{"id":9316,"date":"2021-12-19T00:23:58","date_gmt":"2021-12-18T22:23:58","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/immunology\/systemic-lupus-erythematosus-symptoms-diagnosis-treatment\/"},"modified":"2022-02-04T08:19:08","modified_gmt":"2022-02-04T06:19:08","slug":"systemic-lupus-erythematosus-symptoms-diagnosis-treatment","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/immunology\/systemic-lupus-erythematosus-symptoms-diagnosis-treatment\/","title":{"rendered":"Systemic lupus erythematosus: symptoms, diagnosis, treatment"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">SLE is a chronic, multisystemic, autoimmune disease that is characterized by the production and deposition of antibodies in tissues leading to inflammation. <\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>SLE is classified as a connective tissue disease.<\/li><li>Most commonly affected tissues include the skin, joints, and kidneys. <\/li><li>Circulating blood cells are also often affected.<\/li><li>Typically affects young females.<\/li><\/ul>\n\n\n<span class=\"block-heading\" id=\"header_1\">\n<h4 class=\"wp-block-heading\" id=\"pathomechanism\" class=\"wp-block-heading\" id=\"pathomechanism\" class=\"title_collection title1\">Pathomechanism<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">The exact mechanism is unknown, but it is thought to arise in genetically susceptible individuals as a result of an environmental trigger (such as UV light causing tissue damage).<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>During the apoptosis of damaged cells, nuclear fragments are also released, and in some individuals, are not cleared out rapidly enough.<\/li><li>The nuclear fragments are highly antigenic, and when presented by APC to the adaptive immune system, lead to the production of antibodies against them (autoantibodies).<\/li><li>These autoantibodies target the different components of the nucleus and DNA, circulate in the blood and deposit in tissues, causing inflammation due to both <strong>type II<\/strong> (cytotoxic) and <strong>type III<\/strong> (immune complex formation) <strong>hypersensitivies<\/strong>.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Other causes are known triggers for SLE, such as certain drugs (isoniazid, procainamide, hydralazine), and hormonal factors (female gender).<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" id=\"symptoms-and-tissues-involved\" class=\"wp-block-heading\" id=\"symptoms-and-tissues-involved\" class=\"title_collection title1\">Symptoms and tissues involved<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<p class=\"wp-block-paragraph\">Patients typically present with:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Skin symptoms. <\/strong>Malar and discoid rash and alopecia<\/li><li><strong>General symptoms. <\/strong>Low-grade fever, weight-loss, Sj\u00f6gren syndrome<\/li><li><strong>Joint and limb symptoms<\/strong>. Polyarthritis, Raynaud phenomenon<\/li><li><strong>Cardiac involvement<\/strong>. Endocarditis (Libman-Sacks endocarditis), myocarditis, pericarditis<\/li><li><strong>Pulmonary involvement<\/strong>. Pleuritis, pleural effusion<\/li><li><strong>Renal involvement<\/strong>. Nephritic syndrome and ESRD<\/li><li><strong>Hematological involvement<\/strong>. Antiphospholipid syndrome (miscarriage), anemia, leukopenia, thrombocytopenia (in severe SLE)<\/li><li><strong>CNS involvement<\/strong>. Seizures, psychosis<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">In drug-induced lupus, the renal system and CNS are not involved; in addition, there&#8217;s no malar rash or alopecia.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" id=\"renal-involvement\" class=\"wp-block-heading\" id=\"renal-involvement\" class=\"title_collection title1\">Renal involvement<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<p class=\"wp-block-paragraph\">The deposition of immune complexes leads to nephritic syndrome, and progressive kidney disease. Most patients die due to kidney failure. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The WHO classifies the severity of renal disease into 6 classes based on the histopathological findings (I-VI).<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" id=\"libman-sacks-endocarditis\" class=\"wp-block-heading\" id=\"libman-sacks-endocarditis\" class=\"title_collection title1\">Libman-Sacks endocarditis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<p class=\"wp-block-paragraph\">Libman-Sacks endocarditis is characterized by the deposition of immune complexes on valves (mostly the mitral and aortic valves), forming sterile vegetations. It may present with regurgitation. It may appear in antiphospholipid syndrome as well.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" id=\"diagnosis\" class=\"wp-block-heading\" id=\"diagnosis\" class=\"title_collection title1\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<p class=\"wp-block-paragraph\">The diagnosis of SLE is rather difficult. It is regarded as &#8220;the great imitator&#8221; as its symptoms may seem similar to a variety of diseases.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Clinical criteria; the EULAR\/ACR criteria is a scoring system for the determination of SLE.<\/li><li>CBC<\/li><li>Urinalysis (lupus nephritis; nephritic syndrome)<\/li><li>Serology<ul><li>ANA, anti-dsDNA, anti-Smith, anti-histone (more specific for drug-induced), Ro (SS-A), La (SS-B)<\/li><li>ENA (extractable nuclear antigen) panel<\/li><li>ANA-negative lupus is a possibility for a rare form of lupus; in most cases, however, negative serology suggests a disease other than lupus.<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" id=\"treatment\" class=\"wp-block-heading\" id=\"treatment\" class=\"title_collection title1\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<p class=\"wp-block-paragraph\">Avoid UV exposure as it may exacerbate the cutaneous lesions.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Depending on the severity of the disease, the following should be used:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Antimalarials (hydroxychloroquinel; to be used in all patients, except those with G6PD; yearly opthalmological tests are warranted due to retinotoxicity)<\/li><li>NSAIDs<\/li><li>Local corticosteroids for cutanous lesions<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">In severe SLE:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Corticosteroids<ul><li>Methylprednisolone 1g\/day IV for 3 days, followed by oral prednisone 60mg\/day<\/li><\/ul><\/li><li>Cyclophosphamide\/mycophenolate&nbsp;mofetil\/azathioprine<\/li><li>Rituximab<\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h4 class=\"wp-block-heading\" id=\"pathomechanism\" class=\"wp-block-heading\" id=\"pathomechanism\">Pathomechanism<\/h4><h4 class=\"wp-block-heading\" id=\"symptoms-and-tissues-involved\" class=\"wp-block-heading\" id=\"symptoms-and-tissues-involved\">Symptoms and tissues involved<\/h4><h4 class=\"wp-block-heading\" id=\"renal-involvement\" class=\"wp-block-heading\" id=\"renal-involvement\">Renal involvement<\/h4><h4 class=\"wp-block-heading\" id=\"libman-sacks-endocarditis\" class=\"wp-block-heading\" id=\"libman-sacks-endocarditis\">Libman-Sacks endocarditis<\/h4><h4 class=\"wp-block-heading\" id=\"diagnosis\" class=\"wp-block-heading\" id=\"diagnosis\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" id=\"treatment\" class=\"wp-block-heading\" id=\"treatment\">Treatment<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>SLE is a chronic, multisystemic, autoimmune disease that is characterized by the production and deposition of antibodies in tissues leading to inflammation. SLE is classified as a connective tissue disease. Most commonly affected tissues include the skin, joints, and kidneys. Circulating blood cells are also often affected. Typically affects young females. Pathomechanism The exact mechanism [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":9306,"menu_order":4,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-9316","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Systemic lupus erythematosus: symptoms, diagnosis, treatment &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/immunology\/systemic-lupus-erythematosus-symptoms-diagnosis-treatment\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/immunology\\\/systemic-lupus-erythematosus-symptoms-diagnosis-treatment\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/immunology\\\/systemic-lupus-erythematosus-symptoms-diagnosis-treatment\\\/\",\"name\":\"Systemic lupus erythematosus: symptoms, diagnosis, treatment &#8211; 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