Lupus

Systemic lupus erythematosus (SLE) is an autoimmune rheumatic disease of unknown cause that affects multiple organs. The presence of autoantibodies provokes cell damage which is correlated with a very varied and very extensive clinic in terms of affected organs. It usually appears between the ages of 20 and 40, in women and more frequently in the black race.

How is it produced?

It is a chronic disease of Unknown cause in which several factors of different types are involved: infectious, hormonal, genetic, chemical and environmental.

A virus has been linked as an infectious agent that could participate in the disease, as well as the fact that it is more frequent in women (up to 90% in women of childbearing age) indicates the hormonal influence that exists. The genetic aspect it is deduced by the higher family incidence of SLE, as well as the higher frequency (up to 3 times more) of SLE in the black race. Some drugs such as procainamide or hydralazine have also been implicated in SLE, as well as ultraviolet radiation as triggers for certain skin lesions.

However, it is thought that all these factors are those that could trigger on a genetically predisposed person, the most important affectation of SLE, which is the disorder of the regulation of immunity, with the deposition of immune complexes in different organs.

Symptoms

The clinical manifestations are very varied, since the deposition of immune complexes can occur in any organ, with general symptoms such as tiredness, loss of weight and appetite, the malaise and fever without apparent cause.

The musculoskeletal symptoms appear in up to 95% of patients and consist of arthromyalgias (joint pain) that usually vary from joint, between intermittent and daily and can affect any joint. Less frequently, arthritis (joint inflammation) may appear with greater involvement of distal joints without causing their deformity and symmetry.

The skin lesions they appear in up to 80% of patients at the onset of the disease. Skin involvement is divided into acute, subacute, and chronic cutaneous lupus. At acute cutaneous lupus the most characteristic lesion is erythema in «butterfly wings«, Which is defined as a reddening of the skin on the cheeks and in the nose. It usually appears in half of the cases, especially after sun exposure. In subacute cutaneous lupus, erythematous, symmetrical lesions appear that usually affect the shoulders, décolleté and arms.

The affectation pleuropulmonary It occurs in half of SLE patients in the form of pleurisy and pericarditis in the case of cardiac involvement.

The kidney involvement It occurs in 50% of patients and its presence constitutes a poor prognostic factor, although the type of kidney injury and severity vary from one patient to another. Along with infections, it is the leading cause of death in SLE.

Diagnosis

It is based on the symptoms and the determination of autoantibodies. There are some classification criteria that reflect the most typical organic conditions and the most significant analytical alterations. For him diagnosis of SLE requires the presence of at least four of them.

SLE classification criteria:

• Malar erythema
• Serositis: pleurisy or pericarditis
• Oral ulcers
• Neurological: seizures or psychosis with no clear cause
• Hemolytic anemia, leukopenia, lymphopenia, or thrombopenia
• arthritis
• Photosensitivity
• Renal involvement: proteinuria
• Antinuclear Antibodies (ANA)
• Immune impairment

Treatment

It is a chronic disease, and although the prognosis has improved, there is no curative treatment. The drugs currently used are: Nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, antimalarials and immunosuppressants. The use of each of them depends on the type and severity of the clinical manifestations.

NSAIDs are used in mild illness, such as arthralgia, fever, fatigue, and mild pleuropericarditis. Cream corticosteroids are used for cutaneous manifestations, but in extensive situations and if accompanied by arthritis, the appropriate treatment is antimalarial drugs (chloroquine). For the serious manifestations (renal, neurological, hematological) corticosteroids are used, which should be restricted to cases of acute outbreaks and then gradually reduce the doses. Immunosuppressants are useful in severe renal cases in which corticosteroids have failed or in which they should be avoided due to their side effects.

As a general rule, in addition to pharmacological treatment, it is recommended to avoid exposure to ultraviolet rays in patients photosensitive, not taking drugs with the capacity to trigger new outbreaks (contraceptives) and monitor situations that can reactivate the disease (infections, surgery, pregnancy).