Systemic lupus erythematosus (SLE) is a very severe, progressive pathological condition that manifests itself in many syndromes and mainly affects young women.
The first signs appear at the age of 15 - 25 - the genetically imperfect immune system of the body does not recognize some of its own cells and activates antibodies against them, causing damage and chronic inflammation organs.
Systemic lupus erythematosus - prognosis for life
In past most of patients died after 2 - 5 years after the first symptoms of the disease. With the possibilities of modern medicine, the prognosis for surviving to old age is quite high.
The duration and quality of life is associated with the severity of chronic organ damage, since with this form of the disease drug therapy works well for all kinds of symptoms. Correct scheme treating systemic lupus erythematosus improves the prognosis for a person's life. Doctors claim that modern medicines give the opportunity to live for more than 20 years after an accurate diagnosis is made.
Symptoms and signs of systemic lupus erythematosus appear depending on the form and speed of the disease. Most people with SLE are full life and continue to work.
In severe acute form, a person often cannot work due to intense joint pain, severe weakness, and neuropsychiatric disorders.
Symptoms of systemic lupus erythematosus, photo
photos of characteristic manifestations of systemic lupus erythematosus
Since with SLE, damage to any organ can be expected, the symptoms are rather blurred, and the signs are characteristic of many diseases:
- an increase in temperature of unknown origin;
- muscle pain (myalgia), fast fatiguability with physical and mental stress;
- muscle pain, headache attacks, general weakness;
- frequent diarrhea;
- nervousness, irritability, sleep disturbance;
- depression.
Specific signs
In addition to common symptoms, lupus erythematosus has many specific symptoms allocated into groups according to the affected organ or system.
Skin manifestations:
- The classic symptom of the disease, which gave it its name - characteristic erythema - reddening of the skin in the form of a "butterfly", which occurs when the capillaries expand, and the appearance of a rash in the area of the bridge of the nose and on the cheekbones. It is noted in every second or third patient. Erythema is also observed on the body, limbs in the form of separate or confluent edematous red spots of various shapes.
- Small hemorrhagic rash (due to bursting small vessels) on the skin of the palms and fingertips.
- On the mucous membrane of the genitals, nose, throat, lips, ulcers, dental aphthae appear.
- Trophic ulcers occur in severe disease.
- Nails become brittle, hair dry, focal hair loss is observed.
Joint problems:
The connective tissue present in the area of the joints is severely affected by lupus, so most patients note:
- Pain in the small joints of the wrists, hands, knees;
- Manifestation of polyarthritic inflammations that pass without destruction of bone tissue (in comparison with rheumatoid arthritis), but with frequent deformities of damaged joints (in every fifth);
- Inflammation and pain in the coccyx and sacrum (mainly in men).
Reaction from the hematopoietic system:
- The detection of lupus LE cells in the blood is a characteristic sign of SLE.
- These cells are altered leukocytes, within which nuclei of other blood cells are found. This phenomenon indicates that the immune system is mistaken, perceiving its own cells as foreign and dangerous, giving a signal to leukocytes to absorb them.
- Anemia, leukopenia, thrombocytopenia (in every second patient), arising from the disease, and because of the drugs taken.
Cardiac activity and vascular system
Many patients have:
- Pericarditis, endocarditis and myocarditis (without revealing signs of infection that provokes such inflammatory diseases).
- Damage to the heart valves with further development disease.
- The development of atherosclerosis.
Nephrology for SLE:
- The development of Lupus nephritis (lupus nephritis) is a pronounced renal inflammation with disruption of the glomeruli and a decrease in renal function (more likely in the acute form of the disease).
- Hematuria (an abundance of blood in the urine) or proteinuria (), proceeding without painful manifestations.
At timely diagnosis and the beginning of therapy, acute renal pathology occurs in only 1 out of 20 patients.
Neurological and mental disorders
Without effective treatment, the likelihood of occurrence is high:
- Encephalopathy (damage to brain cells).
- Convulsive seizures.
- Cerebrovasculitis (inflammation of the vessels of the brain).
- Decreased sensitivity.
- Visual hallucinations.
- Confusion of perception, violation of the adequacy of thinking.
These deviations in the neuropsychiatric sphere are difficult to correct.
Respiratory system
Symptoms of lupus erythematosus appear in the area of the lung system in the form of shortness of breath, painful sensations in the chest when breathing (often - with the development of pleurisy).
Forms of the disease
There are three forms of the disease.
Acute form characterized by:
- abrupt onset, when the patient can name a certain day;
- high fever, chills;
- polyarthritis;
- rash and the appearance of a "lupus butterfly" on the face;
- cyanosis (bluish skin color) on the nose and cheeks.
Within six months, signs of acute serositis (inflammation of the serous membranes of the pericardium, pleura, peritoneum), pneumonitis (inflammation of the lungs with damage to the alveolar walls), neurological and mental disorders, seizures similar to epileptic ones develop.
The course of the disease in acute form is severe. Life expectancy without active therapy is no more than a year or two.
Subacute form begins with manifestations such as:
- general symptoms of lupus erythematosus;
- soreness and swelling of small joints;
- recurrent arthritis;
- cutaneous lesions in the form of lupus erythematosus (ulceration of the skin, scaly, scaly);
- photodermatosis appearing in the neck, chest, forehead, lips, ears.
The undulation of the flow of the subacute form manifests itself quite clearly. For a period of 2 - 3 years, a complete clinical picture is formed.
Noted:
- Persistent paroxysmal headaches, high degree of fatigue.
- Severe heart damage in the form of Liebman-Sachs endocarditis and inflammation of the valves - mitral, aortic, tricuspid.
- Myalgia (muscle pain, even at rest).
- Inflammation of the muscles and muscles of the skeleton with their atrophy - myositis.
- Raynaud's syndrome (blue discoloration or whitening of the skin of the fingertips or feet in cold, stressful conditions), often resulting in death of the fingertips.
- Lymphadenopathy is a pathological enlargement of the lymph nodes.
- Lupus pneumonitis (inflammation of the lungs with SLE, developing in the form of SARS or atypical pneumonia).
- Inflammation of the kidneys, not becoming as severe as in the acute form;
- Anemia, leukopenia (a strong decrease in the number of leukocytes), thrombocytopenia or Welhoff's syndrome (a sharp decrease in blood platelets, which is accompanied by bruises, hematomas on the skin, mucous membranes, bleeding and difficulty stopping bleeding even after minor injuries).
- Increased concentration of immunoglobulins in the blood.
Chronic form
Disease lupus erythematosus, occurring in chronic form, for a long time expressed in frequent polyarthritis, manifestations of lupus erythematosus, lesions of small arteries, Welhoff's syndrome.
During 6 - 9 years of the disease, other organic pathologies (nephritis, pneumonitis) join.
The diagnosis is made on the basis of a set of signs (joint and muscle pain, fever), systemic lupus erythematosus syndromes - Raynaud and Welhoff, and research results.
To make a reliable diagnosis, certain criteria are taken into account that manifested themselves during the patient's illness.
They include:
- Lupus butterfly.
- Photosensitization - increased sensitivity exposed skin to sunlight.
- Discoid lupus, a coin-sized, edematous, scaly rash that leaves scarring.
- Ulcers on the mucous membranes.
- Arthritis with tenderness and swelling of the joints (often symmetrical).
- Serositis or inflammation of the membranes surrounding the heart, lungs, peritoneum, causing difficulty breathing and pain when changing body position.
- Inflammation of the kidneys develops in almost all patients with SLE in mild or severe form. At first, it is detected only by urine tests, detecting blood and protein in it, and by edema of the eyes, legs and feet.
- Neurological manifestations expressed in depressive conditions, acute attacks of headache, memory impairment, concentration of attention, psychosis (severe pathology of the psyche with impaired behavior and perception).
- Pathological changes in blood cells: destruction of red blood cells that carry oxygen (causes anemia), a decrease in the number of leukocytes (leukopenia), platelets with the occurrence of nosebleeds, urinary tract, brain, digestive organs and uterus.
- Immunological disorders: the formation of autoantibodies (antibodies to native DNA), which indicates the development of SLE. An increase in their number indicates the active development of the disease.
- The appearance of SM antibodies, which are detected only in systemic lupus erythematosus. This confirms the diagnosis.
- Antiphospholipid antibodies (ANA) in the blood, directed against cell nuclei are also found in almost every patient.
- Blood complement levels (proteins that kill bacteria and are responsible for regulating the body's inflammatory and immune responses). Low level indicates the progression of the disease,
Laboratory examinations and tests are needed to:
- clarification of the diagnosis;
- determining the organs involved in the disease process;
- monitoring the progression and severity of SLE;
- determining the effectiveness of drug therapy.
There are many tests that measure the effect of lupus on various organs:
- taking an X-ray of the lungs, heart;
- electrocardiogram, echocardiography of the heart;
- definition respiratory function lungs;
- for brain examination - electroencephalography EEG, MRI.
The main goals of complex treatment:
- removal of inflammation and regulation of immune pathology;
- prevention of exacerbations and complications;
- treatment of complications provoked by the intake of immunosuppressants, hormonal and anticancer drugs;
- active treatment of certain syndromes;
- cleansing the blood of antibodies and toxins.
Basic methods:
Pulse therapy, which includes the use of:
- corticosteroids, which are prescribed in the early stages of the disease. All patients are registered in the dispensary so that hormones are used in a timely manner at the very initial manifestations of exacerbation of SLE.
- the use of increased doses of cytostatics (drugs that suppress the processes of growth and development cancer cells), which allows you to quickly get rid of severe symptoms of the disease. The course is short.
The method of hemosorption is the removal of toxins, pathological cells of immune complexes and blood cells from the blood, regulation of hematopoiesis using a special apparatus through which blood is passed through a filter with an absorbent.
- If it is impossible to use steroids, drugs are prescribed that suppress some pathological manifestations central nervous system.
- Immunosuppressants (drugs that suppress abnormal immune responses).
- Drugs that block the action of enzymes that provoke inflammation and help relieve symptoms.
- Non-steroidal anti-inflammatory drugs.
- Mandatory treatment of diseases that cause lupus - nephritis, arthritis, pulmonary pathology... It is especially important to monitor the condition of the kidneys, since lupus nephritis is the most common reason death of patients with SLE.
- All drugs and techniques are used according to strict medical indications in compliance with the dosage regimen and precautions.
- During periods of remission, the dose of steroids is reduced to maintenance therapy.
Complications of SLE
The main complications that SLE provokes:
1. Renal pathologies (nephritis, nephrosis) develop in 25% of patients with SLE. The first symptoms are swelling in the legs, the presence of protein and blood in the urine. Failure of the kidneys to work properly is extremely life-threatening. Treatment includes application strong drugs from SLE, dialysis, kidney transplant.
2. Heart disease:
- pericarditis - inflammation of the heart bag;
- hardening of the coronary arteries that feed the heart due to an accumulation of thrombotic clots (atherosclerosis);
- endocarditis (infection of damaged heart valves) due to hardening of the heart valves, an accumulation of blood clots. Valve transplants are often performed;
- myocarditis (inflammation of the muscle of the heart), causing severe arrhythmias, diseases of the heart muscle.
3. Diseases of the lungs (30%), pleurisy, muscle inflammation chest, joints, ligaments. Development of acute tuberculous lupus erythematosus (inflammation of the lung tissue). Pulmonary embolism - blockage of the arteries by emboli (blood clots) due to increased blood viscosity.
4. Diseases of the blood, life-threatening.
- a decrease in erythrocytes (supplying cells with oxygen), leukocytes (suppressing infections and inflammation), platelets (promoting blood clotting);
- hemolytic anemia caused by a lack of red blood cells or platelets;
- pathological changes in the organs of hematopoiesis.
Although pregnancy with lupus has a high likelihood of exacerbations, most women have a successful gestation and delivery period.
But, if we compare with 15% of miscarriages in healthy expectant mothers, then in pregnant patients with SLE, the number increases to 25%.
It is very important that no signs of lupus should be found six months before conception. And in these 6 months, all medications that can cause dosage form lupus.
The choice of therapy during pregnancy is important. Some SLE medications are discontinued to avoid miscarriage and harm to the fetus.
Symptoms of SLE during pregnancy:
- exacerbations of mild or moderate;
- with the use of corticosteroids there is a high risk of increasing blood pressure, the development of diabetes, kidney complications.
One in four babies from lupus pregnancy are born prematurely, but they do not have any defects. In the future, children also do not show either mental or physical retardation.
Very rarely, children born to women with special antibodies in their blood show some signs of lupus in the form of a rash or a low red blood cell count. But these symptoms are recurrent, and most children do not need treatment at all.
Pregnancy that has arisen unplanned - at the time of exacerbation of the disease - has Negative influence on the fetus and mother, increasing all manifestations of SLE, and creating difficulties with bearing.
Most safe method contraception - the use of diaphragms, caps with contraceptive gels and uterine spirals. It is not recommended to use contraceptive oral medications, the use of medications with a high content of estrogen is especially dangerous.
The autoimmune process leads to inflammation of the vascular walls and various tissues. The course of the disease can be mild. But most people who are diagnosed with the disease must see their doctor regularly and take their medications on a regular basis.
Lupus erythematosus syndrome can accompany systemic organ damage. There are other forms of the disease, for example, discoid, drug-induced lesion or red form of pathology in newborns.
The defeat occurs due to the formation of antibodies in the blood to the body's own tissues. They cause inflammation of various organs. The most common type of such antibodies are antinuclear antibodies (ANA), which react with DNA regions of the body's cells. They are determined when a blood test is ordered.
Lupus is a chronic condition. It is accompanied by damage to many organs: kidneys, joints, skin and others. Their dysfunctions increase in acute period disease, which is then replaced by remission.
The disease is not contagious. More than 5 million people worldwide suffer from it, 90% of them are women. Pathology occurs at the age of 15 - 45 years. She is incurable, but her symptoms can be controlled with medication and lifestyle changes.
Systemic lupus erythematosus
Systemic lupus erythematosus has an autoimmune mechanism of development. B-lymphocytes of the patient ( immune cells) produce antibodies to the tissues of their own body. In addition to direct damage to cells, autoantibodies that combine with autoantigens form circulating immune complexes that are transported with the blood and deposited in the kidneys and walls of small vessels. Inflammation develops.
The process is systemic, that is, violations can occur in almost any organ. Usually the skin, kidneys, headache and spinal cord, peripheral nerves... Clinical manifestations of the disease are also caused by the involvement of joints, muscles, heart, lungs, mesentery, eyes. In a third of patients, the disease causes the development of antiphospholipid syndrome, which in women is accompanied by miscarriage.
The pathology analysis reveals specific antinuclear antibodies, antibodies to cell DNA and Sm antigen. The activity of the disease is determined using a blood test, and therapy mainly depends on it.
Causes of the disease
The exact causes of lupus are unknown. Doctors believe that the onset of the disease is caused by a combination of external and internal factors, including disorders hormonal background, genetic changes and the effects of the environment.
Several studies have examined the relationship between estrogen levels and disease in women. The disease often worsens in the period before menstruation and during pregnancy, when the secretion of these hormones is higher. However, the effect of elevated estrogen levels on the occurrence of lesions has not been proven.
The causes of the disease may be associated with genetic changes, although a specific gene mutation has not been found. The probability of the same diagnosis in both identical twins is 25%, in fraternal twins - 2%. If there are people with this disease in the family, the risk of getting sick in their relatives is 20 times higher than the average.
Symptoms and causes of pathology are often associated with the action external factors:
- ultraviolet irradiation in a solarium or sunbathing, as well as from fluorescent lamps;
- the action of silica dust in production;
- taking sulfa drugs, diuretics, tetracycline preparations, penicillin antibiotics;
- viruses, in particular, Epstein-Barr, hepatitis C, cytomegalovirus and other infections;
- exhaustion, trauma, emotional stress, surgical interventions, pregnancy, childbirth and other causes that cause stress;
- smoking.
Under the influence of these factors, the patient develops autoimmune inflammation in the form of nephritis, changes in the skin, nervous system, heart and other organs. The body temperature usually rises slightly, so the sick do not immediately go to the doctor, and the disease gradually progresses.
Lupus symptoms
Common signs are weakness, lack of appetite, weight loss. The lesion can develop over 2 to 3 days or gradually. At sharp beginning there is an increased body temperature, inflammation of the joints, redness in the form of a butterfly on the face. The chronic course is characterized by polyarthritis, after a few years, with an exacerbation, the kidneys, lungs, nervous system.
The symptoms of lupus erythematosus are much more common in women than in men. The manifestations of the disease occur in young patients. They are associated with immune disorders in which the body produces antibodies against its own cells.
Symptoms of the disease:
- red rash on the face in the form of a butterfly;
- pain and swelling of the joints of the hand, wrist and ankle;
- small skin rash on the chest, rounded foci of redness on the limbs;
- hair loss;
- ulcers at the ends of the fingers, their gangrene;
- stomatitis;
- fever;
- headache;
- muscle pain;
- chest pain when breathing;
- the appearance of pallor of the fingers when exposed to cold (Raynaud's syndrome).
Changes may affect different systems organism:
- kidneys: half of the patients develop glomerulonephritis and renal failure;
- the nervous system suffers in 60% of patients: headaches, weakness, convulsions, impaired sensitivity, depression, impairment of memory and intelligence, psychosis;
- heart: pericarditis, myocarditis, arrhythmias, heart failure, thromboendocarditis with the spread of blood clots through the vessels to other organs;
- respiratory organs: dry pleurisy and pneumonitis, shortness of breath, cough;
- digestive organs: abdominal pain, diarrhea, vomiting, intestinal perforation is possible;
- eye damage can cause blindness within a few days;
- antiphospholipid syndrome: thrombosis of arteries, veins, spontaneous abortion;
- blood changes: bleeding, decreased immunity.
Discoid pathology - more light form diseases accompanied by skin lesions:
- redness;
- edema;
- peeling;
- thickening;
- gradual atrophy.
The tuberculous form of the disease received this name due to the similarity of skin lesions with red. This is another disease, it is caused by Mycobacterium tuberculosis and is accompanied by spots, lumpy skin rashes. Most often, children are sick. This disease is contagious.
Diagnosis of the disease
Diagnosis of lupus erythematosus is carried out taking into account the clinical signs of the disease and laboratory changes.
When examining a general blood test, the following violations are found:
- hypochromic anemia;
- a decrease in the number of leukocytes, the appearance of LE cells;
- thrombocytopenia;
- increase in ESR.
Diagnosis of the disease necessarily includes a urinalysis. With the development of autoimmune glomerulonephritis, erythrocytes, protein and casts are found in it. V severe cases a kidney biopsy is prescribed. The examination includes blood biochemistry with determination of the level of protein, liver enzymes, C-reactive protein, creatinine, urea.
Immunological studies to help confirm the diagnosis:
- antinuclear antibodies are found in 95% of patients, but they are also recorded in some other diseases;
- more accurate analysis for pathology - determination of antibodies to native DNA and Sm antigen.
The activity of the disease is assessed by the severity of the inflammation syndrome. The criteria of the American Rheumatological Association are used to confirm the diagnosis. If 4 out of 11 signs of the disease are present, the diagnosis is considered confirmed.
Differential diagnosis carried out with such diseases:
- rheumatoid arthritis;
- dermatomyositis;
- drug reaction to taking penicillamine, procainamide and other drugs.
Pathology treatment
The disease requires treatment by a rheumatologist. The disease is accompanied by prolonged exacerbations, when signs of inflammation, weakness and other symptoms are expressed. Remission is usually short-lived, but with constant medication, the anti-inflammatory effect of therapy is more pronounced.
How is the disease treated? First, the doctor determines the activity of the autoimmune process depending on the clinical signs and changes in the tests. Treatment for lupus erythematosus depends on its severity and includes the following drugs:
- non-steroidal anti-inflammatory drugs;
- for rashes on the face - antimalarial drugs (chloroquine);
- glucocorticoids inside, in severe cases - in large doses, but in a short course (pulse therapy);
- cytostatics (cyclophosphamide);
- with antiphospholipid syndrome - warfarin under INR control.
After the patient's symptoms of exacerbation pass, the dose of medication is gradually reduced. These drugs are quite effective, but they cause many side effects.
With the development of renal failure, hemodialysis is prescribed.
The disease in children is very rare, but it is accompanied by the defeat of many systems, severe clinical manifestations, crisis course. The main drugs for the treatment of the disease in children are glucocorticoid hormones.
Pathology during pregnancy often increases its activity. It carries the risk of complications for the mother and fetus. Therefore, they continue to take prednisolone, because this medicine does not cross the placenta and does not harm the baby.
Skin form of the disease - more easy option, manifested only by changes in the skin. Antimalarial drugs are prescribed, but if there is a suspicion of a transition to the systemic form, more serious treatment is needed.
Treatment folk remedies ineffective. They can be used as an adjunct to conventional therapy rather for a psychological effect. Decoctions and infusions of such plants are recommended:
- burnet;
- pion;
- calendula flowers;
- celandine;
- mistletoe leaves;
- hemlock;
- nettle;
- cowberry.
Such mixtures help to reduce the activity of inflammation, prevent bleeding, soothe, saturate the body with vitamins.
Lupus videos
Lupus erythematosus is a rather dangerous and, unfortunately, common disease. The situation is complicated by the fact that today the reasons for the appearance this ailment not fully studied, which, accordingly, does not make it possible to find a truly effective medicine.
So what is this disease? Why does it appear? What symptoms are accompanied by? How dangerous can it be? The answers to these questions will be of interest to many.
Lupus erythematosus - what is it?
In fact, today many people are interested in the question of what this disease is. Lupus erythematosus belongs to the group of autoimmune diseases that develop against the background of certain malfunctions immune system... This ailment is accompanied by dystrophy of the connective tissues, and it can affect both the skin and mucous membranes, and all internal organs.
Unfortunately, the causes and mechanisms of the development of this disease are not well understood. However, there are some interesting statistics. For example, women have similar skin diseases diagnosed almost ten times more often than men. Lupus is most common in countries with maritime, humid climates, although people in other climates also suffer from it. People between the ages of 20 and 45 are most susceptible to the disease, although, on the other hand, the symptoms of the disease can also appear in adolescence, and even in infancy.
A bit of history
Lupus erythematosus is a disease that has been known to mankind for centuries. By the way, its name arose in medieval times and in Latin sounded like lupus erythematodes. The fact is that the characteristic butterfly-shaped rash on the face of a sick person was somewhat reminiscent of the marks left after the bite of a hungry wolf.
The first descriptions of this disease in the medical literature appeared in 1828. It was at this time that the French dermatologist Biett described the main skin signs of the disease. And after 45 years famous doctor Kaposi noticed that some patients have not only skin symptoms, but also damage to internal organs. In 1890, the English physician and researcher Osler noted that lupus can occur without the appearance of the characteristic skin rash.
The first tests for the presence of this disease appeared in 1948. But only in 1954, specific antibodies were first discovered in the blood of patients, which were produced by the human body and attacked their own cells. It was these substances that began to be used to develop tests. By the way, in diagnostics, such analyzes are extremely important to this day.
Lupus erythematosus: the causes of the development of the disease
This ailment accounts for approximately 5-10% of chronic skin diseases. And today, many people are interested in questions about why lupus erythematosus occurs, how the disease is transmitted and whether it can be avoided.
Unfortunately, today there are no clear answers to these questions. There are many theories for the development of lupus. In particular, some researchers point to the presence of a genetic predisposition. On the other hand, genes encoding such a disease have never been found. Moreover, the likelihood of developing lupus in a child whose parents suffer from a similar ailment is only 5-10%.
And, of course, this is far from the only factor under the influence of which lupus erythematosus develops. The reasons may lie in the work of the endocrine system. In particular, many women with this diagnosis have increased amount prolactin and progesterone. In addition, the disease often manifests itself during sexual development or during pregnancy.
There is also a theory about infectious origin lupus. For example, the Epstein-Barr virus is often found in patients. And even more recent studies have shown that the genetic material of some bacterial microorganisms can stimulate the production of specific autoimmune antibodies.
Allergic reactions can also be attributed to risk factors, since the ingress of an allergen into the body can lead to signs of lupus. No less dangerous is exposure to ultraviolet radiation, high and too low temperatures.
Therefore, to date, the question of the causes of the appearance of lupus erythematosus is still open. Most scientists believe that this disease develops under the influence of a complex of factors at once.
Disease classification
Lupus erythematosus is a chronic disease. Accordingly, with such an ailment, periods of relative well-being are replaced by exacerbations. Depending on the initial symptoms, v modern medicine there are several forms of this disease:
- The acute form of lupus erythematosus begins quickly - in most cases, patients can even indicate the exact day when the first symptoms appeared. People tend to complain about a rise in temperature, severe weakness, body aches and joint pain. Most often, after 1-2 months, a fully formed clinical picture can be observed in such a patient - there are also signs of damage to internal organs. Often, this form of the disease leads to the death of the patient 1-2 years after the onset of the disease.
- At subacute form disease symptoms are not so pronounced. Moreover, from the moment of their appearance until the defeat of internal systems, it can take more than a year.
- Chronic lupus erythematosus is a disease that develops over the years. Periods of relative well-being of the body can last long enough. But under the influence of certain environmental factors (hormonal disruptions, ultraviolet radiation), the first symptoms begin to appear. In most cases, patients complain of a characteristic rash on the face. But lesions of internal organs with properly selected treatment appear quite rarely.
The mechanism of development of the disease
In fact, the mechanism for the development of this disease is still under study. Nevertheless, some information is still known to modern medicine. One way or another, autoimmune skin diseases are primarily associated with a malfunction of the immune system. Under the influence of one or another factor of the external or internal environment, the body's defense system begins to identify the genetic material of certain cells as foreign.
Thus, the body begins to produce specific antibody proteins that attack the body's own cells. With lupus erythematosus, damage occurs mainly to the connective tissue elements.
After the interaction of the antibody and antigen, the so-called immune protein complexes are formed, which can be fixed in various organs, as they are carried throughout the body along with the blood stream. Such protein compounds cause damage to the cells of the connective tissue of an organ and often lead to the development of an immune inflammatory process.
This is roughly how the mechanism for the development of this ailment looks. Moreover, freely circulating in human blood, immune complexes can provoke the development of thrombosis, anemia, thrombocytopenia and other rather dangerous diseases.
Lupus erythematosus: symptoms and photos
It should be noted right away that the clinical picture with such a disease may look different. So what are the signs and symptoms of lupus erythematosus? The skin form (photo) occurs most often. The main symptoms include the appearance of erythema. In particular, one of the most characteristic features is a butterfly-shaped rash on the face that covers the skin of the cheeks, nose, and sometimes extends to the area of the nasolabial triangle.
In addition, erythema can appear in other places - mainly the disease affects the exposed skin on the chest, shoulders and forearms. The areas of redness can be of various shapes and sizes. As the disease progresses, the affected areas become inflamed, after which edema forms. Eventually, areas of cutaneous atrophy form on the skin, where the scarring process begins.
Of course, these are not the only signs of lupus erythematosus. Occasionally, patients may have characteristic small-point hemorrhages under the skin on the palms or soles of the feet. The disease can also affect the hair - baldness is often added to the problems of patients. Symptoms also include changes in the nail plate, as well as gradual tissue atrophy of the periungual fold.
There are other disorders that accompany lupus erythematosus. The disease (the photo shows some of its manifestations) often causes damage to the mucous membranes of the nose, nasopharynx and oral cavity... As a rule, red but painless sores form first, which then develop into erosion. In some cases, patients develop aphthous stomatitis.
In about 90% of cases, joint damage is observed. Arthritis is another of the pathologies that causes lupus erythematosus. The disease (the photo shows its obvious signs) most often causes inflammation in small joints, for example, on the hands. The inflammatory process in this case is symmetrical, but rarely accompanied by deformities. Patients complain of soreness and a feeling of stiffness. Complications can also include necrosis of the articular tissues, sometimes ligamentous structures are involved in the process.
Lupus erythematosus often affects the connective tissues of the respiratory system. The most common complications include pleurisy, which is accompanied by the accumulation of fluid in pleural cavity, the appearance of shortness of breath and chest pain. In more severe cases, the disease causes pneumonitis and pulmonary hemorrhage. dangerous conditions that require urgent medical attention.
The inflammatory process can also affect the connective tissues of the heart. For example, quite frequent complication is endocarditis, as well as damage to the mitral valve. With such a pathology, inflammation leads to fusion of the valve leaflets. In some patients with lupus, pericarditis is diagnosed, in which there is a significant thickening of the walls of the heart bag and the accumulation of fluid in the pericardial cavity. It is also possible the development of myocarditis, which is characterized by an enlarged heart and the appearance of chest pains.
Lupus can also affect the vascular system. In particular, inflammation is most susceptible to coronary arteries(vessels that feed the heart muscle) and the arteries of the brain. By the way, ischemia and stroke are considered one of the most common causes of early death in patients with systemic lupus erythematosus.
Dangerous complications include lupus nephritis, which often develops into acute or chronic renal failure. Damage to the central nervous system is also common, accompanied by migraines, cerebral ataxia, epileptic seizures, loss of vision, etc.
In any case, you should understand that lupus is an extremely dangerous disease. And at the slightest suspicion, a person should immediately consult a doctor and in no case refuse the therapy proposed by a specialist.
Features of the disease in children
According to statistics, over the past decade, the number of patients with such a diagnosis has increased by almost 45%. In most cases, the disease is diagnosed in adulthood. Nevertheless, the possibility of its development much earlier is not excluded. By the way, lupus erythematosus in children most often begins to develop at the age of 8-10 years, although the appearance of signs at an earlier age is also possible.
The clinical picture in this case corresponds to the course of the disease in adult patients. The first symptoms are erythema, dermatitis, and fever. Therapy is selected individually, but necessarily includes the use of hormonal anti-inflammatory drugs.
With the right treatment and the observance of preventive measures, the life span of a child after the first symptoms appear is from 7 to 20 years. The causes of death, as a rule, are systemic damage to the body, in particular the development of renal failure.
Modern diagnostic methods
It should be noted right away that only a doctor can diagnose lupus erythematosus. Diagnostics in this case is rather complicated and includes a lot various procedures and research. In 1982, a special symptom scale was developed by the American Rheumatological Association. Lupus patients typically have the following disorders:
- Erythema on the face, which is shaped like a butterfly.
- Discoid skin rash.
- Photosensitivity - The rash becomes more pronounced after exposure to ultraviolet light (for example, with prolonged exposure to the sun).
- Painless ulcers on the lining of the nasopharynx or mouth.
- Inflammation of the joints (arthritis), but no deformity.
- Pleurisy and pericarditis.
- Kidney damage.
- Various disorders of the central nervous system.
- Hematologic disorders, including thrombocytopenia or anemia.
- An increase in the number of antinuclear bodies.
- Various disorders in the functioning of the immune system (for example, people with lupus may have a false-positive Wasserman reaction, and no traces of treponema are found in the body).
In order to detect the presence of certain symptoms, various tests will be required. In particular, urine, blood, serotological and immunological studies... If a patient has four or more of the above criteria during the diagnosis process, this in most cases indicates the presence of lupus erythematosus. On the other hand, some patients show no more than 2-3 signs throughout their lives.
Is there an effective treatment?
Of course, many patients are interested in the question of whether it is possible to permanently get rid of a disease called lupus erythematosus. Naturally, there is a cure. And correctly selected therapy allows you to avoid complications and improve the quality of life. Unfortunately, drugs that can permanently rid the body of the disease have not yet been developed.
What does therapy look like? After the diagnosis, the doctor decides whether the treatment can be carried out on an outpatient basis. In turn, the indications for hospitalization are:
- a sharp and persistent increase in body temperature;
- the presence of neurological complications;
- occurrence dangerous complications including pneumonitis and renal failure;
- a significant decrease in the number of blood cells.
Naturally, the therapy regimen in this case is selected individually for each patient immediately after the diagnosis of lupus erythematosus is made. Treatment, as a rule, includes taking steroid anti-inflammatory drugs, in particular, the drug "Prednisolone". Various hormonal ointments or creams ("Elokom", "Fucicort") can be used to eliminate rashes and dermatitis.
For fever and joint pain, the patient is prescribed non-steroidal anti-inflammatory drugs. In some cases, the use of immunomodulatory agents is appropriate. Sometimes patients are advised to take multivitamin complexes. The presence of certain complications requires additional consultation with a specialist of a narrow profile. For example, in case of kidney damage, the patient needs an examination by a nephrologist, who will prescribe adequate treatment in the future.
Basic preventive measures
Today, many patients or their relatives are interested in how to treat lupus erythematosus and whether there is a means to prevent this disease. Unfortunately, there are no drugs that can protect against this ailment. Nevertheless, compliance with some rules helps to slow down the process or avoid another aggravation.
For starters, it is worth noting that in most patients, lupus erythematosus (the cutaneous form of the disease in particular) is exacerbated against the background of overheating or after a long stay under the scorching rays of the sun. That is why experts recommend that people with a similar diagnosis avoid prolonged sunbathing, refuse to visit tanning salons, and in sunny weather protect the skin with clothes, hats, umbrellas, etc.
For some patients, the danger is high fever, so doctors often recommend avoiding saunas, baths, hot production workshops, etc. And before planning a vacation on the seashore, be sure to consult with your doctor.
Since this disease is associated with disorders of the immune system, then, of course, you need to try to avoid allergic reactions. Before using any medicinal and cosmetic product (including even decorative cosmetics), you need to ask your doctor's permission. Diet is also extremely important - highly allergenic foods should be excluded from the diet. And, of course, you need to follow all the doctor's prescriptions, pass on time medical examinations and not give up medication.
lupus erythematosus is a systemic autoimmune disease in which the body's own immune system damages connective tissue in various organs, mistaking its cells for foreign. Due to damage by antibodies of cells of various tissues in them develops inflammatory process, which provokes a very diverse, polymorphic clinical symptoms of lupus erythematosus, reflecting damage in many organs and systems of the body.
Lupus erythematosus and systemic lupus erythematosus are different names for the same disease
Lupus erythematosus currently in the medical literature is also denoted by names such as lupus erythematodes, erythematous chroniosepsis, Liebman-Sachs disease or systemic lupus erythematosus (SLE)... The most common and common term for the described pathology is "systemic lupus erythematosus". However, along with this term, its abbreviated form - "lupus erythematosus" is also very often used in everyday life.The term "systemic lupus erythematosus" is a distorted, commonly used version of the name "systemic lupus erythematosus".
Doctors and scientists prefer the fuller term "systemic lupus erythematosus" to denote a systemic autoimmune disease, since the reduced form of "lupus erythematosus" can be misleading. This preference is due to the fact that the name "lupus erythematosus" is traditionally used to refer to tuberculosis of the skin, which is manifested by the formation of skin reddish brown tubercles. Therefore, the use of the term "lupus erythematosus" to denote a systemic autoimmune disease requires clarification that we are not talking about tuberculosis of the skin.
When describing an autoimmune disease, we will in the following text use the terms “systemic lupus erythematosus” and simply “lupus erythematosus” to denote it. In this case, it must be remembered that lupus erythematosus is understood precisely as a systemic autoimmune pathology rather than skin tuberculosis.
Autoimmune lupus erythematosus
Autoimmune lupus erythematosus is systemic lupus erythematosus. The term "autoimmune lupus erythematosus" is not entirely correct and correct, but illustrates what is commonly called "oil oil". So, lupus erythematosus is an autoimmune disease, and therefore an additional indication in the name of the disease for autoimmunity is simply superfluous.Lupus erythematosus - what is this disease?
Lupus erythematosus is an autoimmune disease that develops as a result of a disorder normal functioning the human immune system, resulting in antibodies are produced to the cells of the body's own connective tissue located in different organs. This means that the immune system mistakes its own connective tissue for foreign, and develops antibodies against it, which have a detrimental effect on cellular structures, thereby damaging various bodies... And since connective tissue is present in all organs, lupus erythematosus is characterized by a polymorphic course with the development of signs of damage to various organs and systems.Connective tissue is essential for all organs, since it is in it that the blood vessels pass. After all, the vessels do not pass directly between the cells of the organs, but in special small, as it were, "cases" formed by the connective tissue. Such layers of connective tissue pass between sections of various organs, dividing them into small lobes. At the same time, each such lobule receives a supply of oxygen and nutrients from those blood vessels that pass along its perimeter in "cases" of connective tissue. Therefore, damage to the connective tissue leads to a breakdown in the blood supply to areas of various organs, as well as to a violation of the integrity of the blood vessels in them.
With regard to lupus erythematosus, it is obvious that antibody damage to connective tissue leads to hemorrhages and destruction of the tissue structure of various organs, which causes various clinical symptoms.
Lupus erythematosus is more common in women, and according to various sources, the ratio of sick men and women is 1: 9 or 1:11. This means that for one man with systemic lupus erythematosus, there are 9-11 women who also suffer from this pathology. In addition, it is known that lupus is more common in the Negroid race than in Caucasians and Mongoloids. People of all ages, including children, get sick with systemic lupus erythematosus, but most often the pathology first appears at the age of 15 - 45 years. Lupus is extremely rare in children under 15 and adults over 45.
There are also known cases neonatal lupus erythematosus when a newborn child is born with this pathology. In such cases, the child fell ill with lupus while still in the womb, who herself suffers from this disease. However, the presence of such cases of transmission of the disease from mother to fetus does not mean that women suffering from lupus erythematosus necessarily have sick children. On the contrary, women with lupus usually carry and give birth to normal healthy children, since the disease is not infectious and cannot be transmitted through the placenta. And the cases of the birth of children with lupus erythematosus, mothers also suffering from this pathology, indicate that the predisposition to the disease is due to genetic factors. And therefore, if a baby receives such a predisposition, then he, while still in the womb of a mother suffering from lupus, becomes ill and is born with pathology.
The causes of systemic lupus erythematosus are currently not reliably established. Doctors and scientists suggest that the disease is polietiologic, that is, it is caused not by any one reason, but by a combination of several factors at once acting on the human body in the same period of time. Moreover, probable causal factors can provoke the development of lupus erythematosus only in people with a genetic predisposition to the disease. In other words, systemic lupus erythematosus develops only in the presence of a genetic predisposition and under the influence of several provoking factors simultaneously. Among the most likely factors that can provoke the development of systemic lupus erythematosus in people with a genetic predisposition to the disease, doctors distinguish stresses, long-term viral infections (for example, herpes infection, infection caused by the Epstein-Barr virus, etc.), periods of hormonal body restructuring, prolonged exposure to ultraviolet radiation, taking certain drugs (sulfonamides, antiepileptic drugs, antibiotics, drugs for the treatment of malignant tumors, etc.).
Although chronic infections can contribute to the development of lupus erythematosus, the disease is not contagious and does not belong to tumor... Systemic lupus erythematosus cannot be contracted from another person; it can only develop individually if there is a genetic predisposition.
Systemic lupus erythematosus occurs in the form of a chronic inflammatory process that can affect almost all organs, and only some individual tissues of the body. Most often, lupus erythematosus occurs in the form systemic disease or in isolated cutaneous form. At systemic form Lupus affects almost all organs, but the joints, lungs, kidneys, heart and brain are most affected. In the cutaneous form of lupus erythematosus, the skin and joints are usually affected.
Due to the fact that a chronic inflammatory process leads to damage to the structure of various organs, the clinical symptoms of lupus erythematosus are very diverse. but any form and variety of lupus erythematosus is characterized by the following general symptoms:
- Soreness and swelling of the joints (especially large ones);
- Long-term unexplained increase in body temperature;
- Rash on the skin (on the face, on the neck, on the trunk);
- Chest pain that occurs with deep inhalation or exhalation;
- A sharp and severe blanching or blue discoloration of the skin of the fingers and toes in the cold or during a stressful situation (Raynaud's syndrome);
- Swelling of the legs and eye area;
- Swollen and tender lymph nodes;
- Sensitivity to solar radiation.
For lupus characterized by the presence of not all symptoms at once, but their gradual emergence over time... That is, at the beginning of the disease, only some of the symptoms appear in a person, and then, as lupus progresses and more and more organs are damaged, new ones join Clinical signs... So, some symptoms may appear years after the development of the disease.
Women with lupus erythematosus may lead sex life... Moreover, depending on the goals and plans, you can both use contraceptives, and vice versa, try to get pregnant. If a woman wants to endure a pregnancy and give birth to a child, then she should register as early as possible, since with lupus erythematosus, the risk of miscarriage and premature birth is increased. But in general, pregnancy with lupus erythematosus proceeds quite normally, albeit with high risk complications, and in the overwhelming majority of cases, women give birth to healthy children.
Currently systemic lupus erythematosus cannot be completely cured... Therefore, the main task of the therapy of the disease, which doctors set themselves, is to suppress the active inflammatory process, achieve a stable remission and prevent severe relapses. To do this, apply wide range medicines. Depending on which organ is most affected, various medicines.
The main drugs for the treatment of systemic lupus erythematosus are glucocorticoid hormones (for example, Prednisolone, Methylprednisolone and Dexamethasone), which effectively suppress the inflammatory process in various organs and tissues, thereby minimizing the degree of their damage. If the disease has led to damage to the kidneys and the central nervous system, or the functioning of many organs and systems at once is disrupted, then in combination with glucocorticoids for the treatment of lupus, immunosuppressants are used - drugs that suppress the activity of the immune system (for example, Azathioprine, Cyclophosphamide and Methotrexate).
In addition, sometimes in the treatment of lupus erythematosus, in addition to glucocorticoids, antimalarial drugs (Plaquenil, Aralen, Delagil, Atabrin) are used, which also effectively suppress the inflammatory process and maintain remission, preventing exacerbations. The mechanism behind the beneficial action of antimalarial drugs for lupus is unknown, but in practice it is well established that these drugs are effective.
If a person with lupus erythematosus develops secondary infections, then he is injected with immunoglobulin. If there is severe pain and swelling of the joints, then, in addition to the main treatment, it is necessary to take medications NSAID groups(Indomethacin, Diclofenac, Ibuprofen, Nimesulide, etc.).
A person suffering from systemic lupus erythematosus should remember that this disease is lifelong, it cannot be completely cured, as a result of which you will have to constantly take any medications in order to maintain a state of remission, prevent relapses and be able to lead a normal life.
Lupus erythematosus reasons
The exact reasons for the development of systemic lupus erythematosus are currently not known, but there are a number of theories and assumptions that put forward as causal factors various diseases, external and internal influences on the body.So, doctors and scientists came to the conclusion that lupus develops only in people with a genetic predisposition to the disease... Thus, the main causal factor is conventionally considered the genetic characteristics of a person, since without a predisposition, lupus erythematosus never develops.
However, in order for lupus erythematosus to develop, one genetic predisposition is not enough, additional long-term exposure to certain factors that can trigger the pathological process is also necessary.
That is, it is obvious that there are a number of provoking factors that lead to the development of lupus in people with a genetic predisposition to it. It is these factors that can be conditionally attributed to the causes of systemic lupus erythematosus.
Currently, doctors and scientists include the following as provoking factors of lupus erythematosus:
- The presence of chronic viral infections(herpes infection, infection caused by Epstein-Barr virus);
- Frequent diseases with bacterial infections;
- Stress;
- The period of hormonal changes in the body (puberty, pregnancy, childbirth, menopause);
- Exposure to high-intensity ultraviolet radiation or for a long time (the sun's rays can both provoke an initial episode of lupus erythematosus and lead to an exacerbation during remission, since under the influence of ultraviolet radiation, the process of producing antibodies to skin cells can be triggered);
- Exposure to the skin of low temperatures (frost) and wind;
- Taking certain medications (antibiotics, sulfonamides, antiepileptic drugs, and medications for treatment malignant tumors).
Medicines, which are one of the causative factors of lupus, can cause both the disease itself and the so-called lupus syndrome... At the same time, in practice, it is lupus syndrome that is most often recorded, which in its clinical manifestations Similar to lupus erythematosus, but not a disease, and resolves when the drug that caused it is discontinued. But in rare cases, drugs can provoke the development of their own lupus erythematosus in people with a genetic predisposition to this disease... Moreover, the list of drugs that can provoke lupus syndrome and lupus itself is exactly the same. So, among the drugs used in modern medical practice, the following can lead to the development of systemic lupus erythematosus or lupus syndrome:
- Amiodarone;
- Atorvastatin;
- Bupropion;
- Valproic acid;
- Voriconazole;
- Gemfibrozil;
- Hydantoin;
- Hydralazine;
- Hydrochlorothiazide;
- Glyburide;
- Griseofulvin;
- Guinidine;
- Diltiazem;
We will investigate the causes and treatment of systemic lupus erythematosus, a difficult diagnosed autoimmune disease, the symptoms of which occur suddenly and can lead to disability and even death within ten years.
What is systemic lupus erythematosus
Systemic lupus erythematosus Is difficult chronic inflammatory disease of an autoimmune nature that affects connective tissue. Therefore, it attacks various organs and tissues, and has a systemic character.
Its autoimmune nature stems from a malfunction of the immune system, which recognizes certain cells in the body as "enemies" and attacks them, causing a strong inflammatory response ... In particular, systemic lupus erythematosus attacks the proteins of the cell nuclei, i.e. structure that preserves DNA.
Inflammatory response brought by the disease affects the functions of the affected organs and tissues, and if the disease is not controlled, then it can lead to their destruction.
Usually, the disease develops slowly, but it can also occur very suddenly and develop as a form acute infection... Systemic lupus erythematosus, as already mentioned, is chronic illness for which there is no cure.
Her development is unpredictable and runs from alternating remissions and exacerbations... Modern methods of treatment, while not guaranteeing a complete cure, make it possible to control the disease and allow the patient to lead an almost ordinary life.
The most at risk of developing the disease are representatives of ethnic groups in the African Caribbean.
Lupus Causes: Only Risk Factors Known
Everything causes that lead to the development of systemic lupus erythematosus, - unknown... It is assumed that there is no one specific reason, and the complex influence of various causes leads to the disease.
However, known factors predisposing to the disease:
Genetic factors... There is a predisposition to the development of the disease, recorded in the genetic characteristics of each person. This predisposition is due to mutations of some genes that can be inherited or acquired from scratch.
Of course, the possession of genes that predispose to the development of systemic lupus erythematosus does not yet guarantee the development of the disease. There are some conditions that act as a trigger. These conditions are among risk factors development of systemic lupus erythematosus.
Environmental hazards... There are many such factors, but all are associated with the interaction of humans and the environment.
The most common are:
- Viral infections... Mononucleosis, parvovirus B19 responsible for cutaneous erythema, hepatitis C and others, can cause systemic lupus erythematosus in genetically susceptible individuals.
- Exposure to ultraviolet rays... Where ultraviolet rays are electromagnetic waves not perceived human eye, with a wavelength shorter than violet light and with higher energy.
- Medicines... There are many drugs, usually used for chronic conditions, that can cause systemic lupus erythematosus. About 40 drugs can be classified in this category, but the most common are: isoniazid, used to treat tuberculosis, idralazine to combat hypertension, quinidinazine used to treat arrhythmic heart disease, etc.
- Exposure to toxic chemical substances ... The most common are trichlorethylene and dust silica.
Hormonal factors... Many considerations lead us to think that female hormones and in particular estrogen play an important role in the development of the disease. Systemic lupus erythematosus is a common disease in women and usually occurs during the years of sexual development. Animal studies have shown that estrogen treatment causes or worsens lupus symptoms, while treatment male hormones improves the clinical picture.
Disorders in immunological mechanisms... The immune system, under normal conditions, does not attack and protects the cells of the body. This is regulated by a mechanism known as immunological tolerance for autologous antigens. The process that regulates all this is extremely complex, but simplifying it, we can say that during the development of the immune system, under the influence of lymphocytes, autoimmune reactions can appear.
Lupus symptoms and signs
It is difficult to describe the overall clinical picture of systemic lupus erythematosus... There are many reasons for this: the complexity of the disease, its development, characterized by alternating periods of prolonged rest and relapse, a large number of affected organs and tissues, variability from person to person, individual progress of pathology.
All this makes systemic lupus erythematosus the only disease for which there are hardly two completely identical cases. Of course, this greatly complicates the diagnosis of the disease.
Initial symptoms of lupus erythematosus
Lupus is accompanied by the appearance of very vague and nonspecific symptoms associated with the onset of an inflammatory process, which is very similar to the manifestation of seasonal flu:
- Fever... Typically, temperatures are low, below 38 ° C.
- General light fatigue... Fatigue, which may be present even at rest or after minimal exertion.
- Muscle aches.
- Joint pain. Pain syndrome may be accompanied by swelling and redness of the joint.
- Rash on the nose and cheeks in the form of a "butterfly".
- Rash and redness on other parts of the body exposed to the sun, such as the neck, chest, and elbows.
- Ulcers on mucous membranes especially on the palate, gums and inside the nose.
Symptoms in specific areas of the body
After initial stage and damage to organs and tissues, a more specific clinical picture develops, which depends on the areas of the body affected by the inflammatory process, so the sets of symptoms and signs shown below may occur.
Skin and mucous membranes... An erythematous rash with raised edges that tend to flake off. Erythema is typical for this disease. butterfly shape that appears on the face and is symmetrical about the nose. The rash appears mainly on the face and scalp, but other regions of the body may be involved. A scalp rash can lead to hair loss (baldness). There is even a type of systemic lupus erythematosus that affects only the skin without affecting other organs.
The mucous membranes of the mouth and nose are also affected, where very painful lesions can develop that are difficult to treat.
Muscles and skeleton... The inflammatory process causes myalgia ("causeless" muscle pain and fatigue). Also affects joints: pain and, in some cases, redness and swelling. Compared to the disorders caused by arthritis, lupus is associated with less serious disorders.
The immune system... The disease defines the following immunological disorders:
- Antibody positive directed against nuclear antigens or against internal proteins of the nucleus, which include DNA.
- Antibody positive against DNA.
- Antiphospholipid antibody positivity... This is a category of autoantibodies directed against proteins that bind phospholipids. It is assumed that these antibodies are capable of interfering with blood coagulation processes and causing thrombus formation even in thrombocytopenia.
Lymphatic system... Symptoms that characterize systemic lupus erythematosus when it affects lymphatic system, this is:
- Lymphadenopathy... That is, an increase lymph nodes.
- Splenomegaly... Enlarged spleen.
Kidney... Renal disorders are sometimes called lupus nephritis. It can go through several stages, from mild to severe. Lupus nephritis requires prompt treatment as it can lead to loss of kidney function with the need for dialysis and transplantation.
Heart... The involvement of the heart muscle can lead to the development of various diseases and their symptoms. The most common are: inflammation of the pericardium (the membrane that surrounds the heart), inflammation of the myocardium, severe arrhythmias, valve abnormalities, heart failure, angina pectoris.
Blood and blood vessels... The most noticeable consequence of blood vessel inflammation is hardening of the arteries and premature development atherosclerosis(the formation of plaques on the walls of blood vessels, which narrows the lumen and interferes with normal blood flow). This is accompanied by angina pectoris, and in severe cases of myocardial infarction.
Severe systemic lupus erythematosus affects the concentration of blood cells. In particular, a large one can have:
- Leukopenia- a decrease in the concentration of leukocytes, caused mainly by a decrease in lymphocytes.
- Thrombocytopenia- a decrease in the concentration of platelets. This causes problems with blood clotting, which can lead to serious internal bleeding... In some cases, namely in those patients who, due to the disease, develop antibodies to phospholipids, the situation is diametrically opposite, that is, a high level of platelets, which leads to the risk of developing phlebitis, embolism, stroke, etc.
- Anemia... That is low concentration hemoglobin as a result of a decrease in the number of erythrocytes circulating in the blood.
Lungs... Systemic lupus erythematosus can cause inflammation of the pleura and lungs, and then pleurisy and pneumonia with corresponding symptoms. It is also possible for fluid to accumulate at the pleural level.
Gastrointestinal tract... The patient may have gastrointestinal pain due to inflammation mucous membranes that cover the inner walls, intestinal infections... In severe cases, the inflammatory process can lead to intestinal perforation. There may also be fluid accumulations in the abdomen (ascites).
central nervous system... The disease can cause both neurological and psychiatric symptoms. Obviously, neurological symptoms are the most formidable and, in certain situations, can seriously threaten the very life of the patient. The main neurological symptom is headache, but paralysis, difficulty walking, seizures and epileptic seizures, accumulation of fluid in the intracranial cavity and an increase in pressure, etc. Psychiatric symptoms include personality disorders, mood disorders, anxiety, psychosis.
Eyes... Dry eyes are the most common symptom. Retinal inflammation and dysfunction may also occur, but these cases are rare.
Diagnosis of an autoimmune disease
Because of the complexity of the disease and the nonspecificity of symptoms, it is very difficult to diagnose systemic lupus erythematosus. The first assumption about the diagnosis is usually formulated by the doctor. general practice, the final confirmation is given by an immunologist and a rheumatologist. It is the rheumatologist who then monitors the patient. Also, given the large number of damaged organs, the help of a cardiologist, neurologist, nephrologist, hematologist, and so on may be required.
I must say right away that not a single test can, by itself, confirm the presence of systemic lupus erythematosus. The disease is diagnosed by combining the results of several studies, namely:
- Anamnestic history of the patient.
- Evaluation of the clinical picture and, therefore, the symptoms experienced by the patient.
- Results of some laboratory tests and clinical studies.
In particular, the following laboratory tests and clinical studies may be prescribed:
Blood test:
- Hemochromocytometric analysis with an assessment of the number of leukocytes, the concentration of all blood cells and the concentration of hemoglobin. The goal is to identify anemia and blood clotting problems.
- ESR and C-reactive protein to assess whether there is an inflammatory process in the body.
- Liver function analysis.
- Kidney function analysis.
- Test for the presence of antibodies against DNA.
- Search for antibodies against proteins of cell nuclei.
Analysis of urine... Used to detect protein in the urine to get a complete picture of kidney function.
Chest x-ray to test for pneumonia or pleural inflammation.
Echodoplerography of the heart... To make sure the heart and its valves are working properly.
Systemic lupus erythematosus therapy
Treatment for systemic lupus erythematosus depends on the severity of the symptoms and the specific organs involved, and thus the dose and type of drug is subject to constant change.
In any case, the following medicines are commonly used:
- All NSAIDs... They serve to relieve inflammation and pain, reduce fever. However, they have side effects when taken for a long time and in high doses.
- Corticosteroids... They are very effective as anti-inflammatory drugs, but the side effects are very serious: weight gain, hypertension, diabetes and bone loss.
- Immunosuppressants... Drugs that suppress the immune response and are used for severe forms of systemic lupus erythematosus, which affects vital important organs such as kidneys, heart, central nervous system. They are effective, but they have many dangerous side effects: an increased risk of infections, liver damage, infertility, and an increased likelihood of developing cancer.
Risks and complications of lupus
Complications from systemic lupus erythematosus are associated with those disorders that result in damage to organs affected by the disease.
Also to the complication should be added additional problems caused by side effects therapy... For example, if the pathology affects the kidneys, kidney failure and the need for dialysis may develop in the long term. In addition, nephrologic lupus should be closely monitored, and therefore there is a need for immunosuppressive therapy.
Life expectancy
Systemic lupus erythematosus is chronic disease for which there is no cure. The prognosis depends on which organs are damaged and to what extent.
Of course, worse when vital organs such as the heart, brain, and kidneys are involved... Fortunately, in most cases, the symptoms of the disease are rather subtle, and modern methods treatments can cope with the disease, allowing the patient to lead an almost normal life.
Systemic lupus erythematosus and pregnancy
High estrogen levels observed during pregnancy stimulates a specific group of T lymphocytes or Th2, which produce antibodies that cross the placenta barrier and reach the fetus, which can lead to miscarriage and preeclampsia in the mother... In some cases, they cause what is called neonatal lupus in the fetus, which is characterized by myocardiopathy and liver problems.
In any case, if the baby survives after childbirth, the symptoms of systemic lupus erythematosus will persist for no more than 2 months as long as the mother's antibodies are present in the baby's blood.
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