Systemic Lupus Erythematosus (SLE) or Lupus is a chronic disease that has variable manifestations. This autoimmune condition follows a course characterized by frequent remissions and relapses. Lupus causes chronic widespread inflammation that can affect various organ systems such as the skin, kidneys, joints, blood cells, the heart and lungs, and the nervous system.
According to the Centers for Disease Control and Prevention (CDC), SLE affects about 2-8 individuals per 100,000 people annually in the United States. It is estimated that around 250,000 Americans have the disease. Women are more likely to be affected and it typically occurs in their child-bearing years.
Signs and Symptoms
The classic presentation of SLE consists of a triad of symptoms. These consist of joint pain, fever, and rash. However, some patients have other manifestations such as fatigue, weight loss, and muscle aches.
Skin changes include a butterfly or malar rash on the face and increased sensitivity to light (photosensitivity). Hair loss, mouth sores, and swollen lymph nodes are common.
The kidneys are often involved in SLE, but patients are often initially asymptomatic. In the later stages, patients may experience acute or chronic renal failure, which may cause signs and symptoms like high blood pressure, edema, and weight gain.
Headaches, anxiety, mental confusion and other neurologic symptoms may also occur. The lungs may be affected, causing chest pain from pleuritis or pleural effusion. Chest pain may also occur due to pericarditis, or inflammation of the heart membranes. Patients may also experience abnormal heart rhythms, abdominal pain, nausea, vomiting, and other non-specific symptoms.
The diagnosis of SLE is based on proper assessment of clinical findings and laboratory tests. The American College of Rheumatology criteria summarizes the features that help make a diagnosis of SLE. These criteria include a combination of clinical signs and symptoms typically found in patients with lupus, as well as laboratory findings, such as a decrease in red blood cells or white blood cells, an increase in urine protein, and the presence of specific antibodies in the blood such as antinuclear antibody (ANA). If at least four of the eleven criteria are present, or a kidney biopsy confirms the presence of ANA antibodies, the likelihood of a positive diagnosis for SLE increases.
Although there is no cure for lupus, doctors will often prescribe various treatments to control its symptoms. In mild forms of the disease, over-the-counter medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended for joint pains, muscle aches and headaches. Low-dose corticosteroid treatment may also be prescribed for the skin. Some patients may need high-dose corticosteroids and immunosuppressive drugs to suppress the immune system and control widespread inflammation. Some of the immunosuppressive drugs used to regulate immune responses include azathioprine, cyclosporine, cyclophosphamide, methotrexate, and mycophenolate. Other drugs used include hydroxychloroquine, a drug used to treat malaria, and belimumab, a biologic drug, which are helpful in some patients. Belimumab (Benlysta) inhibits the biologic activity of a naturally occurring protein needed to produce autoantibodies, which destroy the body’s own cells. It is often used for patients who do not respond to standard therapy such as NSAIDs, corticosteroids, antimalarials, and immunosuppressive drugs.
Severe symptoms that indicate involvement of the kidneys, heart, lungs, and other organs require evaluation and treatment from specialists. These include cardiologists, rheumatologists, pulmonologists, and other professional consultants.
At American Infusion Centers, we use the following drugs for Systemic Lupus Erythematosis: