Systemic lupus erythematosus- diagnosis and treatment

Systemic Lupus Erythematosus

As it is an autoimmune disease, systemic lupus erythematosus (SLE)  is characterized by the presence of antinuclear antibodies (ANA) in the blood. They are present in over 95% of patients and are of several types (anti-Smith, anti-double stranded DNA antibodies, anti-histone antibodies and others) and can be detected by several methods: indirect immunofluorescence or ELISA test. Other specific abnormalities found in patients with SLE are hypergammaglobulinemia (IgM and IgG) cryoglobulinemia, low levels of serum complement, elevated rheumatoid factor, etc.
Because the disease is associated with a variety of symptoms (this is why it has been called “the great imitator”), the diagnosis of SLE is based on the criteria proposed by the American College of Rheumatology (ACR). These are:
– Malar rash

– Discoid rash

– Oral ulcers

– Polyserositis (pleurisy, pericarditis)

– Arthritis

– Renal disease

– Neurologic: seizures, psychosis

– Photosensitivity

– Antinuclear antibodies

– Immunological abnormalities: Smith antibodies, antiphospholipid antibodies, etc.

For a patient to be diagnosed with systemic lupus erythematosus is required to meet four of the 11 criteria proposed by the American College of Rheumatology (ACR). It must be said that there are several clinical forms of SLE ( incomplete lupus, drug-induced lupus, antiphospholipid syndrome) and the differential diagnosis is rheumatoid arthritis, Felty syndrome and various kidney, lung, skin and nervous disorders.

Drugs

Treatment

Systemic lupus erythematosus is an incurable disease but it can, however, be kept under control. There are a number of drugs used by patients with systemic lupus erythematosus, depending on the location and severity of disease. Disease-modifying Antirheumatic Drugs (DMARDs) are drugs used to prevent new flares and to reduce the use of corticoisteroids. One of them is hydroxychloroquine (Plaquenil), which is actually an antimalarial, but has been shown to be effective in treating mild forms of lupus. It has few side effects and is well tolerated by patients.

In more severe cases corticosteroids and immunosuppressive agents are needed to alleviate symptoms. There are several  treatment regimens: pulse therapy (methylprednisolone), which is administered intravenously initially and then continued with oral therapy, oral cortisone (prednisone, triamcinolone) etc.. Although effective, corticosteroids give many side effects: weight gain, diabetes, osteoporosis, hypertension etc. Of immunosuppressive agents, there can be mentioned cyclophosphamide, azathioprine, cyclosporine, mycophenolate mofetil, etc.. Patients can use various painkillers (NSAIDs), retinoids or topical glucocorticoids to relieve various symptoms.

Intravenous immunoglobulins can be used in renal disease resistant to other therapies, and  also have the advantage that do not suppress the immune system and therefore there is no risk of infection ( as it is with immunosuppressive drugs). However, in end-stage renal disease renal transplantation remains the only solution. It must be said that, as far as SLE is concerned, there are also other treatments that are under investigation.