Systemic Lupus Erythematosus
Systemic lupus erythematosus is a chronic autoimmune inflammatory disease that can affect any part of the body. In the United States this disease affects in average 50 per 100,000 inhabitants and it seems that the incidence is higher in African-American women and Hispanics. Also, the disease is more common in women than in men and in the group of age 20-50 years.
Systemic lupus erythematosus ( SLE) is triggered by autoantibodies that attack self cells, and this autoimune attack can damage practically any organ: kidney, skin, joints, blood vessels, pleura, etc.. Regarding the etiopathogenesis of this disease, it seems that there are involved genetic factors, hormonal factors and environmental factors. Genetic factors have been highlighted by experiments on laboratory animals and in studies on monozygotic and heterozygous twins. In addition, there are several genetic markers that predispose some people to develop SLE: HLA DR2, DR3, DQ2, DQ6, etc..
Hormonal factors are considered possible causes of SLE due to increased incidence in women and because of the association with high levels of estrogen and prolactin. It is believed that the disease is aggravated by birth control pills and estrogen therapies. As for environmental factors, it seems that ultraviolet rays, Epstein Barr virus infection, bacterial infections, certain drugs, and various foods can contribute to this disease.
As it is a systemic disease, SLE may lead to general manifestations such as fever, weight loss, fatigue, myalgia, joint pain, etc.. Musculoskeletal symptoms include arthritis, deforming arthropathy (‘swan neck’ deviation of the fingers of the hand), aseptic necrosis, myopathy and others. Dermatological symptoms are malar rash, discoid lupus, that is red patches on the skin, alopecia, oral or genital painless ulcers etc.
Renal symptoms occur in 50% of patients at onset and is manifested by lupus nephritis and glomerulonephritis. Frequently, patients with SLE have hematuria (blood in urine), proteinuria (protein in urine), hypertension and nitrogen retention. It should be pointed out that kidney damage eventually lead to kidney failure and it is one of the serious complications of the disease.
There are also many cardiovascular manifestations which, in advanced stages, may even lead to heart failure: pericarditis, myocarditis and endocarditis. In addition, due to hematological disturbances, patients with SLE have an increased risk of atherosclerosis and arterial and venous thrombosis. The lungs may also be affected; patients may develop acute pneumonia (shortness of breath, fever, coughing, etc.), interstitial pneumonia, pleurisy etc. Cognitive dysfunction, psychosis, convulsions, headache, cerebrovascular lesions, polyneuropathies are some of the nervous system symptoms.
SLE patients may also develop some gastrointestinal disorders such as pancreatitis, peritonitis, hepatic steatosis, etc. In addition, in SLE there are hematological disorders, that is anemia, leukopenia, thrombocytopenia which may lead to infections and coagulation disorders.