Systemic Lupus Erythematosus (SLE) is an inflammatory, multi-system disease of unknown etiology. It is recognized worldwide and mainly prevalent in women, appearing especially in their reproductive years. The effects of age and sex on incidence and prevalence rates of SLE suggests that hormonal factors play a role in the development of this disease. Additionally, in the USA, SLE is three times more common among African Americans than Caucasians, suggesting a genetic component. The disease is also more prevalent among twins.
How Does Systemic Lupus Erythematosus Occur?
As mentioned, Systemic Lupus Erythematosus is a chronic inflammatory disease with variable clinical causes. The clinical picture of SLE can change over time, in terms of both disease activity and organ involvement. The pathogenesis of SLE is complex and usually involves a wide range of clinical symptoms. No single mechanism of action applies to all cases and the initial triggering events remain largely unknown.
What Are the Symptoms?
SLE can affect the skin, joints, kidneys, lungs, nervous system, serous membranes and/or other organs of the body. Immunologic abnormalities, especially the production of a number of antinuclear antibodies, are another prominent feature of the disease. Additionally, the disease is characterized by periods of remissions and chronic or acute relapses.
Typically four of the following 11 items listed below are enough to recognize Systemic Lupus Erythematosus:
- Malar rash – Fixed erythema, flat or raised, over the malar eminences, sparing the nasolabial folds.
- Discoid rash – Erythematous raised patches with adherent keratotic scaling and follicular plugging; possible atrophic scarring in older lesions.
- Photosensitivity – Skin rash as a result of unusual reaction to sunlight, by patient’s history or physician observation.
- Oral ulcers – Oral or nasopharyngeal ulceration, usually painless, observed by a physician.
- Non-erosive arthritis – Involving two or more peripheral joints, characterized by tenderness, swelling or effusion.
- Serositis / Pleuritis – convincing history of pleuritic pain or rub or evidence of pericardial effusion or Pericarditis (documented electrocardiography or rub or evidence of pericardial effusion).
- Renal disorder – Persistent proteinuria of >0.5 g/d or 3+ if quantitative not performed, OR Cellular casts – red cell, hemoglobin, granular, tubular or mixed.
- Neurological disorders – Seizures – in the absence of offending drugs or metabolic derangement, OR Psychosis (in the absence of offending drugs or metabolic derangement).
- Hematologic abnormalities – Hemolytic anemia with reticulocytosis, OR Leukopenia – <4,000/mm3 on two occasions, OR Lymphopenia – <1,500/mm3 on two occasions, OR Thrombocytopenia – <100,000/mm3 in the absence of drugs.
- Immunologic abnormalities – Anti-DNA – antibody to native DNA in abnormal titer, OR Anti-Sm – presence of antibody to Sm nuclear antigen, OR Antiphospholipid antibodies – an abnormal IgG or IgM anticardiolipin antibodies or positive lupus anticoagulant, OR False positive test for >6 months, confirmed by Treponema pallidum immobilization or fluorescent treponemal test.
- Positive ANA – An abnormal titer of antinuclear antibody by immunofluorescence or an equivalent assay in any point in time in the absence of drug.
Managing Systemic Lupus Erythematosus
Most patients with SLE have mild to moderate disease with chronic smoldering symptoms, punctuated by gradual or sudden increases in disease activity (flare-ups). The disease course in a smaller percentage of patients is characterized by alternating flare-ups and complete clinical remissions. Rarely, a patient has a single episode of active SLE followed by sustained remission. The management of patients with SLE is decided on an individual basis and guided by the degree and severity of specific symptoms and organ involvement.
Preventive strategies for decreasing SLE flare-ups are recommended for most patients and tend to include:
- Avoidance of ultraviolet light exposure not only through the use of sunscreens but by staying out of the sunlight or wearing protective clothing.
- Avoidance of exhaustive exercise as extreme physical efforts are likely to trigger increased lupus activity.
- Avoidance of infections. Many common respiratory infections can be prevented by frequent washing of the hands and other simple hygiene measures.
- Being mindful of pregnancy. Pregnancy may entail a slightly increased risk of a lupus flare-up. Also, breast-feeding may increase the risk of a postpartum flare-up.
Treatment for Systemic Lupus Erythematosus In Thousand Oaks, CA
If you feel like you may be suffering from Systemic Lupus Erythematosus, we urge you to make an appointment at our Ventura County center. Dr. Cohen and his talented team at Cohen Medical Centers are ready to help you feel like yourself again. To learn more, call us at (805) 449-8781 to schedule your consultation; you may also fill out the form below, and a member of our helpful staff will get back to you.