Medical essentials

What is Systemic Lupus Erythematosus? (SLE)

What is Systemic Lupus Erythematosus? (SLE)

What is Systemic Lupus Erythematosus? (SLE)

Did you know that Systemic Lupus Erythematosus (SLE) affects at least 5 MILLION people worldwide?

This is only a conservative number as we might only be scrapping the surface of the iceberg.

The word “Lupus” means wolf in Latin, which was first described in the 18th century. The disease was named Lupus due to the skin rash that resembles a wolf bite.

In the past, Lupus was only known as a dermatological condition. As of today, the understanding of Lupus has evolved.

It is now divided into four broad categories:

1.) Systemic Lupus Erythematosus

2.) Discoid Lupus Erythematosus

3.) Cutaneous Lupus Erythematosus

4.) Drug-Induced Lupus Erythematosus

In this post I will only focus on talking about the most prevalent type, which is Systemic Lupus Erythematosus.(SLE) 

The reason it is being called systemic is because it can affect any organs in your body.

If you have been diagnosed with SLE, chances are you’re a young fertile female asian. Later I will explain why you are one of the more susceptible groups of individual to have this disease.

 

What is Systemic Lupus Erythematosus?

Basically, you can think of it as a disease triggered by your own immune system.

Yes, you are allergic to yourself.

Your body produces antibodies that target or sit on your organ tissues.

As a result, your body starts secreting a series of chemical substances called cytokines which are responsible for triggering inflammation at where the antibodies reside.

 

How can I be allergic to myself?

As with many other diseases, the underlying causes for SLE are not really well known, considering how far we’ve come in the realm of medicine.

What we do know though, is that genetics and environment play an important role in the disease origin.

To put things in perspective, let me give you an analogy…

For example you’re a woman with SLE susceptible gene embedded in your body, as someone who runs errand regularly, you’re frequently exposed under the sunlight..

UV rays then penetrate through your skin and damage your body cells causing DNA mutation.

The damaged tissues then undergo a programmed cell death known as apoptosis.

Nuclear contents that leak out from the cell are exposed to be targeted by your white blood cells.

They bind to these nuclear debris to form an antigen-antibodies complex. This complex is known as antinuclear antibodies

The complex can either be deposited in the blood vessels or tissue organs, causing you to scream in agony.

The reason why I mentioned above that you are likely to be a woman of childbearing age was because the use of exogenous hormones has been linked to lupus onset and flares, suggesting hormonal factors as one of the triggers for the disease.

As a matter fact, the female to male ratio of SLE is at 9:1 during the childbearing years.

 

What are the symptoms?

SLE is known for being the “monkey of all disease”, meaning the range of symptoms varies so much from one person to another that it mimics many other diseases.

To illustrate the symptoms of SLE clearly, I will categorize them based on our body’s functioning system:

• Constitutional symptoms

Generally, the constitutional symptoms include vague complaints that can’t differentiate diseases from one another.

But you should know that SLE patients are easily tired even without doing much physical work. So your doctor might anticipate to find anaemia in your blood test.

You might also complain of having on and off fever and weight loss issues. This is seen when SLE is in active and infection occurs during the autoimmune state.

• Musculoskeletal symptoms

Up to 90% of SLE patients have joint pains and swelling of the hand, wrist and knee joints. It’s almost as if the immune system has a preference for attacking joints.

You should also take notice that the joint pain may be asymmetrical and the pain is disproportionate to the degree of swelling.

Apart from that, there won’t be any permanent joint deformity.

• Skin manifestation

Almost all SLE patients will experience some form of skin changes. The malar rash is classically seen in SLE. The pattern of malar rash resembles a butterfly spreading its wings as shown in the image below. It is also described as a reddish rash over the cheeks and nasal bridge). It usually occurs after sun exposure.

SLE

Apart from the malar rash, you may also experience hair loss or another type of skin rash called livedo reticularisThis form of rash is not specific to SLE but it can be suggestive of the disease.

It is also common for SLE patients to have mouth ulcer during the active phase of the disease.

If you have seen someone with SLE, you might probably notice that they put on gloves or socks frequently. This is because their skin changes colour when exposed to coldness.

The changes would lead to numbness and pain in the extremities. In medicine, we called this Raynaud’s phenomenon.

 

Did you happen to also experience one of the following events?

Interestingly, SLE has been closely associated with antiphospholipid syndrome. However, I will get into that in another post.

Basically, the body of SLE patients might contain a type of antibody called antiphospholipid antibody that can lead to the occurrence of deep vein thrombosis or repetitive miscarriages. 

There may also be the history of stroke or transient ischemic attack.

That being said, having one of these events in your past medical history makes it more suggestive of SLE.

 

Complications

Ultimately, I should highlight again that the symptoms of SLE are progressive and multiple organs can be affected.

Therefore it is not unusual for SLE patients to be admitted to the hospital for reasons that are not directly relatable to SLE.

In fact, this is also what makes the disease hard to be diagnosed.

Some of the clinical complications that SLE can cause include a new onset of hypertension. This is due mainly to renal insufficiency whereby renal vessels get occluded. This confuses the kidney into thinking that the bloody pressure is low.

It then attempts to compensate by releasing a hormone called renin to bring the blood pressure back to baseline.

More importantly, the lungs and heart can potentially be affected. You may experience some chest pain related to breathing or find it difficulty to breath.

Neuropsychiatric features such as history of seizures, memory or mood changes can also occur in SLE.

 

How do doctors diagnose SLE?

Well, usually your doctor will make the diagnosis only after considering the combination of the aforementioned symptoms together with a series of blood work results.

For the ease of your understanding, you just have to know that on top of your symptoms, your blood results are suggestive of SLE only if there is:

  • Low haemoglobin level ( indicates anaemia)
  • Leukopenia, Lymphocytopenia, Thrombocytopenia. In short, low white blood cells/platelet levels
  • Low C3 & C4 complement level
  • Abnormal renal profile (protein or casts in urine)
  • **Inflammatory markers** such as ESR & CRP level increased
  • **Antinuclear antibodies** increased (over 95% sensitivity)
  • **Anti-dsDNA antibodies** (high specificity, but only 70% sensitivity)
  • **Anti-sm antibodies** (highest specificity, but only 30-40% sensitivity)

** = IMPORTANT

For a doctor to confirm an SLE diagnosis, there is a list of up to 11 criteria needed to be fulfilled. If you are interested in checking out all the criteria, I’ll leave a link for you to check out here.

 

Viable options of treatment

If you are diagnosed with SLE, do not panic because your doctor will familiarize you with the symptoms and natural course of the disease as well as how you are going to manage it.

On the other hand, you can also consider joining a support group. Knowing that thousands of people in the world are going through the same experience will provide you a sense of relieve.

You can visit the link here if you are interested in joining an SLE support group on Facebook.

If the SLE happens to target your joints and cause you to have severe joint pain, you can try doing some SLE designated physical therapy to maintain posture and proper range of motion.

Besides that, you should also avoid over-exposing yourself under the sunlight because it can trigger the disease. If necessary, you can apply sunblock before going outdoor.

Pharmacological treatment

The aim of using pharmacological treatment is to relieve your pain symptom and prevent lupus flares from occurring.

Interestingly, Hydroxychloroquine is an effective anti-malarial drug that is used also for treating SLE.

The idea here is that the drug mediates a mild immune response in your body without causing your immune system to be suppressed.

Hydroxychloroquine is proven for its safety and efficacy. Hence, it is effective in treating and preventing lupus skin rashes, joint pain and joint inflammation.

More importantly, it has been associated with reduced morbidity and mortality in SLE patients in observational trials.

Similar to many diseases that can cause you to experience excruciating pain, your doctor will most probably prescribe you with pain killers such as NSAID’s to numb the pain.

For more severe cases where organs are involved, you might need to take systemic steroid therapy and be put under close monitoring.

The way steroids work in treating SLE is that it suppresses your overly active immune system to a modest level so it stops attacking your own tissue organs.

If the kidney or central nervous system is affected, cyclophosphamide and mycophenolate may also confer some benefits in improving the condition.

 

Do you know of anyone who suffers from SLE or that you might have SLE?

Leave a comment below and share your experience with us.

Thank you for reading the blog post.  


 

46 thoughts on “What is Systemic Lupus Erythematosus? (SLE)

  1. Mary

    Such an informative post! I have an aunt who had lupus and I remember her struggling for years to get a proper help. Pages like this would have really helped her. Thank you.

    1. Kallmann Post author

      Thank you Mary! I hope your aunt is coping well with the disease. I find many people lacking in knowledge about the disease they have, hence the unnecessary anxiety. This is the reason I decided to write about SLE, hopefully to inform patients about the disease and provide some mental relieve that stemming from uncertainty.

  2. Maria

    wow, I had no idea how complicated lupus actually was… I didn’t know there were different types of lupus, and am surprised to learn its complications and how it can affect your life!
    I know a girl that has SLE, I remember she had a leave on work when she was getting treatment… But she’s okay now, I think 🙂
    Your post was super informative, by the way!

    1. Kallmann Post author

      Undoubtedly, SLE has affected the life quality of all patients, but what’s more important is that they learn to live with it and be compliant to their doctor’s advice.

  3. Danie

    Several friends of mine have been diagnosed with Lupus but I did not really understand what it was like for them. This really explained it. I am glad I read it.

    1. Kallmann Post author

      Actually autoimmune diseases have been existing for hundreds or thousands of years. It wasn’t until recent decade(s) people started having a more thorough understanding towards them and began coming up with the technology necessary for disease detection.

  4. Eric Coleman

    Wow! I wasn’t even aware of this disease until now. Thank you for the information! I found this article incredibly informative.

  5. Rachael Stray

    A really interesting read. When I think of lupus I think of House when he constantly said it wasn’t lupus as you’ve correctly discussed it does mimic other diseases and can be different for different people.

    1. Kallmann Post author

      Being the smarty pants as he is, of course he would first try to cross lupus off the list. Unfortunately in the real world, lupus is a real deal and it has greatly affected people’s daily lives.

  6. Sreekar

    Auto-immune disorders like SLE are a little tricky to treat as that can manifest in a variety of symptoms and may involve multiple systems. I loved your post. It’s very informative for people unaware of SLE.

  7. Kayla

    I had no clue that there were different types of Lupus. Due to the complications mentioned in this article, I cant help but to think of all the people who may be missed diagnosed. I wonder if its possible for this type to be mistaken for other types of lupus?

    1. Kallmann Post author

      Brilliant! This is the reason why some autoimmune diseases are difficult to diagnose. Because different diseases might present with common markers. Some markers show high sensitivity, but relatively low SPECIFICITY.

  8. Gabriella

    Wow, that’s crazy!! I didn’t even know that was possible. I watched a tv show one time where a wife thought she was allergic to her husband or the other way around. I thought that was strange. But being allergic to your own self? I didn’t know that was possible. How interesting!

    1. Kallmann Post author

      If you look closely to the small little details around us every day, you will notice many things defy logic, wait until you hear about people who eat their way to death 🙂

  9. Stephanie

    I have a niece that has recently been diagnosed with Lupus. This is a horrible disease and caused her to miss a half of year of school. The good thing is she is young and healthy otherwise so has the endurance to fight.

    1. Kallmann Post author

      I agree, having been diagnosed at early stage of her life gives her time to make peace with the disease. The drawback is she will have to undergo the treatment process at a very young age. It’s not an easy task to shoulder both physically and mentally.

  10. Jared Ong

    Informative and useful contents. Thanks for sharing with us. It’s really helpful especially to medical student like me . Once again , thank you !

    1. Kallmann Post author

      Thanks Jared! I will be writing about more medical conditions in a more engaging manner, hopefully you will learn something out of it.

      PS: Much better reading experience as opposed to the dry materials you find in medical textbooks 🙂

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