Systemic lupus erythematosus(SLE): Symptoms, Diagnosis & Treatments
Symptoms
Systemic lupus erythematosus (SLE) is an autoimmune disease involving multiple organs. The immune complex formed by autoantibody and autoantigen binds to various organs such as joints, skin, kidneys, and CNS and causes inflammation. The prevalence rate is high.
In most SLE patients, fatigue, fever, myalgia, and weight loss are present. In addition, there are other cutaneous lesions such as cutaneous lesions, oral or nasal ulcers, vascular disease (Raynaud phenomenon, Vasculitis, Thromboembolic disease ), Nephritis, GI symptoms (adverse medication reactions or infections), pleuritis, and life threatening diseases such as pericarditis.
Diagnosis
SLE can be diagnosed according to the 2012 SLICC criteria. 11 clinical and 6 immunologic criteria, at least one criterion is met and more than 4 of 17 criteria are met. Clinical criteria include Acute cutaneous lupus, Chronic cutaneous lupus, Nonscarring alopecia, Oral or nasal ulcer, Joint disease, Serositis, Renal, Neurologic, Hemolytic anemia, Leukopenia or lymphopenia, Thrombocytopenia. Immunologic criteria include ANA, Anti0dsDNA, Anti-Sm , Antiphospholipid, low complement, direct coombs' test.
When SLE is suspected, we should differentiate between rheumatoid arthritis, systemic sclerosis, Sjogren's syndrome, and Vasculitis. Rheumatoid arthritis can be distinguished as an anti-CCP antibody positive, and should be suspected of systemic sclerosis if sclerodactyly or telangiectasis is observed in the physical examination. Sjogren's syndrome is diagnosed by keratoconjunctivitis sicca, xerostomia, and salivary gland biopsy. Vasculitis can be detected by examining ANA antibodies.
Treatments
SLE management involves avoiding ultraviolet light, avoiding smoking, and managing muscle and bone loss by SLE flare through proper exercise. Influenza, pneumococcus, and HPV vaccines are needed to prevent infections that can be easily caused by immunosuppressive therapy, and live vaccine vaccination (MMR, chicken pox) during immunosuppressive treatment should be avoided. If the patient has no symptoms and no organ invasion is found, the NSAID, acetaminophen, arthritis / arthralgia, fever, and cutaneous lesion and fatigue are controlled with hydroxychloroquine. If there is no response to this medication, symptom control with low dose systemic glucocorticoid may be attempted. If life threatening disease is present, high-dose systemic glucocorticoids should be used for 4 to 6 weeks and low-dose glucocorticoid maintenance therapy for several years thereafter. In the more severe cases, additional cytotoxic and immunosuppressive agents may be used.
Systemic lupus erythematosus (SLE) is an autoimmune disease involving multiple organs. The immune complex formed by autoantibody and autoantigen binds to various organs such as joints, skin, kidneys, and CNS and causes inflammation. The prevalence rate is high.
In most SLE patients, fatigue, fever, myalgia, and weight loss are present. In addition, there are other cutaneous lesions such as cutaneous lesions, oral or nasal ulcers, vascular disease (Raynaud phenomenon, Vasculitis, Thromboembolic disease ), Nephritis, GI symptoms (adverse medication reactions or infections), pleuritis, and life threatening diseases such as pericarditis.
Diagnosis
SLE can be diagnosed according to the 2012 SLICC criteria. 11 clinical and 6 immunologic criteria, at least one criterion is met and more than 4 of 17 criteria are met. Clinical criteria include Acute cutaneous lupus, Chronic cutaneous lupus, Nonscarring alopecia, Oral or nasal ulcer, Joint disease, Serositis, Renal, Neurologic, Hemolytic anemia, Leukopenia or lymphopenia, Thrombocytopenia. Immunologic criteria include ANA, Anti0dsDNA, Anti-Sm , Antiphospholipid, low complement, direct coombs' test.
When SLE is suspected, we should differentiate between rheumatoid arthritis, systemic sclerosis, Sjogren's syndrome, and Vasculitis. Rheumatoid arthritis can be distinguished as an anti-CCP antibody positive, and should be suspected of systemic sclerosis if sclerodactyly or telangiectasis is observed in the physical examination. Sjogren's syndrome is diagnosed by keratoconjunctivitis sicca, xerostomia, and salivary gland biopsy. Vasculitis can be detected by examining ANA antibodies.
Treatments
SLE management involves avoiding ultraviolet light, avoiding smoking, and managing muscle and bone loss by SLE flare through proper exercise. Influenza, pneumococcus, and HPV vaccines are needed to prevent infections that can be easily caused by immunosuppressive therapy, and live vaccine vaccination (MMR, chicken pox) during immunosuppressive treatment should be avoided. If the patient has no symptoms and no organ invasion is found, the NSAID, acetaminophen, arthritis / arthralgia, fever, and cutaneous lesion and fatigue are controlled with hydroxychloroquine. If there is no response to this medication, symptom control with low dose systemic glucocorticoid may be attempted. If life threatening disease is present, high-dose systemic glucocorticoids should be used for 4 to 6 weeks and low-dose glucocorticoid maintenance therapy for several years thereafter. In the more severe cases, additional cytotoxic and immunosuppressive agents may be used.
