Systemic lupus erythematosus: what it is, characteristics and symptoms

This autoimmune disease, the most widespread form of lupus, generates many different symptoms.

The human animal shares the planet with beings that could pose a serious threat to its life. Since times lost in oblivion, we have learned to flee from wild and/or huge creatures, natural predators that would wipe us out in the blink of an eye. True "walking dangers" that lurked in the darkness.

Nevertheless, the most implacable killers of the human species are so tiny that they hide from our naked gaze. We are talking about microorganisms, especially viruses and bacteria, whose voracity has led to the extermination of hundreds of millions of people in very sad recent and remote historical episodes.

In order to survive, which is the purpose of existence, the body needs to orchestrate a series of defenses by which to deal with such pathogens when they inadvertently pathogens when they burst unnoticed into the body. Such an army makes up the immune system, a biological battalion of great efficiency and effectiveness.

However, sometimes this same resource (so essential for life) gets "confused" and attacks the organism with unusual virulence. Such is the case of lupus erythematosus such is the case with systemic lupus erythematosus (SLE), the most common form of lupus erythematosus (SLE).the most common form of lupus, and the subject of this article.

What is systemic lupus erythematosus?

Systemic lupus erythematosus (SLE) is an autoimmune disease. an autoimmune diseaseIt is an entity whose origin lies in the altered functioning of the physiological mechanisms by which the body fights against external pathogens or other threats to life (such as parasites, viruses or bacteria).

Thus, the defensive arsenal would be turned against oneself, affecting very disparate organs and functions. In this case, the skin, kidneys, joints and brain would be particularly sensitive. As it turns out, the consequences can be potentially serious and even fatal.

It is estimated that the prevalence of SLE is estimated to be around 35-45 patients per 100,000 people, with a much higher prevalence (4:1:1).It is much more common (4:1) in women than in men (as is the case with other autoimmune diseases such as multiple sclerosis or Sjogren's syndrome). Its course is variable and there may be periods in which it shows more severe symptomatology. Also, despite the diverse clinical expression of SLE, not all signs emerge at the same time, but can appear at any time. Sometimes such a form of presentation makes diagnosis difficult, as its particularities sprout spaced out and hardly "interconnected".

The initial symptoms (which usually occur at puberty, although it could debut even in the vicinity of the fourth decade of life) are fever, fatigue and joint pain; similar to what can be observed during a viral infection (such as the "common" flu). Occasionally a kind of rash may also appear on the face, the shape of which resembles a rash.The shape of the rash resembles that of a butterfly. An earlier onset is suggestive of genetic alterations and extreme rarity, which would require detailed DNA analysis.

Undoubtedly, the most important danger faced by all SLE patients lies in complications involving vital organs. This situation led to the unfortunate circumstance that, a few years ago, practically all of them died within the first decade after diagnosis (since the process is more aggressive and there is an increased risk of serious bacterial infections). At the present time, scientific advances in diagnosis and treatment allow up to 92% to live beyond the first years of the fight against lupus..

Let us see how this disease could be expressed. It is basic to remember that not all symptoms must appear at the same moment, but may appear over time and with different forms of severity.

Systemic lupus erythematosus symptoms

The following are the symptoms of SLE. As noted, this medical condition usually progresses in such a way that not all of the symptoms will always be present with the same intensity, or even be present at the same time.or even be present continuously. Therefore, they most commonly manifest themselves abruptly during acute episodes (or outbreaks), and subside in between. However, it is quite possible that fatigue or skin problems may persist in some form. We proceed to delve into the clinical expression of this disease.

1. Skin alterations

Between 66% and 75% of subjects with SLE have skin problems, half of which worsen during exposure to direct sunlight. The most frequently affected body sites are the face, back, chest and arms. A butterfly-shaped rash is likely to appear on the cheeks or bridge of the nose and is a particularly characteristic symptom of this health condition (in 25% of cases it is the first symptom). In fact, there is the discoid form of SLE, where skin lesions are the cardinal feature.

The most common in such pathology is the sprouting of reddened discs on the skin, with an evident relief to the touch and absence of pain. As time goes by, pigmentation marks may appear where the reddish discs were, as well as scar tissue.. In the cases in which they emerge on the scalp, there are usually areas of depopulated hair that alter the personal appearance and can cause an imbalance in self-image. Other times the person presents calcium deposits under the skin (calcinosis), especially when there is some degree of renal insufficiency.

There are many skin problems in SLE, and they require an exhaustive follow-up by the relevant professionals. It is possible that, with the passage of time, tissue inflammations generate permanent traces and even damage the blood vessels. In these cases one would say that one suffers from vasculitis, which looks like small spots of purplish hues, as well as hematomas of wide distribution in the body. As one enters old age, small blackish spots may appear, especially at the tip of the arms and legs.especially on the tips of the fingers or toes, which would suggest gangrenous process (and require immediate attention).

Other common skin symptoms in SLE are palmar erythema or livedo reticularis (abnormal blood flow leaving a residual bluish tinge, especially on the legs or face) and petechiae, reddish spots caused by thrombocytopenia or platelet shortage. This alteration in blood density is also frequent in SLE, although it does not usually lead to hemorrhage (fortunately).

2. Ulcers

Ulcers are very frequent problems in SLE, especially those located in the oral cavity, but also in the nostrils and vagina. That is, any mucosa of the body can be involved.. In general, these lesions are asymptomatic, although they can cause pain when manipulated (e.g. during brushing). Sometimes they cause open fissures, in which slight bleeding occurs (although it can be copious if combined with low platelet levels).

3. Alopecia

Most people with SLE report that their hair is excessively brittle, so that it breaks even with the slight tugging of an everyday hairstyle. Structural analyses point to a thinning of the diameter of the hairs on the head, which is revealed by low hair density.This is revealed by low hair density and a particularly disheveled appearance. This test (trichoscopy) makes it possible to differentiate this problem from alopecia areata, whose etiology is usually genetic but whose expression is very similar to that of SLE (due to the diffuse extension of hair loss).

In some cases lupus causes "bald patches" of scattered location, but which do not remain for too long (the affected region recovers as the hair follicles regenerate hair). However, recurrent skin alterations, which eventually lead to scarring, do cause irreversible local hair loss. In such a case, the following would be evident the characteristic plaques distributed at various points on the head, which can be a cause for embarrassment or concern..

4. Respiratory problems

SLE can affect the very structure of the lungs, the capillaries that enable blood oxygenation and even the diaphragm (muscle that contributes to ventilation and/or respiration). Most commonly, there is pleuritis, a specific/localized inflammation in the membrane (of serous consistency) covering the lungs. In this case, it is common to report more or less intense chest pain, accompanied by dyspnea (effort to breathe) and shortness of breath. All this is aggravated by laughing, coughing, breathing in deeply or speaking for a long time.

When this inflammation persists, serious problems, such as interstitial lung disease (ILD), are likely to develop. (which is related to scar tissue in these organs, limiting their flexibility and volume) or thromboembolism in the region that irrigates the adnexal tissue (vascular obstruction that limits blood conduction and releases substances resulting from this situation). Likewise, many authors suggest that there could be a greater probability of lung cancer, as well as hemorrhages that require immediate intervention.

5. Fatigue

Fatigue is a common symptom in SLE, to the point of affecting 80% of sufferers and meriting the descriptive "label" of lupus fatigue. It is a very disabling phenomenon, which sometimes has dramatic consequences (forced abandonment of work or other personal responsibilities) and even conditions the emotional experience (increased anxiety and sadness). The latter may be bidirectionally related to fatigue, since it has been assumed that depression also accentuates the loss of energy and/or vitality.

Respiratory disturbances, oxygen restriction or the use of certain drugs are at the root of the problem; they explain why the symptomand explain why the symptom is so prominent in this population, as it is in other autoimmune clinical conditions (such as multiple sclerosis). This fatigue is not always easy to diagnose or to assess, since it would depend solely on the subjective account of the person reporting it (tiredness from early in the day, together with an irresistible need to interrupt activities requiring moderate/intense physical effort and problems in the performance of daily tasks).

6. Sensitivity to sunlight and cold

Exposure to sunlight can cause an exacerbation of the skin problems that patients present, worsening their consequences and their appearance.worsening their consequences and their appearance. It is for this reason that they often avoid direct exposure to ultraviolet light or light emitted by certain artificial (fluorescent) sources, which has an impact on their serum vitamin D levels.

This photosensitivity also causes a high number of people with SLE to suffer from new rashes on particularly sunny days.

Cold weather also has a major impact on people with SLE. During the coldest months of the year, many of them report that their fingers and toes turn blue or white in low temperatures (and also in cold situations). at low temperatures (and also in situations of acute stress), known as Raynaud's Phenomenon. Although it can occur spontaneously in individuals who do not suffer from any disease (primary), it is most commonly associated with some form of peripheral vasculitis (secondary). Its duration is usually about 10-15 minutes.

7. Joint and muscle pain

Inflammation is undoubtedly the underlying factor for the muscle and bone pain that plagues those living with this disease. SLE Arthritis is manifested by pain, warmth, stiffness and swelling (especially at the start of the day). (especially at the beginning of the day) in the small and distal joints of the body (hands, feet, wrists, ankles, elbows, etc.).

Most of the time this involvement is bilateral in nature, although it very rarely degenerates into a structural deformity. With the passing of hours it usually softens somewhat and its effect on activity is reduced. Up to 90% report some problem of this type.

Inflammation of the muscles is also very likely to occur.This contributes to the aforementioned fatigue and leads to intense general weakness. The most common areas affected are the shoulders, arms, thighs, pelvis and neck. This symptom tends to be one of the most disabling in SLE, although it can improve with specific physiotherapy.

8. Neurological involvement

SLE can also have an impact on the central nervous system. Although the exact reasons for this are still unknown, a not inconsiderable percentage of SLE patients report feeling disoriented and having trouble remembering or communicating and have problems remembering or communicating what they think/feel.

These are effects that are expressed in a fluctuating manner, but often constrain basic autonomy and/or reduce quality of life. Moreover, it appears that this cognitive impairment is closely related to fatigue and depression.

On the other hand, migraine-type headache (headache) is up to twice as common among migraine sufferers as in the general population. among sufferers of this disease than in the general population. It is also likely that at some point in the course of the disease the blood vessels in the brain will become severely inflamed, which is a very serious situation. Characteristic symptoms are seizures, rigidity and high fever (hyperthermia); although occasionally psychosis-like processes (hallucinations and delusions) may also break out.

9. Alteration in other organs and systems

Lupus can affect in an extraordinary way the heart, the kidneys, the skin, the brain, the intestines and the lungs.thus becoming a systemic condition requiring the assistance of numerous health care professionals. From heart valve involvement to declining glomerular filtration rate (GFR), the patient with SUI is exposed to a number of risks that he/she must be aware of in order to maintain adequate health.

Renal function replacement therapies (hemodialysis, peritoneal dialysis, etc.) or other intervention strategies on the other potentially affected organs (drugs, surgeries, transplantation, etc.), may be essential during the evolution of SLE.

Bibliographic references:

• Bernknopf, A., Rak, K. and Bailey, T. (2011). A review of systemic lupus erythematosus and current treatment options. Formulary (Cleveland, Ohio), 46, 178-194.
• Martínez-Godoy, M., Oliva Gutiérrez, E., Zapata Zúñiga, M. and Sánchez-Rodríguez, S. (2012). Systemic Lupus Erythematosus: General features, immunopathogeny and relevant antigens. Archives of Medicine, 8(12), 109-132.