• Systemic Lupus Erythematosus (SLE)

    What Is Systemic Lupus?

    David Freeman, MD, examines patient with Lupus symptomsSystemic lupus erythematosus (SLE) is the most common form of lupus, a chronic, autoimmune disease characterized by inflammation of, and damage to, various body tissues.

    In a healthy immune system, white blood cells produce antibodies that protect the body against foreign substances. In people with autoimmune disorders such as systemic lupus, the immune system mistakes the body's healthy tissue for a foreign invader and attacks it.

    Patients diagnosed with SLE have a form of lupus in which several different body systems may be affected. Symptoms can range from mild to severe and tend to differ from one patient to the next. For instance, while one SLE patient may experience symptoms in the skin and joints only, another patient may be affected in major internal organs such as the kidneys, nervous system, lungs and/or heart.

    Most patients with SLE experience periods of more intense disease activity followed by remissions when few or no signs of lupus are present. Although there is currently no cure for lupus, innovative new treatments combined with patient education and ongoing communication with your Lahey health care provider can you help maintain an active lifestyle. 

    Am I at Risk for SLE?

    Although no one understands exactly what causes lupus, researchers believe that a combination of genetic, environmental and possibly hormonal factors may contribute to the development of the disease. Factors that appear to increase one's risk include being  

    • Female
    • Of childbearing age (18 to 45 years, although lupus does occur in young children and older people)
    • Related to someone who has been diagnosed with the disease

    Researchers are also studying the role other factors can play in the development and severity of lupus, including stress, sunlight, certain medications and infectious agents such as viruses. 

    Diagnosing Lupus at Lahey

    Lupus is unpredictable. No two patients have exactly the same symptoms, which is why diagnosing lupus can be difficult.

    The American College of Rheumatology (ACR) has developed guidelines to help doctors classify lupus. If a person has 3 or more of the 11 symptoms listed below, it is likely that the person has lupus (or a similar disorder):  

    • Malar rash, a butterfly-shaped rash across the cheeks and across the bridge of the nose
    • Discoid rash, a scaly, disk-shaped rash on the face, neck and/or chest
    • Sensitivity to sunlight, such as severe rashes or sunburns from minimal sun exposure
    • Sores on the tongue, inside the mouth and/or in the nose
    • Arthritis (pain, stiffness and swelling)
    • Serositis - inflammation of the lining of some organs such as the heart and lungs that can cause painful breathing or shortness of breath
    • Kidney problems - can be detected by a urine sample that shows protein and/or red blood cells in the urine, or by a blood test of kidney function called creatinine; severe cases may be associated with symptoms such as swelling of the legs and feet from protein leaking into the urine
    • Brain or spinal cord problems - in a small percentage of people, seizures or mental problems may develop
    • Blood problems (can include low white blood cell count, low platelet count or anemia)
    • Antinuclear antibodies (these attack the body's own cells)
    • Immune system problems

    Other common early symptoms of lupus may include fever, weakness, fatigue, weight loss, muscle aches, swollen glands, low-grade fever, loss of appetite, hair loss and/or Raynaud's disease, in which fingers, toes and other extremities become extremely sensitive to cold and turn white or blue.

    On your initial visit, your Lahey health care provider will take a detailed medical history and perform a comprehensive physical exam. A blood test may be administered to measure red and white blood cell counts and/or to detect the presence of certain antibodies and/or autoantibodies (antibodies that are directed against the body's own cells). Depending on where in the body you are experiencing symptoms, other tests may be necessary, such as a urinalysis to detect kidney problems or a chest X-ray to view the lungs or heart. 

    Treatment Options

    Your Lahey health care provider will work with you to develop the most effective treatment plan to meet your unique needs.

    Typically, treatment for lupus includes a combination of medications to reduce inflammation and the activity of the immune system, a balance of rest and exercise, and an appropriate diet. If you are experiencing symptoms in major internal organs such as the heart, lungs or kidneys, you may be referred to other specialists at Lahey to ensure that you receive optimal care.

    Medications typically prescribed to treat lupus can include  

    • Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
    • Antimalarial drugs, which interfere with the body's ability to produce antibodies
    • Glucocorticoids, or potent immunosuppressive drugs that reduce inflammation. Other immunosuppressive drugs may be prescribed in conjunction with glucocorticoids to reduce activity of the immune system.

    Further information on systemic lupus

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