What is systemic lupus erythematosus (SLE)?
Systemic lupus erythematosus (SLE) is an autoimmune disorder, with symptoms in a variety of organs. It is distinguished from other variants of lupus erythematosus that remain confined to the skin.
Epidemiology
The disease is uncommon in Western countries (6 to 7 per 100,000 people). It is more common in women than in men (ratio 9: 1) and can begin at any age, although particularly adolescent and young adult women are more often affected. It can occur secondary to specific medication use. 90% of patients with SLE has joint problems which, however, are distinct from the joint in rheumatoid arthritis by the fact that there is no erosion formation occurs.
Pathogenesis
Systemic lupus erythematosus resembles the type III hypersensitivity reactions, due to the formation of IgG antibodies by plasma cells, against so-called free auto-antigens (molecules encoded by DNA). Here, small immune-complexes (antibodies which are bound to antigens) are formed which can not bind to complement. Complement is a system that is needed to clean up the immune complexes. The immune complexes are cleared and will not get stuck in the small blood vessels of organs such as those of the glomeruli of the kidneys. Also, they are deposited in the skin, causing the characteristic rash / red rash.
Systemic lupus erythematosus symptoms and diagnosis
The disease is diagnosed based on symptoms and laboratory tests. In 1982, proposed the American College of Rheumatology (ACR) criteria for the classification of patients with systemic lupus erythematosus. The ACR criteria are intended to define an unambiguous group of patients for medical research. In 1997 these criteria were revised. In practice, the disease is often diagnosed on the basis of these criteria. If at least four of the following 11 criteria are met, spoken of systemic lupus erythematosus:
- Butterfly Exanthema (red rash on both cheeks which overflows on the nasal bridge, in the shape of a butterfly);
- Discoid lupus (erythematous (red) spots with Hyperkeratosis (thickening of the skin)), for example the butterfly-shaped Exanthema in the face (the rash/Exanthema/red spots are formed by the deposition of the small immune complexes);
- Light hypersensitivity;
- Oral or nasopharyngeal ulcers (mouth-/keelzweren);
- Arthritis (inflammation of one or more joints);
- serositis (pleuritis (inflammation of the lung membrane)/pericarditis (inflammation of pericardium));
- Kidney abnormalities (proteinuria (protein in the urine), hematuria (blood in the urine), celcilinders);
- Neurological disorders (seizures (epilepsy), psychoses);
- Hematologic Disorders (hemolytic anemia, leukopenia (low white blood cells), trombopenie (too few platelets));
- ANA-positive serology (antinuclear antibodies);
- Immunological abnormalities (anti-dsDNA +).
Systemic lupus erythematosus treatment
Most patients are treated with NSAIDs given the arthritis symptoms. Prednisolone and cyclophosphamide are given less frequently, in severe infections, such as nephritis (inflammation of kidney tissue) or encephalitis (brain inflammation).
Alternative treatments focus on the removal of mercury amalgam fillings that can leak from that to which can accumulate in the body. In addition, these treatments focus on kwikdetoxificatie
Course
The course of the disease varies between patients. Usually exchange active periods alternate with periods of calm. It may also happen that the disease remains completely calm after a very active start. When the disease is in an active period, it is called a flare.