (drugs which dampen or suppress the immune system): These medicines are used if you do not get better with corticosteroids, or if your symptoms get worse when you stop taking them. Side effects from these drugs can be severe, so you need to be monitored closely if you take them. These drugs include methotrexate, azathioprine, cyclosporine, mycophenolate and cyclophosphamide.
If you have SLE, it is also important to:
- Wear protective clothing, sunglasses, and sunscreen when in the sun.
- Get preventive heart care.
- Stay up-to-date with immunizations.
- Have tests to screen for thinning of the bones (osteoporosis).
The following organizations are good resources for information on systemic lupus erythematosus: