- a group of severe autoimmune diseases of the connective tissue, affecting mainly the skin and internal organs of a person. This disease got its name from the characteristic rashes on the skin of the face, in appearance resembling wolf bites. Young women are sick more often, men and children suffer from lupus erythematosus much less often.
The total number of people with lupus erythematosus is 0.004-0.25% of the total.
Among the reasons are: hereditary predisposition to this disease, other reasons for its occurrence remain still unexplored. It is believed that acute infectious diseases, severe psychological trauma, prolonged exposure to stress or intolerance to certain pharmacological drugs can provoke the appearance of lupus erythematosus.
A characteristic feature of lupus erythematosus is a wide range of its manifestations, because this disease affects almost all organs and systems of the human body. Nevertheless, there is a list of symptoms, the presence of which is mandatory with lupus erythematosus:
- constitutional symptoms (malaise, emaciation)
- skin lesions (increased sensitivity to light, baldness, characteristic erythema on the skin of the nose and cheeks in the shape of a butterfly)
- erosive damage to the mucous membranes
- joint damage as arthritis
- damage to the lungs and heart
- kidney damage (in 50% of patients) up to renal failure
- disorders of the nervous system (acute psychosis, organic brain syndrome)
- changes in general blood and urine tests
- antiphospholipid syndrome in 20-30% of patients
- antinuclear antibody titer high
The specific type of lupus erythematosus and the degree of activity of the disease at one time or another is determined by a rheumatologist after a comprehensive examination. Cutaneous lupus is most often treated by a dermatologist.
Lupus erythematosus treatment methods
The disease cannot be completely cured, so the treatment continues throughout life. How to treat lupus erythematosus is decided by the attending physician individually for each patient, depending on the specific symptoms, the severity of the disease and its activity.
With a mild course of the disease or in the stage of remission, treatment is mostly symptomatic. The following drugs are prescribed:
- analgesics for severe pain syndrome
- aspirin (80-320 mg per day) with a tendency to thrombosis
- antimalarial drugs: hydroxychloroquine (200 mg orally per day) or a combination of chloroquine (250 mg) and quinacrine (50-100 mg) - for severe skin and joint damage
- vitamins A, B6, B12, C
In a severe course of the disease with damage to internal organs, apply:
- glucocorticoids (in severe condition, daily 40-60 mg of prednisolone, 20-40 mg - with moderate activity of the disease) are taken for a month with a gradual decrease to a therapeutic dose (up to 10 mg per day)
- immunosuppressants (mycophenalate mofetil 500-1000 mg, azathioprine 1-2.5 mg / kg or cyclophosphamide 1-4 mg / kg orally once a day)
- heparin in combination with subcutaneous aspirin, heparin or oral vafarin for thrombosis and vascular embolism
- in severe cases, with low efficiency of glucorticoid treatment, pulse therapy with methylprednisolone and cyclophosphamide is indicated, which are administered in large doses (1 g per day) intravenously drip for 3 consecutive days
- hemosorption and plasmapheresis - to remove toxic immune complexes from the body
- stem cell transplantation - an expensive procedure inaccessible to most patients
- calcium preparations and vitamin D3 - to minimize the negative consequences of the use of glucocorticoids
Patients are monitored dispensary. Indications for their immediate hospitalization are:
- infectious complications
- chest pain
- severe symptoms of pathologies of the nervous system
- renal failure
- thrombosis
Traditional medicine against lupus erythematosus
Treatment of cutaneous and systemic lupus erythematosus according to the recipes of traditional medicine is supportive and can be used during a mild course of the disease or at the stage of remission. In this case, you can not use drugs that stimulate immunity - this can aggravate the course of the disease.
Popular effective recipes:
- Decoction of dried mistletoe leavescollected from birch in the cold season. 2 tsp leaves are poured with a glass of boiling water, simmer in a water bath for 1-2 minutes and insist for half an hour. The resulting infusion is drunk in three doses during the day. Take 1 month.
- Licorice decoction... Pour the dried licorice roots (1 tablespoon) with boiling water (500 ml), simmer over the fire for 15 minutes, cool at room temperature. Drink the filtered broth during the day between meals. Do this for a month.
- Ointment from birch buds or tarragon for the treatment of erythema lupus. A glass of ground birch buds (tarragon) is mixed with a half-liter can of pork fat. This mixture is simmered for 5-7 days for several hours in the oven with the door open. The resulting ointment is applied to erythema and taken orally before meals for 1 tsp.
There are many other alternative medicine recipes that are used to treat lupus erythematosus. However, with a severe form of the disease and at the stage of its exacerbation, traditional medicine should give way to traditional drug treatment.
How to live with a diagnosis of lupus erythematosus?
In this case, it is necessary to follow basic recommendations:
- avoid stress and traumatic situations
- exclude long exposure to the sun and solarium
- monitor your health: prevent exacerbation of chronic diseases, treat colds immediately after their first symptoms
- do not take oral contraceptives or smoke - this significantly increases the risk of thrombosis
- use high-quality cosmetics, do not carry out hardware and dry cleaning of the face
- take vitamin complexes
- eat a balanced diet and exercise
Options for the course of the disease and prognosis
The prognosis is poor. The mortality rate among patients with lupus erythematosus is 3 times higher than usual. Most often, the cause of death is infectious complications and the consequences of deep damage to internal organs. But with the timely detection of the disease and competent drug therapy, it is possible to keep this disease under control and not allow it to destroy life and health.
One of the most serious diseases is systemic lupus erythematosus (SLE). It is characterized by autoimmune inflammation with many other symptoms. This disease is dangerous for its complications. With it, organs of many body systems suffer, but most of all problems occur with the musculoskeletal system and kidneys.
Description of the disease
Lupus develops due to a malfunctioning immune system, in which antibodies are formed that negatively affect healthy cells and tissues. This leads to negative changes in blood vessels and connective tissue.
The term "lupus" was once used to refer to red patches that appear on the face. They resembled the bites of wolves or she-wolves, which often attacked people and tried to get to unprotected parts of the body, like the nose or cheeks. Even one of the symptoms of the disease is called a lupus butterfly. Today the name is associated with the cute word "wolf cub".
Autoimmune disease develops against a background of hormonal disorders. An important role is played by the increased amount of estrogens, therefore, lupus is most often observed in the fair sex. The disease is usually diagnosed in adolescent girls and young women under 26 years of age.
In men, SLE is more severe, and remissions are rare, but their disease occurs 10 times less often, since androgens have a protective effect. Symptoms may be more pronounced in different genders. For example, in women, joints are more affected, and in men, the central nervous system and kidneys.
Lupus can be congenital. SLE symptoms appear in children during the first years of life.
The disease develops in waves, while periods of exacerbations and remissions alternate. SLE is characterized by an acute onset, rapid progression and early spread of the disease process. In children, the symptoms of systemic lupus erythematosus are the same as in adults.
Causes of occurrence
More than one cause affects the onset and development of lupus. It is due to the simultaneous or sequential influence of several factors at once. Scientists were able to find the main causes of the disease:
Scientists do not include the last factor in the general causes of SLE, but they believe that the patient's relatives are at risk.
Stage classification
SLE has a wide range of symptoms. During the illness, exacerbations and remissions occur.
Lupus is classified according to the forms of its course:
The stages of the disease are also distinguished. The minimum is characterized by mild headaches and joint pains, high fever, malaise and the first manifestations of lupus on the skin.
In the moderate phase, the face and body are severely affected, and then the vessels, joints and internal organs. At a pronounced stage, the work of various body systems is disrupted.
Disease symptoms
At the onset of SLE, skin lesions concern only 20% of patients. In 60% of patients, symptoms appear later. For some people, they don't appear at all. Signs of the disease can be seen on the face, neck, and shoulders. On the back of the nose and cheeks, a rash appears in the form of reddish, scaly plaques, reminiscent of wolf bites in the past. It is called the "lupus butterfly" because it looks like this insect. The patient's skin sensitivity to ultraviolet light increases.
Some people with lupus lose hair in the temporal areas and break their nails. Mucous membranes are affected in 25% of cases. Lupus cheilitis appears, characterized by dense edema of the lips in the form of grayish scales. Small ulcers of red or pink color may appear along the border. In addition, the oral mucosa is affected.
Lupus affects various body systems:
Common symptoms of lupus in women and men are CNS lesions. The disease is characterized by rapid fatigue, weakness, decreased memory and performance, deterioration of intellectual abilities. A person suffering from an autoimmune disease has irritability, depression, headaches, etc.
The patient may have decreased sensitivity. Seizures, psychosis, and seizures also develop with lupus.
Diagnostic methods
Differential diagnosis can be used to confirm the diagnosis of lupus. It is done because each manifestation speaks of the pathology of a particular organ. For this, a system developed by the American Rheumatological Association of Specialists is used.
The diagnosis of SLE is confirmed with four or more of these symptoms:
After a preliminary diagnosis is made, the patient is referred to a specialist with a narrow focus, for example, a nephrologist, pulmonologist or cardiologist.
A detailed examination includes a thorough history taking. The doctor needs to know about all the patient's previous illnesses and methods of their treatment.
Treatment methods
Medication therapy for a patient with SLE is selected individually. Treatment methods depend on the stage and form of the disease, the symptoms manifested and the characteristics of the patient's body.
It will be necessary to hospitalize a person suffering from lupus only in certain cases: a constant temperature above 38 degrees, a decrease, and also if a stroke, heart attack or severe central nervous system damage is suspected. If the clinical signs of the disease progress, then the patient will also be referred to hospitalization.
Lupus erythematosus treatment includes:
Hormonal creams and ointments eliminate peeling and burning sensations that have arisen in certain areas of the skin.
Particular attention is paid to the patient's immune system. During remission, the patient is treated with immunostimulants in combination with vitamin complexes and physiotherapy procedures.
Comorbidities and complications are also taken into account. Since the first place in cases of mortality is occupied by kidney problems, they must be constantly monitored for SLE. It is necessary to timely treat lupus arthritis and heart disease.
Dandelion P acts as a natural chondroprotector that prevents joints from collapsing and restores cartilage tissue. It lowers blood cholesterol levels and detoxifies the body. Dihydroquercetin Plus is used to strengthen the walls of blood vessels. It also eliminates bad cholesterol and improves blood microcirculation.
People with lupus are prescribed foods to help ease the symptoms of the disease. The patient should be given preference to food that can protect the brain, heart and kidneys.
For a person who has been diagnosed with lupus must be consumed in sufficient quantities:
Protein will help fight the disease. Doctors recommend eating veal, turkey and other dietary meats and poultry. The diet should include cod, pollock, pink salmon, tuna, squid, low-fat herring. Fish contains omega-3 unsaturated fatty acids that are vital for the normal functioning of the brain and heart.
You need to drink at least 8 glasses of clean water per day. It improves the functioning of the gastrointestinal tract, controls hunger and improves overall health.
Some foods will need to be abandoned or limited in your diet:
- Fatty meals. Foods that contain a lot of butter or vegetable oil increase the risk of exacerbations from the cardiovascular system. Due to fatty foods, cholesterol is deposited in the vessels. Because of it, acute myocardial infarction can develop.
- Caffeine. This component is present in large quantities in coffee, tea and some other drinks. Because of caffeine, the stomach lining is irritated, the heart beats more often and the nervous system is overloaded. If you stop drinking cups of drinks with this substance, you will be able to avoid the occurrence of erosion and the duodenum.
- Salt. Food should be limited as it overloads the kidneys and raises blood pressure.
People with lupus erythematosus should give up alcoholic beverages and cigarettes. They are already harmful in themselves, and in combination with medications can lead to disastrous consequences.
Patient predictions
The prognosis will be favorable if the disease is detected at an early stage of its development. At the very beginning of the course of lupus, tissues and organs are not severely deformed. A mild rash or arthritis is easily controlled by a specialist.
With advanced forms of SLE, aggressive treatment with large doses of various medications will be required. In this case, it is not always possible to determine what brings more harm to the body: large dosages of drugs or the pathological process itself.
Lupus erythematosus is not amenable to complete cure, but this does not mean that you cannot live happily with it. If you seek medical help in time, you can avoid serious problems. When following medical recommendations and the correct lifestyle, the patient does not have to limit himself in many ways.
Complication and progression of the disease is possible if a person has chronic infectious diseases. Frequent vaccinations and colds also have an impact. Therefore, such a patient needs to take care of his health and avoid factors that negatively affect his body.
Preventive actions
Prevention of SLE will help prevent recurrence of the disease and stop further progression of pathological processes. Secondary measures promote timely and adequate treatment of lupus.
Patients should regularly undergo dispensary examinations and consult a rheumatologist. The drugs must be taken in the prescribed dosage for a certain period of time.
It will be possible to maintain a state of stable remission with hardening, therapeutic exercises and regular walks in the fresh air. The patient must observe the regime of work and rest, avoiding unnecessary psychological and physical stress. Adequate sleep and proper nutrition are important not only for improving the condition during illness, but also for the normal functioning of the whole organism.
If a person has isolated areas of affected skin, it is necessary to find out if any of his relatives have been diagnosed with the disease. A person with lupus should avoid ultraviolet light and stay out of direct sunlight. In the warm season, you need to use special ointments that can protect the skin from the negative effects of the sun. A person with SLE needs to give up bad habits that only exacerbate their condition.
The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. A specialist consultation is required!
lupus erythematosus is a systemic autoimmune disease in which the body's own immune system damages connective tissue in various organs, mistaking its cells for foreign cells. Due to the damage of cells of various tissues by antibodies, an inflammatory process develops in them, which provokes very diverse, polymorphic clinical symptoms of lupus erythematosus, reflecting damage in many organs and systems of the body.Lupus erythematosus and systemic lupus erythematosus are different names for the same disease
Lupus erythematosus is now also referred to in the medical literature by names such as lupus erythematodes, erythematous chroniosepsis, liebman-Sachs disease or systemic lupus erythematosus (SLE)... The most commonly used and common term for the described pathology is "systemic lupus erythematosus". However, along with this term, its abbreviated form - "lupus erythematosus" is also very often used in everyday life.The term "systemic lupus erythematosus" is a distorted version of the name "systemic lupus erythematosus" used in everyday life.
Doctors and scientists prefer the fuller term "systemic lupus erythematosus" to denote a systemic autoimmune disease, since the reduced form of "lupus erythematosus" can be misleading. This preference is due to the fact that the name "lupus erythematosus" is traditionally used to refer to skin tuberculosis, which is manifested by the formation of red-brown bumps on the skin. Therefore, the use of the term "lupus erythematosus" to denote a systemic autoimmune disease requires clarification that we are not talking about skin tuberculosis.
In describing an autoimmune disease, we will in the following text use the terms “systemic lupus erythematosus” and simply “lupus erythematosus” to denote it. In this case, it must be remembered that lupus erythematosus is understood precisely as a systemic autoimmune pathology, and not skin tuberculosis.
Autoimmune lupus erythematosus
Autoimmune lupus erythematosus is systemic lupus erythematosus. The term "autoimmune lupus erythematosus" is not entirely correct and correct, but illustrates what is commonly called "oil oil". So, lupus erythematosus is an autoimmune disease, and therefore an additional indication in the name of the disease for autoimmunity is simply superfluous.Lupus erythematosus - what is this disease?
Lupus erythematosus is an autoimmune disease that develops as a result of a malfunction of the human immune system, as a result of which antibodies are produced to the cells of the body's own connective tissuelocated in different organs. This means that the immune system mistakenly takes its own connective tissue for foreign, and develops antibodies against it, which have a detrimental effect on cellular structures, thereby damaging various organs. And since connective tissue is present in all organs, lupus erythematosus is characterized by a polymorphic course with the development of signs of damage to various organs and systems.Connective tissue is essential for all organs, as it is in it that the blood vessels pass. After all, the vessels do not pass directly between the cells of the organs, but in special small, as it were, "cases" formed by the connective tissue. Such layers of connective tissue pass between sections of various organs, dividing them into small lobes. At the same time, each such lobule receives a supply of oxygen and nutrients from those blood vessels that pass along its perimeter in "cases" of connective tissue. Therefore, damage to the connective tissue leads to a breakdown in the blood supply to areas of various organs, as well as to a violation of the integrity of the blood vessels in them.
With regard to lupus erythematosus, it is obvious that antibody damage to connective tissue leads to hemorrhages and destruction of the tissue structure of various organs, which causes a variety of clinical symptoms.
Lupus erythematosus is more common in women, and according to various sources, the ratio of sick men and women is 1: 9 or 1:11. This means that for one man with systemic lupus erythematosus, there are 9-11 women who also suffer from this pathology. In addition, it is known that lupus is more common in the Negroid race than in Caucasians and Mongoloids. People of all ages, including children, get sick with systemic lupus erythematosus, but most often the pathology first appears at the age of 15 - 45 years. Lupus is extremely rare in children under 15 and adults over 45.
There are also known cases neonatal lupus erythematosuswhen a newborn child is born with this pathology. In such cases, the child fell ill with lupus while still in the womb, who herself suffers from this disease. However, the presence of such cases of transmission of the disease from mother to fetus does not mean that women suffering from lupus erythematosus necessarily have sick children. On the contrary, women with lupus usually carry and give birth to normal healthy children, since the disease is not infectious and cannot be transmitted through the placenta. And the cases of the birth of children with lupus erythematosus, mothers also suffering from this pathology, indicate that the predisposition to the disease is due to genetic factors. And therefore, if a baby receives such a predisposition, then he is still in the womb of a mother suffering from lupus, gets sick and is born with pathology.
The causes of systemic lupus erythematosus are currently not reliably established. Doctors and scientists suggest that the disease is polietiologic, that is, it is caused not by any one reason, but by a combination of several factors at once that act on the human body in the same period of time. Moreover, probable causal factors can provoke the development of lupus erythematosus only in people with a genetic predisposition to the disease. In other words, systemic lupus erythematosus develops only in the presence of a genetic predisposition and under the influence of several provoking factors simultaneously. Among the most likely factors that can trigger the development of systemic lupus erythematosus in people with a genetic predisposition to the disease, doctors identify stress, long-term viral infections (for example, herpes infection, infection caused by the Epstein-Barr virus, etc.), periods of hormonal body restructuring, prolonged exposure to ultraviolet radiation, taking certain drugs (sulfonamides, antiepileptic drugs, antibiotics, drugs for the treatment of malignant tumors, etc.).
Although chronic infections can contribute to the development of lupus erythematosus, the disease is not contagious and does not belong to tumor... Systemic lupus erythematosus cannot be contracted from another person; it can only develop individually if there is a genetic predisposition.
Systemic lupus erythematosus occurs in the form of a chronic inflammatory process, which can affect almost all organs, and only some individual tissues of the body. Most often, lupus erythematosus occurs as a systemic disease or in an isolated cutaneous form. In the systemic form of lupus, almost all organs are affected, but the joints, lungs, kidneys, heart and brain are most affected. In the cutaneous form of lupus erythematosus, the skin and joints are usually affected.
Due to the fact that a chronic inflammatory process leads to damage to the structure of various organs, the clinical symptoms of lupus erythematosus are very diverse. However any form and variety of lupus erythematosus is characterized by the following general symptoms:
- Soreness and swelling of the joints (especially large ones);
- Long-term unexplained increase in body temperature;
- Rashes on the skin (on the face, on the neck, on the trunk);
- Chest pain that occurs with deep inhalation or exhalation;
- A sharp and severe blanching or blue discoloration of the skin of the fingers and toes in the cold or during a stressful situation (Raynaud's syndrome);
- Swelling of the legs and eye area;
- Swollen and tender lymph nodes;
- Sensitivity to solar radiation.
For lupus characterized by the presence of not all symptoms at once, but their gradual appearance over time... That is, at the beginning of the disease, only a few symptoms appear in a person, and then, as lupus progresses and more and more organs are damaged, new clinical signs join. So, some symptoms may appear years after the development of the disease.
Women with lupus erythematosus can have a normal sex life. Moreover, depending on the goals and plans, you can either use contraceptives or, on the contrary, try to get pregnant. If a woman wants to endure pregnancy and give birth to a child, then she should register as early as possible, since with lupus erythematosus, the risk of miscarriage and premature birth is increased. But in general, pregnancy with lupus erythematosus proceeds quite normally, albeit with a high risk of complications, and in the vast majority of cases, women give birth to healthy children.
Currently systemic lupus erythematosus cannot be completely cured... Therefore, the main task of the treatment of the disease, which doctors set themselves, is to suppress the active inflammatory process, achieve a stable remission and prevent severe relapses. A wide range of drugs are used for this. Depending on which organ is most affected, various drugs are selected for the treatment of lupus erythematosus.
The main drugs for the treatment of systemic lupus erythematosus are glucocorticoid hormones (for example, Prednisolone, Methylprednisolone and Dexamethasone), which effectively suppress the inflammatory process in various organs and tissues, thereby minimizing the degree of their damage. If the disease has led to damage to the kidneys and the central nervous system, or the functioning of many organs and systems at once is disrupted, then in combination with glucocorticoids, immunosuppressants are used to treat lupus - drugs that suppress the activity of the immune system (for example, Azathioprine, Cyclophosphamide and Methotrexate).
In addition, sometimes in the treatment of lupus erythematosus, in addition to glucocorticoids, antimalarial drugs (Plaquenil, Aralen, Delagil, Atabrin) are used, which also effectively suppress the inflammatory process and maintain remission, preventing exacerbations. The mechanism behind the beneficial action of antimalarial drugs for lupus is unknown, but in practice it is well established that these drugs are effective.
If a person with lupus erythematosus develops secondary infections, then he is injected with immunoglobulin. If there is severe pain and swelling of the joints, then, in addition to the main treatment, it is necessary to take drugs of the NSAID group (Indomethacin, Diclofenac, Ibuprofen, Nimesulide, etc.).
A person suffering from systemic lupus erythematosus should remember that the disease is lifelong, it cannot be completely cured, as a result of which you will have to constantly take any medications in order to maintain a state of remission, prevent relapses and be able to lead a normal life.
Lupus erythematosus reasons
The exact reasons for the development of systemic lupus erythematosus are not currently known, but there are a number of theories and assumptions that put forward various diseases, external and internal influences on the body as causal factors.So, doctors and scientists came to the conclusion that lupus only develops in people with a genetic predisposition to the disease... Thus, the main causal factor is conventionally considered human genetic characteristics, since without a predisposition, lupus erythematosus never develops.
However, in order for lupus erythematosus to develop, one genetic predisposition is not enough; additional long-term exposure to certain factors that can trigger the pathological process is also necessary.
That is, it is obvious that there are a number of provoking factors that lead to the development of lupus in people with a genetic predisposition to it. These factors can be conditionally attributed to the causes of systemic lupus erythematosus.
Currently, doctors and scientists include the following as provoking factors of lupus erythematosus:
- The presence of chronic viral infections (herpes infection, infection caused by the Epstein-Barr virus);
- Frequent diseases with bacterial infections;
- Stress;
- The period of hormonal changes in the body (puberty, pregnancy, childbirth, menopause);
- Exposure to high-intensity ultraviolet radiation or for a long time (the sun's rays can both provoke an initial episode of lupus erythematosus and lead to an exacerbation during remission, since under the influence of ultraviolet radiation it is possible to start the process of producing antibodies to skin cells);
- Exposure to the skin of low temperatures (frost) and wind;
- Taking certain medications (antibiotics, sulfonamides, antiepileptic drugs and drugs for the treatment of malignant tumors).
Medicines, which are one of the causative factors of lupus, can cause both the disease itself and the so-called lupus syndrome... At the same time, in practice, it is lupus syndrome that is most often recorded, which in its clinical manifestations is similar to lupus erythematosus, but is not a disease, and passes after the withdrawal of the drug that caused it. But in rare cases, drugs can provoke the development of their own lupus erythematosus in people with a genetic predisposition to this disease. Moreover, the list of drugs that can provoke lupus syndrome and lupus itself is exactly the same. So, among the drugs used in modern medical practice, the following can lead to the development of systemic lupus erythematosus or lupus syndrome:
- Amiodarone;
- Atorvastatin;
- Bupropion;
- Valproic acid;
- Voriconazole;
- Gemfibrozil;
- Hydantoin;
- Hydralazine;
- Hydrochlorothiazide;
- Glyburide;
- Griseofulvin;
- Guinidine;
- Diltiazem;
Pathological changes in the skin are accompanied by negative manifestations in the general functioning of the body, because the reasons that caused the visible pathologies of the upper layer of the epidermis are mainly caused by internal disorders in the work of organs. And systemic lupus erythematosus, which is one of the varieties of this dermatological disease, can be considered one of the most frequent disorders accompanied by serious negative changes in the condition of the skin, the degree of its protective qualities and having many consequences that are dangerous to the health of the skin and the whole body.
Systemic lupus erythematosus is accompanied by changes in the state of the skin, while there is a change in functional qualities in the cardiac, respiratory, nervous systems, as well as in the state of the joints. However, first of all, this autoimmune disease is expressed in the occurrence of pathologies of the connective tissue of the skin. It becomes less elastic, susceptible to even minor mechanical influences, the basic processes are disturbed in it, which leads to stagnation in the tissues.
Features of the disease
Overly active production of antibodies that do not attack foreign cells (infectious and viral), but are directed against the cells of their own body - this is what happens with systemic lupus erythematosus, which significantly disrupts the entire process of functioning of the body's systems. At the same time, the body begins to "fight" against itself, as a result of which a large number of habitual functions are disturbed, the whole process of metabolism gets lost.
ICD-10 code: M32 (SLE).
Most often, this disease is noted in the female population, the age category generally does not matter. However, children and people (mainly women) at the age of 25-40 years most often suffer from systemic lupus erythematosus. Men get this disease 8-10 times less often.
Photo of systemic lupus erythematosus
Pathogenesis of systemic lupus erythematosus
The clinical picture of systemic lupus erythematosus is quite diverse: in some patients at the onset of the disease, only skin lesions are noted in the form of a tiny rash, which is localized mainly in the area of \u200b\u200bthe skin of the face (neck, cheeks, nose), in some - in addition to the skin, certain internal organs are also affected and the disease begins with symptoms of the predominant lesion. For example, if:
- joints are more affected, then there is a pathological change in the joints of the fingers,
- with damage to the cardiac system, manifestations and,
- and when the lung membrane is damaged, painful sensations occur in the patient's chest.
Also, in some cases, there is a lesion of the excretory system, in particular, the kidneys. This manifests itself in the form of the appearance of a large amount, pain appears when urinating, it can gradually develop. Further aggravation of the pathological process with the development of systemic lupus erythematosus leads to the appearance of negative changes in tissues and nervous processes in the brain. This becomes the cause of obvious changes in the patient's behavior, signs of mental abnormalities may be noted.
Due to the variety of manifestations of systemic lupus erythematosus, the diagnosis of this disease is difficult. However, with an appropriate differential diagnosis, it is possible to identify an incipient disease by performing a comparative analysis with a similar disease.
Systemic lupus erythematosus is discussed in this video:
Etiology
The presence of general complaints about the deterioration of health is a common picture of the current disease. However, a doctor should, if suspected of systemic lupus erythematosus, carry out a full range of diagnostic procedures that will help detect even the initial stages of the current pathological process.
Classification
Today it is customary to divide systemic lupus erythematosus into three types:
- Acute lupus, in which there is a sharp and rapidly current progression of the characteristic symptoms of the disease. A large number of internal organs and systems are affected, this type of disease can be considered a continuously current exacerbation of the disease. The survival rate of patients with the detection of an acute type of systemic lupus erythematosus is low, most of the patients die within the first two years after the detection of the disease. There is practically no susceptibility to treatment, which accounts for the high mortality rate among patients.
- Subacute form systemic lupus erythematosus is characterized by a not too rapid progression of the existing manifestations of the disease, however, in this case, the prognosis for the patient is not too optimistic, and only the detection of the disease at the earliest possible stage can save life for the next 5-8 years from the moment the disease is detected. Most often, in the subacute form of systemic lupus, the joints of the body and the skin are affected.
- Chronic form - this type of the disease in question is considered the only one with a benign course, which consists of stages of exacerbation and prolonged ongoing remissions. With the help of adequate and thoughtful treatment, it is possible to lengthen the periods of remission, which makes it possible to stabilize the general condition of the patient, allowing him to lead a normal life.
Three forms of the disease indicate the degree of neglect of the current pathological process, and also makes it possible, when detected, to apply the generally accepted drug scheme.
Organ problems in SLE
Localizations
The manifestation of the symptoms of this autoimmune disease can vary significantly in different patients. However, the common places of localization of lesions, as a rule, are the skin, joints (mainly hands and fingers), heart, lungs and bronchi, as well as digestive organs, nails and hair, which become more fragile and prone to loss, as well as the brain and the nervous system.
Causes of occurrence
Depending on the location of the main lesion, the manifestation of the disease can vary significantly. And the reasons for these negative changes can be both a hereditary factor and acquired current diseases of an infectious, inflammatory and viral nature. Also, various kinds of injuries can provoke the manifestation of the first symptoms of the disease (for example, damage to the skin most often occurs due to exposure to mechanical stimuli, as well as prolonged exposure to low or high temperatures, irradiation (artificial or solar).
Today, doctors continue numerous studies of the causes that can lead to the occurrence of systemic lupus erythematosus. There are also a significant number of provoking factors that become the starting point of this disease.
Symptoms and first signs
Depending on the area of \u200b\u200bthe lesion, the symptoms of the beginning pathological process in the body can also differ significantly. The most common symptoms and manifestations of systemic lupus erythematosus include the following characteristic changes in the body:
- lesions of the skin in the form, the affected areas gradually increase in size and even merge with each other, becoming a significant area of \u200b\u200bthe lesion. The skin in these places loses its natural firmness and elasticity, easily lends itself to external influences;
- with damage to the joints, an increase in their sensitivity is noted, soreness appears, fingers can gradually deform;
- brain damage entail changes in the state of the psyche, violation of the patient's behavior;
- damage to the membrane of the lungs and bronchi leads to chest pains, difficulty breathing in the patient;
- with severe kidney damage, the process of excretion and discharge of urine worsens, even renal failure can occur during advanced stages of the disease.
Relatively minor manifestations such as hair loss, increased nail brittleness, alopecia, fever, as well as loss of appetite and weight changes are also often noted in the initial stages of current systemic lupus erythematosus.
Systemic lupus erythematosus in adults and children
Diagnostics
To set up a preliminary analysis, the attending physician analyzes the patient's subjective feelings. A visual examination of the affected areas of the body is also carried out. However, to clarify the diagnosis, a number of tests are carried out, which will provide the most complete picture of the disease in a particular case.
To clarify the preliminary diagnosis, a dermatologist may prescribe the following tests and studies:
- samples of affected skin, and in case of damage to nails or hair and particles of hair and nail plate, they can distinguish this disease from,.
- samples of skin and hair scales.
- Immunological research - based on the interaction of antigens with antibodies.
Analyzes that help clarify the preliminary diagnosis are as follows:
- blood tests, which examine the presence or absence of specific antibodies, a reaction to syphilis, a decrease in the number of leukocytes and platelets;
- biochemical studies of tissue samples taken from lesions are carried out.
The treatment and symptoms of SLE are covered in this video:
Treatment
A dermatologist prescribes a type of therapeutic effect that will allow, in the shortest possible time and for a long time, to eliminate the characteristic manifestations of this disease. The choice of a treatment regimen is determined by the existing manifestations, by assigning the type of disease to a specific type. When conducting treatment, the doctor takes into account the individual characteristics of the body, as well as the degree of susceptibility to the treatment being carried out.
- Adults are treated with antimalarial drugs, the dosage and duration of use of which is prescribed by the doctor. When carrying out a therapeutic effect, the doctor's control over the patient's well-being is mandatory.
- Children are also treated with drugs prescribed by a doctor. The dosage in the treatment of children is determined by their age, weight, as well as the degree of sensitivity of the body to the treatment.
- During pregnancy the treatment process should be carried out taking into account the woman's condition: the absence of a negative effect on the fetus, drugs are selected, and the necessary adjustments are introduced into the exposure process.
It should be remembered that a complete cure for systemic lupus erythematosus is not possible. However, with the correct selection of drug therapy and constant monitoring of the treatment process with the necessary adjustments, it is likely that the strength of symptoms will decrease, and the patient's condition will stabilize.
Complex treatment allows you to get the most pronounced results that last for a longer time and stabilize the patient's condition.
In a therapeutic way
When detecting any stage of systemic lupus erythematosus, an integrated approach is used, which allows you to get the most pronounced results. The therapeutic method involves the use of physiotherapy methods that enhances the ongoing drug treatment.
The method of using magnets, radiation in limited doses to stop the current pathological process can be applied. Also, work and rest time are rationed, the reasons for stressful situations are eliminated.
By medication
Drugs that can also be prescribed for the treatment of systemic lupus erythematosus include:
- in the presence of inflammatory processes in the body, a doctor can prescribe anti-inflammatory non-steroidal drugs of a wide spectrum of action. However, if they are used for too long, a negative effect on the mucous membrane of the intestine and stomach is likely, which can cause gastritis and then;
- corticosteroid drugs also stop inflammation processes, however, they have a lot of side effects in the form of joint deformation, a decrease in the degree of blood coagulability, and obesity;
- in severe forms of damage, a doctor may prescribe drugs that reduce the level of immunity.
In the treatment of manifestations of systemic lupus erythematosus, drugs are used, such as stopping pathological changes in the joints, preventing their pronounced deformation. Also, drugs are prescribed that reduce the rate at which the body produces its own antibodies.
It is often used to help the body cope with the manifestations of this skin lesion and to stimulate the body's defenses. Rashes should be treated with ointments based on zinc and lanolin.
Surgical intervention for detecting systemic lupus erythematosus is not performed.
Folk ways
This disease cannot be cured either with drugs or with the help of alternative methods. However, the use of traditional medicine helps to stabilize the patient's condition; it can be used during final treatment and in remission to consolidate the result.
Even in the absence of the possibility of a complete cure of systemic lupus erythematosus, it is possible to continue to lead a normal life. And as a prophylaxis for relapses and exacerbations of the disease, it is recommended to fully comply with all the doctor's recommendations, try to provoke stressful situations, and do not stay in open sunlight for a long time.
Regular health examinations will promptly detect deterioration in the condition and begin supportive treatment.
Complications
The most terrible complication in systemic lupus erythematosus can be death, which is most often observed in the acute form of the disease. However, even in the absence of the necessary and adequate treatment, the likelihood of death of the patient, even in the chronic course of the disease, is quite high.
SLE in a woman
Forecast
The survival rate in the acute form of the disease is low, it is no more than 2-5 years from the moment the manifestation of systemic lupus erythematosus begins. With the subacute form of the disease, the survival rate is higher is 80-95%. The chronic form of the disease, if properly treated, is not a fatal disease.
The doctor from this video explains how to get rid of SLE:
Systemic lupus erythematosus (SLE) - a chronic autoimmune disease caused by a malfunction of the immune mechanisms with the formation of damaging antibodies to its own cells and tissues. SLE is characterized by damage to joints, skin, blood vessels and various organs (kidney, heart, etc.).
The cause and mechanisms of development of the disease
The cause of the disease has not been clarified. It is assumed that viruses (RNA and retroviruses) are the trigger mechanism for the development of the disease. In addition, humans have a genetic predisposition to SLE. Women get sick 10 times more often, which is due to the peculiarities of their hormonal system (high concentration of estrogen in the blood). The protective effect against SLE of male sex hormones (androgens) has been proven. Factors that can cause the development of the disease can be a viral, bacterial infection, medicines.The mechanisms of the disease are based on the dysfunction of immune cells (T and B - lymphocytes), which is accompanied by excessive formation of antibodies to the body's own cells. As a result of excessive and uncontrolled production of antibodies, specific complexes are formed that circulate throughout the body. Circulating immune complexes (CICs) are deposited in the skin, kidneys, on the serous membranes of internal organs (heart, lungs, etc.) causing inflammatory reactions.
Symptoms of the disease
SLE is characterized by a wide range of symptoms. The disease proceeds with exacerbations and remissions. The onset of the disease can be either lightning fast or gradual. Common symptoms
- Fatigue
- Weight loss
- Temperature
- Decreased performance
- Fast fatiguability
The defeat of the musculoskeletal system
- Arthritis - joint inflammation
- It occurs in 90% of cases, non-erosive, non-deforming, more often the joints of the fingers, wrists, knee joints are affected.
- Osteoporosis - a decrease in bone density
- As a result of inflammation or treatment with hormonal drugs (corticosteroids).
- Muscle pain (15-64% of cases), muscle inflammation (5-11%), muscle weakness (5-10%)
Lesion of mucous membranes and skin
- Skin lesions at the onset of the disease appear only in 20-25% of patients, in 60-70% of patients they occur later, in 10-15% skin manifestations of the disease do not occur at all. Skin changes appear on areas of the body exposed to the sun: face, neck, shoulders. Lesions have the appearance of erythema (reddish plaques with scaling), dilated capillaries at the edges, areas with excess or lack of pigment. On the face, such changes resemble the appearance of a butterfly, since the back of the nose and cheeks are affected.
- Hair loss (alopecia) is rare, usually affecting the temporal regions. Hair falls out in a limited area.
- Hypersensitivity of the skin to the sun's rays (photosensitivity) occurs in 30-60% of patients.
- Mucous membranes are affected in 25% of cases.
- Redness, decreased pigmentation, malnutrition of the tissues of the lips (cheilitis)
- Small-point hemorrhages, ulcerative lesions of the oral mucosa
Respiratory system damage
Lesions from the respiratory system in SLE are diagnosed in 65% of cases. Pulmonary pathology can develop both acutely and gradually with various complications. The most common manifestation of damage to the pulmonary system is inflammation of the membrane covering the lungs (pleurisy). It is characterized by chest pain, shortness of breath. SLE can also cause the development of lupus pneumonitis (lupus pneumonitis), characterized by: shortness of breath, cough with bloody sputum. SLE often affects the vessels of the lungs, resulting in pulmonary hypertension. Against the background of SLE, infectious processes in the lungs often develop, and it is also possible to develop a serious condition such as blockage of the pulmonary artery by a thrombus (pulmonary embolism).Damage to the cardiovascular system
SLE can affect all structures of the heart, the outer shell (pericardium), the inner layer (endocardium), the heart muscle itself (myocardium), valves and coronary vessels. The most common injury is the pericardium (pericarditis).- Pericarditis is an inflammation of the serous membranes that cover the heart muscle.
- Myocarditis is an inflammation of the heart muscle.
- Damage to heart valves, mitral and aortic valves are more often affected.
- Damage to the coronary vessels can lead to myocardial infarction, which can also develop in young patients with SLE.
- Damage to the inner lining of blood vessels (endothelium) increases the risk of developing atherosclerosis. The defeat of peripheral vessels is manifested:
- Livedo reticularis (blue spots on the skin creating a mesh pattern)
- Lupus panniculitis (subcutaneous nodules that are often painful and may ulcerate)
- Thrombosis of the vessels of the extremities and internal organs
Kidney damage
Most often, with SLE, the kidneys are affected, in 50% of patients, lesions of the renal apparatus are determined. A common symptom is the presence of protein in the urine (proteinuria), red blood cells and casts are usually not detected at the onset of the disease. The main manifestations of kidney damage in SLE are: proliferative glomerulonephritis and mebranous nephritis, which is manifested by nephrotic syndrome (proteins in the urine more than 3.5 g / day, decreased protein in the blood, edema).Damage to the central nervous system
It is assumed that disorders of the central nervous system are caused by damage to the vessels of the brain, as well as the formation of antibodies to neurons, to cells responsible for the protection and nutrition of neurons (glial cells), and to immune cells (lymphocytes).The main manifestations of damage to the nervous structures and blood vessels of the brain:
- Headache and migraine, the most common symptoms of SLE
- Irritability, depression - rarely
- Psychoses: paranoia or hallucinations
- Brain stroke
- Chorea, parkinsonism - rarely
- Myelopathies, neuropathies and other disorders of the formation of the nerve sheaths (myelin)
- Mononeuritis, polyneuritis, aseptic meningitis
Digestive tract damage
Clinical lesions of the digestive tract are diagnosed in 20% of patients with SLE.- Lesion of the esophagus, violation of the act of swallowing, expansion of the esophagus occurs in 5% of cases
- Stomach and 12th bowel ulcers are caused by both the disease itself and the side effects of treatment
- Abdominal pain as a manifestation of SLE, and can also be caused by pancreatitis, inflammation of the intestinal vessels, intestinal infarction
- Nausea, abdominal discomfort, indigestion
- Hypochromic normocytic anemia occurs in 50% of patients, the severity depends on the activity of SLE. Hemolytic anemia is rare in SLE.
- Leukopenia - a decrease in leukocytes in the blood. It is caused by a decrease in lymphocytes and granulocytes (neutrophils, eosinophils, basophils).
- Thrombocytopenia is a decrease in platelets in the blood. It occurs in 25% of cases, caused by the formation of antibodies against platelets, as well as antibodies to phospholipids (fats that are part of cell membranes).
Diagnosis of SLE
Diagnosis of SLE is based on data from clinical manifestations of the disease, as well as on data from laboratory and instrumental studies. The American College of Rheumatology has developed special criteria by which a diagnosis can be made - systemic lupus erythematosus.Criteria for the diagnosis of systemic lupus erythematosus
The diagnosis of SLE is made if at least 4 of 11 criteria are present.
| Characteristics: no erosion, peripheral, manifested by pain, swelling, accumulation of insignificant fluid in the joint cavity |
| Red, oval, round or annular, plaques with irregular contours on their surface are scales, there are dilated capillaries nearby, scales are difficult to separate. Untreated lesions leave scars. |
| The oral mucosa or nasopharyngeal mucosa is affected in the form of ulceration. Usually painless. |
| Hypersensitivity to sunlight. As a result of exposure to sunlight, a rash appears on the skin. |
| Specific butterfly rash |
| Constant loss of protein in the urine 0.5 g / day, excretion of cell casts |
| Pleurisy is an inflammation of the membranes of the lungs. It manifests itself as pain in the chest, worsening with inspiration. Pericarditis - inflammation of the heart membrane |
| Convulsions, Psychosis - in the absence of drugs capable of provoking them or metabolic disorders (uremia, etc.) |
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| Elevated anti-nuclear antibodies (ANA) |
The degree of disease activity is determined according to special SLEDAI indices ( Systemic lupus erythematosus Disease Activity Index). The disease activity index includes 24 parameters and reflects the state of 9 systems and organs, expressed in points that are summed up. The maximum is 105 points, which corresponds to a very high disease activity.
Disease activity indices bySLEDAI
| Manifestations | Description | Punctuation |
| Pseudo-epileptic seizure(development of seizures without loss of consciousness) | It is necessary to exclude metabolic disorders, infections, medications that could provoke it. | 8 |
| Psychoses | Violation of the ability to perform actions in a normal mode, impaired perception of reality, hallucinations, decreased associative thinking, disorganized behavior. | 8 |
| Organic changes in the brain | Changes in logical thinking, impaired orientation in space, reduced memory, intelligence, concentration, incoherent speech, insomnia or drowsiness. | 8 |
| Eye disorders | Inflammation of the optic nerve, excluding arterial hypertension. | 8 |
| Cranial nerve damage | The defeat of the cranial nerves revealed for the first time. | |
| Headache | Severe, persistent, may be migraine, unresponsive to narcotic analgesics | 8 |
| Impaired blood circulation in the brain | First identified, excluding the consequences of atherosclerosis | 8 |
| Vasculitis(vascular damage) | Ulcers, gangrene of the limbs, painful knots on the fingers | 8 |
| Arthritis- (joint inflammation) | The defeat of more than 2 joints with signs of inflammation and swelling. | 4 |
| Myositis- (skeletal muscle inflammation) | Muscle pain, weakness with confirmation of instrumental studies | 4 |
| Cylinders in urine | Hyaline, granular, erythrocytic | 4 |
| Red blood cells in urine | More than 5 erythrocytes in the field of view, exclude other pathologies | 4 |
| Protein in urine | More than 150 mg per day | 4 |
| Leukocytes in urine | More than 5 leukocytes per field of view, excluding infections | 4 |
| Skin damage | Inflammatory lesions | 2 |
| Hair loss | Enlargement of lesions or complete hair loss | 2 |
| Mucosal ulcers | Ulcers on the mucous membranes and on the nose | 2 |
| Pleurisy- (inflammation of the lining of the lungs) | Chest pain, pleural thickening | 2 |
| Pericarditis-(inflammation of the lining of the heart) | Revealed on ECG, EchoCG | 2 |
| Decreased compliment | Decrease in C3 or C4 | 2 |
| AntiDNA | Positively | 2 |
| Temperature | More than 38 degrees C, excluding infections | 1 |
| Decreased blood platelets | Less than 150 · 10 9 / L, excluding medicines | 1 |
| Decrease in leukocytes | Less than 4.0 · 10 9 / L, excluding medicines | 1 |
- Light activity: 1-5 points
- Moderate activity: 6-10 points
- High activity: 11-20 points
- Very high activity: more than 20 points
Diagnostic tests used to detect SLE
- ANA-screening test, specific antibodies to cell nuclei are determined, determined in 95% of patients, does not confirm the diagnosis in the absence of clinical manifestations of systemic lupus erythematosus
- Anti DNA - antibodies to DNA, determined in 50% of patients, the level of these antibodies reflects the activity of the disease
- Anti-Sm -specific antibodies to the Smith antigen, which is part of short RNAs, are detected in 30-40% of cases
- Anti -SSA or AntiSSB, antibodies to specific proteins located in the cell nucleus, are present in 55% of patients with systemic lupus erythematosus, are not specific for SLE, are also determined in other connective tissue diseases
- Anticardiolipin -antibodies to mitochondrial membranes (energy station of cells)
- Antihistones - antibodies against proteins necessary for packing DNA into chromosomes, characteristic of SLE caused by drugs.
- Inflammation markers
- ESR - increased
- C - reactive protein, increased
- Compliment level lowered
- C3 and C4 are reduced as a result of excessive formation of immune complexes
- Some people have a reduced level of compliment from birth, this is a predisposing factor for the development of SLE.
- General blood analysis
- Possible decrease in erythrocytes, leukocytes, lymphocytes, platelets
- Analysis of urine
- Protein in urine (proteinuria)
- Red blood cells in urine (hematuria)
- Cylinders in urine (cylindruria)
- Leukocytes in urine (pyuria)
- Blood chemistry
- Creatinine - elevation indicates kidney damage
- ALAT, ASAT - an increase indicates liver damage
- Creatine kinase - increases with damage to the muscular system
- X-ray of the joints
- X-ray and computed tomography of the chest
- Nuclear Magnetic Resonance and Angiography
- Echocardiography
Specific procedures
- A lumbar puncture can rule out infectious causes of neurological symptoms.
- A biopsy (analysis of organ tissue) of the kidneys can determine the type of glomerulonephritis and facilitate the choice of treatment tactics.
- A skin biopsy allows you to clarify the diagnosis and exclude similar dermatological diseases.
Treatment of systemic lupus
Despite significant advances in the modern treatment of systemic lupus erythematosus, this task remains very difficult. Treatment aimed at eliminating the main cause of the disease has not been found, nor has the cause itself been found. Thus, the principle of treatment is aimed at eliminating the mechanisms of development of the disease, reducing provoking factors and preventing complications. - Eliminate physical and mental stress conditions
- Reduce sun exposure, use sunscreen
- Glucocorticosteroidsthe most effective drugs in the treatment of SLE.
Modes of taking drugs:
- Inside:
- Initial dose of prednisolone 0.5-1 mg / kg
- Maintenance dose 5-10 mg
- Prednisone should be taken in the morning, the dose is reduced by 5 mg every 2-3 weeks.
- High-dose intravenous methylprednisolone (pulse therapy)
- Dose 500-1000 mg / day, for 3-5 days
- Or 15-20 mg / kg body weight
Indications for pulse therapy: young age, fulminant lupus nephritis, high immunological activity, damage to the nervous system.
- 1000 mg methylprednisolone and 1000 mg cyclophosphamide on the first day
- Cytostatics:cyclophosphamide (cyclophosphamide), azathioprine, methotrexate, are used in the complex treatment of SLE.
- Acute lupus nephritis
- Vasculitis
- Corticosteroid-resistant forms
- Need to reduce corticosteroid doses
- High SLE activity
- Progressive or fulminant course of SLE
- Cyclophosphamide with pulse therapy 1000 mg, then every day 200 mg until a total dose of 5000 mg is reached.
- Azathioprine 2-2.5 mg / kg / day
- Methotrexate 7.5-10 mg / week, by mouth
- Anti-inflammatory drugs
- Naklofen, Nimesil, Aertal, Katafast, etc.
- Aminoquinoline preparations
- delagil, plaquenil, etc.
- Biological preparationsare a promising treatment for SLE
- Anti CD 20 - Rituximab
- Tumor necrosis factor alpha - Remikade, Gumira, Embrel
- Other drugs
- Anticoagulants (heparin, warfarin, etc.)
- Antiplatelet agents (aspirin, clopidogrel, etc.)
- Diuretics (furosemide, hydrochlorothiazide, etc.)
- Calcium and potassium preparations
- Extracorporeal treatment methods
- Plasmapheresis is a method of purifying blood outside the body, in which part of the blood plasma is removed, and with it the antibodies that cause SLE disease.
- Hemisorption is a method of purifying blood outside the body using specific sorbents (ion-exchange resins, activated carbon, etc.).
What are the complications and prognosis for life with systemic lupus erythematosus?
The risk of developing complications of systemic lupus erythematosus directly depends on the course of the disease.Options for the course of systemic lupus erythematosus:
1.
Acute current - characterized by a lightning-fast onset, a violent course and the rapid simultaneous development of symptoms of damage to many internal organs (lungs, heart, central nervous system, and so on). The acute course of systemic lupus erythematosus, fortunately, is rare, since this option quickly and almost always leads to complications and can cause death of the patient.
2.
Subacute course - characterized by a gradual onset, a change in periods of exacerbations and remissions, a predominance of general symptoms (weakness, weight loss, low-grade fever (up to 38 0
C) and others), damage to internal organs and complications occur gradually, no earlier than 2-4 years after the onset of the disease.
3.
Chronic course - the most favorable course of SLE, there is a gradual onset, damage mainly to the skin and joints, longer periods of remission, damage to internal organs and complications occur after decades.
Damage to organs such as the heart, kidneys, lungs, central nervous system, and blood, which are described as symptoms of the disease, in fact, are complications of systemic lupus erythematosus.
But you can highlight complications that lead to irreversible consequences and can lead to the death of the patient:
1. Systemic lupus erythematosus - affects the connective tissue of the skin, joints, kidneys, blood vessels and other structures of the body.
2. Medicinal lupus erythematosus - in contrast to the systemic type of lupus erythematosus, a completely reversible process. Medicinal lupus develops as a result of exposure to certain drugs:
- Medicines for the treatment of cardiovascular diseases: phenothiazine groups (Apressin, Aminazin), Hydralazine, Inderal, Metoprolol, Bisoprolol, Propranolol and some others;
- antiarrhythmic agent - Novocainamide;
- sulfonamides: Biseptol other;
- anti-tuberculosis drug Isoniazid;
- oral contraceptives;
- herbal preparations for the treatment of venous diseases (thrombophlebitis, varicose veins of the lower extremities, and so on): horse chestnut, venotonic Doppelherz, Detralex and some others.
3. Discoid (or cutaneous) lupus erythematosus may precede the development of systemic lupus erythematosus. In this type of disease, the skin of the face is mostly affected. Changes on the face are similar to those in systemic lupus erythematosus, but blood test indicators (biochemical and immunological) do not have changes characteristic of SLE, and this will be the main criterion for differential diagnosis with other types of lupus erythematosus. To clarify the diagnosis, it is necessary to conduct a histological examination of the skin, which will help differentiate from diseases similar in appearance (eczema, psoriasis, cutaneous form of sarcoidosis, and others).
4. Neonatal lupus erythematosus occurs in newborn babies whose mothers suffer from systemic lupus erythematosus or other systemic autoimmune diseases. In this case, the mother may not have symptoms of SLE, but when they are examined, autoimmune antibodies are detected.
Symptoms of neonatal lupus erythematosus the child usually manifests itself before the age of 3 months:
- changes on the skin of the face (often look like a butterfly);
- congenital arrhythmia, which is often determined by ultrasound of the fetus in the II-III trimesters of pregnancy;
- a lack of blood cells in a general blood test (a decrease in the level of erythrocytes, hemoglobin, leukocytes, platelets);
- identification of autoimmune antibodies specific for SLE.
5. Also, the term "lupus" is used for tuberculosis of the skin of the face - tuberculous lupus... Skin tuberculosis is outwardly very similar to the systemic lupus erythematosus butterfly. The diagnosis will help to establish a histological examination of the skin and microscopic and bacteriological examination of scrapings - mycobacterium tuberculosis (acid-fast bacteria) is detected.
Photo:
it looks like tuberculosis of the skin of the face or tuberculous lupus.
Systemic lupus erythematosus and other systemic connective tissue diseases, how to differentiate?
Group of systemic connective tissue diseases:- Systemic lupus erythematosus.
- Idiopathic dermatomyositis (polymyositis, Wagner's disease) - Damage by autoimmune antibodies to smooth and skeletal muscles.
- Systemic scleroderma Is a disease in which normal tissue is replaced by connective tissue (not carrying functional properties), including blood vessels.
- Diffuse fasciitis (eosinophilic) - damage to the fascia - structures that are sheaths for skeletal muscles, while in the blood of most patients there is an increased number of eosinophils (blood cells responsible for allergies).
- Sjogren's syndrome - damage to various glands (lacrimal, salivary, sweat, and so on), for which this syndrome is also called dry.
- Other systemic diseases.
Differential diagnosis of systemic connective tissue diseases.
| Diagnostic criteria | Systemic lupus erythematosus | Systemic scleroderma | Idiopathic Dermatomyositis |
| Onset of the disease |
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 Photo: Raynaud's syndrome |
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| Temperature | Prolonged fever, body temperature above 38-39 0 С. | Prolonged subfebrile condition (up to 38 0 C). | Moderate prolonged fever (up to 39 0 C). |
| The patient's appearance (at the beginning of the disease and in some of its forms, the patient's appearance may not be changed in all these diseases) | Lesion of the skin, mostly of the face, "butterfly" (redness, scales, scars). Rashes can be all over the body and mucous membranes. Dry skin, loss of hair, nails. Nails are deformed, striated nail plates. Also, hemorrhagic rashes (bruises and petechiae) may occur throughout the body.  | The face can acquire a "mask-like" expression without facial expressions, taut, the skin shines, deep folds appear around the mouth, the skin is motionless, tightly adhered to deep-lying tissues. Dysfunction of the glands is often observed (dry mucous membranes, as in Sjogren's syndrome). Hair and nails fall out. There are dark spots on the skin of the limbs and neck against the background of "bronze skin".  | A specific symptom is swelling of the eyelids, their color can be red or purple, on the face and in the décolleté area there is a varied rash with reddening of the skin, scales, hemorrhages, scars. With the progression of the disease, the face acquires a "mask-like appearance", without facial expressions, taut, can be skewed, often revealing ptosis of the upper eyelid (ptosis).  |
| The main symptoms during the period of disease activity |
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| Forecast | Chronic course, over time, more and more organs are affected. Without treatment, complications develop that threaten the patient's life. With adequate and regular treatment, it is possible to achieve a long, stable remission. | ||
| Laboratory indicators |
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| Treatment principles | Long-term hormone therapy (Prednisolone) + cytostatics + symptomatic therapy and other drugs (see the article section "Treatment of systemic lupus"). | ||
As you can see, there is not a single analysis that would completely differentiate systemic lupus erythematosus from other systemic diseases, and the symptoms are very similar, especially in the early stages. It is often sufficient for experienced rheumatologists to assess the skin manifestations of the disease to diagnose systemic lupus erythematosus (if any).
Systemic lupus erythematosus in children, what are the features of the symptoms and treatment?
Systemic lupus erythematosus is less common in children than in adults. In childhood, rheumatoid arthritis is more often identified from autoimmune diseases. SLE mainly (in 90% of cases) affects girls. Systemic lupus erythematosus can occur in infants and young children, although rarely, the largest number of cases of this disease occurs during puberty, namely at the age of 11-15 years. Considering the peculiarity of immunity, hormonal background, growth rate, systemic lupus erythematosus in children proceeds with its own characteristics.
Features of the course of systemic lupus erythematosus in childhood:
- more severe course of the disease , high activity of the autoimmune process;
- chronic course disease in children occurs only in a third of cases;
- more common acute or subacute course diseases with rapid damage to internal organs;
- also only in children are isolated acute or lightning-fast current SLE - almost simultaneous damage to all organs, including the central nervous system, which can lead to the death of a small patient in the first six months after the onset of the disease;
- frequent development of complications and high mortality;
- the most common complication is bleeding disorder in the form of internal bleeding, hemorrhagic rashes (bruises, hemorrhages on the skin), as a result - the development of the shock state of DIC-syndrome - disseminated intravascular coagulation;
- systemic lupus erythematosus in children often occurs in the form vasculitis - inflammation of the blood vessels, which determines the severity of the process;
- children with SLE are usually wasted , have a pronounced underweight, up to cachexia (extreme degree of dystrophy).
1.
Onset of the disease acute, with an increase in body temperature to high numbers (over 38-39 0 C), with pain in the joints and severe weakness, a sharp loss of body weight.
2.
Skin changes in the form of a "butterfly" in children are relatively rare. But, given the development of a lack of blood platelets, a hemorrhagic rash is more common throughout the body (bruises for no reason, petechiae or punctate hemorrhages). Also, one of the characteristic signs of systemic diseases is the loss of hair, eyelashes, eyebrows, up to complete baldness. The skin becomes marbled, very sensitive to sunlight. There may be various rashes on the skin, characteristic of allergic dermatitis. In some cases, Raynaud's syndrome develops - a violation of blood circulation in the hands. In the oral cavity, there may be long-term non-healing ulcers - stomatitis.
3.
Joint pain - a typical syndrome of active systemic lupus erythematosus, the pain is periodic. Arthritis is accompanied by the accumulation of fluid in the joint cavity. Joint pain over time is combined with muscle pain and stiffness of movement, starting with the small joints of the fingers.
4.
For children characterized by the formation of exudative pleurisy (fluid in the pleural cavity), pericarditis (fluid in the pericardium, the lining of the heart), ascites and other exudative reactions (dropsy).
5.
Heart failure in children, it usually manifests itself as myocarditis (inflammation of the heart muscle).
6.
Kidney damage or nephritis develops much more often in childhood than in adults. Such nephritis relatively quickly leads to the development of acute renal failure (requiring intensive therapy and hemodialysis).
7.
Lung damage rare in children.
8.
In the early period of the disease in adolescents, in most cases, there is damage to the gastrointestinal tract (hepatitis, peritonitis, and so on).
9.
Damage to the central nervous system in children it is characterized by moodiness, irritability, in severe cases, convulsions may develop.
That is, in children, systemic lupus erythematosus is also characterized by a variety of symptoms. And many of these symptoms are masked under the guise of other pathologies, the diagnosis of systemic lupus erythematosus is not assumed immediately. Unfortunately, after all, the treatment started on time is the key to success in the transition of the active process during the period of stable remission.
Diagnostic principles systemic lupus erythematosus are the same as in adults, based mainly on immunological studies (detection of autoimmune antibodies).
In a general blood test, in all cases and from the very beginning of the disease, a decrease in the number of all blood cells (erythrocytes, leukocytes, platelets) is determined, and blood coagulability is impaired.
Treatment of systemic lupus erythematosus in children, as in adults, implies long-term use of glucocorticoids, namely Prednisolone, cytostatics and anti-inflammatory drugs. Systemic lupus erythematosus is a diagnosis that requires urgent hospitalization of the child in the hospital (rheumatology department, with the development of severe complications - in the intensive care unit or intensive care unit).
In a hospital, a complete examination of the patient is carried out and the necessary therapy is selected. Symptomatic and intensive therapy is performed depending on the presence of complications. Given the presence of blood clotting disorders in such patients, Heparin injections are often prescribed.
If started and regular treatment is started on time, stable remission, while children grow and develop according to their age, including normal puberty. In girls, a normal menstrual cycle is established and pregnancy is possible in the future. In this case forecastfor a favorable life.
Systemic lupus erythematosus and pregnancy, what are the risks and treatment options?
As already mentioned, young women are more likely to suffer from systemic lupus erythematosus, and for any woman the issue of motherhood is very important. But SLE and pregnancy are always a big risk for both the mother and the unborn baby. Risks of pregnancy for women with systemic lupus erythematosus:
1. Systemic lupus erythematosus
In most cases does not affect the ability to get pregnant
,
as well as long-term use of Prednisolone.
2. When taking cytostatics (Methotrexate, Cyclophosphamide and others), it is categorically impossible to get pregnant
,
since these drugs will affect the germ cells and cells of the embryo; pregnancy is possible only no earlier than six months after the abolition of these drugs.
3. Half
cases of pregnancy with SLE ends in birth healthy, full-term baby
. At 25%
cases such babies are born premature
, a in a quarter of cases
observed miscarriage
.
4. Possible pregnancy complications with systemic lupus erythematosus,
in most cases associated with vascular lesions of the placenta:
- fetal death;
- ... So, in a third of cases, an aggravation of the course of the disease develops. The risk of such a deterioration is greatest in the first weeks of the first or third trimester of pregnancy. And in other cases, there is a temporary retreat of the disease, but for the most part one should expect a strong exacerbation of systemic lupus erythematosus 1-3 months after childbirth. No one knows which path the autoimmune process will take.
6. Pregnancy can trigger the onset of systemic lupus erythematosus. Also, pregnancy can provoke the transition of discoid (cutaneous) lupus erythematosus to SLE.
7. Mother with systemic lupus erythematosus can pass genes on to her baby , predisposing the development of a systemic autoimmune disease in him during his life.
8. The child may develop neonatal lupus erythematosus associated with the circulation of maternal autoimmune antibodies in the baby's blood; this condition is temporary and reversible.- Planning a pregnancy is necessary under the supervision of qualified doctors , namely a rheumatologist and a gynecologist.
- It is advisable to plan a pregnancy during stable remission chronic course of SLE.
- In acute course systemic lupus erythematosus with the development of complications, pregnancy can adversely affect not only health, but also lead to a woman's death.
- And if, nevertheless, pregnancy occurred during an exacerbation, then the question of its possible preservation is decided by the doctors, together with the patient. Indeed, exacerbation of SLE requires long-term administration of drugs, some of which are absolutely contraindicated during pregnancy.
- It is recommended to get pregnant no earlier than 6 months after discontinuation of cytotoxic drugs (Methotrexate and others).
- For lupus kidney and heart disease pregnancy is out of the question, this can lead to the death of a woman from renal and / or heart failure, because it is on these organs that a huge load goes when carrying a baby.
1. Necessary throughout pregnancy observed by a rheumatologist and obstetrician-gynecologist , the approach to each patient is only individual.
2. Be sure to comply with the regime: do not overwork, do not get nervous, eat normally.
3. Be attentive to any changes in your health.
4. Delivery outside the maternity hospital is unacceptable , as there is a risk of developing severe complications during and after childbirth.
7. At the very beginning of pregnancy, a doctor, a rheumatologist, prescribes or adjusts therapy. Prednisolone is the main drug for the treatment of SLE and is not contraindicated during pregnancy. The dose of the drug is selected individually.
8. Also recommended for pregnant women with SLE taking vitamins, potassium preparations, aspirin (up to the 35th week of pregnancy) and other symptomatic and anti-inflammatory drugs.
9. Mandatory treatment of late toxicosis and other pathological conditions of pregnancy in a maternity hospital.
10. After childbirth the rheumatologist increases the dose of hormones; in some cases, it is recommended to stop breastfeeding, as well as the appointment of cytostatics and other drugs for the treatment of SLE - pulse therapy, since it is the postpartum period that is dangerous for the development of severe exacerbations of the disease.Previously, all women with systemic lupus erythematosus were not recommended to become pregnant, and in case of conception, all were recommended to artificially terminate pregnancy (medical abortion). Now the doctors have changed their opinion on this matter, it is impossible to deprive a woman of motherhood, especially since there are considerable chances of giving birth to a normal healthy baby. But everything must be done in order to minimize the risk to the mother and baby.
Is lupus erythematosus contagious?
Of course, any person who sees strange eruptions on his face thinks: "Maybe it's contagious?" Moreover, people with these rashes walk for so long, feel unwell and constantly take some kind of medicine. Moreover, earlier doctors also assumed that systemic lupus erythematosus is transmitted sexually, by contact, or even by airborne droplets. But having studied the mechanism of the disease in more detail, scientists have completely dispelled these myths, because this is an autoimmune process.The exact cause of the development of systemic lupus erythematosus has not yet been established, there are only theories and assumptions. It all boils down to one thing, that the main reason is the presence of certain genes. However, not all carriers of these genes suffer from systemic autoimmune diseases.
The trigger mechanism for the development of systemic lupus erythematosus can be:
- various viral infections;
- bacterial infections (especially beta-hemolytic streptococcus);
- stress factors;
- hormonal changes (pregnancy, adolescence);
- environmental factors (for example, ultraviolet radiation).
Only tuberculous lupus can be contagious (tuberculosis of the skin of the face), since a large number of tuberculosis sticks are detected on the skin, while the contact route of transmission of the pathogen is isolated.
Lupus erythematosus, what is the recommended diet and are there any methods of treatment with folk remedies?
As with any disease, nutrition is important with lupus erythematosus. Moreover, with this disease there is almost always a deficiency, or against the background of hormone therapy - excess body weight, lack of vitamins, trace elements and biological active substances.The main characteristic of a diet for SLE is a balanced and proper diet.
1. foods containing unsaturated fatty acids (omega-3):
- sea \u200b\u200bfish;
- many nuts and seeds;
- vegetable oil in small quantities;
3. juices, fruit drinks;
4. lean poultry: chicken, turkey fillet;
5. low-fat dairy , especially fermented milk products (low-fat cheese, cottage cheese, yogurt);
6. cereals and vegetable fiber (grain bread, buckwheat, oatmeal, wheat germ and many others).1. Foods with saturated fatty acids have a bad effect on blood vessels, which can aggravate the course of SLE:
- animal fats;
- fried food;
- fatty meats (red meat);
- high fat dairy products and so on.
Photo: alfalfa grass.
3. Garlic - Powerfully stimulates the immune system.
4. Salty, spicy, smoked dishes , retaining fluid in the body.If diseases of the gastrointestinal tract occur against the background of SLE or taking medications, then the patient is recommended frequent fractional meals according to the therapeutic diet - table number 1. All anti-inflammatories are best taken with or immediately after meals.
Home treatment for systemic lupus erythematosus possible only after the selection of an individual therapy regimen in a hospital setting and correction of conditions that threaten the patient's life. The heavy drugs used in the treatment of SLE cannot be prescribed on their own, self-medication will not lead to anything good. Hormones, cytostatics, non-steroidal anti-inflammatory drugs and other drugs have their own characteristics and a bunch of side reactions, and the dose of these drugs is very individual. The therapy selected by doctors is taken at home, strictly adhering to the recommendations. Missing and irregular medication intake is unacceptable.
Concerning traditional medicine recipes, then systemic lupus erythematosus does not tolerate experimentation. None of these remedies will prevent the autoimmune process, you can simply waste valuable time. Folk remedies can be effective if they are used in combination with traditional methods of treatment, but only after consulting a rheumatologist.
Some traditional medicines for the treatment of systemic lupus erythematosus:
Precautions! All folk remedies containing poisonous herbs or substances should be kept out of the reach of children. One must be careful with such means, any poison is a medicine as long as it is used in small doses.Photos, what do the symptoms of lupus erythematosus look like?
Photo: changes on the skin of the face in the form of a butterfly with SLE.
Photo: lesion of the skin of the palms with systemic lupus erythematosus. In addition to skin changes, this patient shows thickening of the joints of the phalanges of the fingers - signs of arthritis.
Dystrophic changes in nails with systemic lupus erythematosus: fragility, discoloration, longitudinal striation of the nail plate.
Lupus lesions of the oral mucosa ... According to the clinical picture, they are very similar to infectious stomatitis, which do not heal for a long time.
And so they may look the first symptoms of discoid or cutaneous lupus erythematosus.
And so it may look neonatal lupus erythematosus, these changes, fortunately, are reversible and in the future the baby will be absolutely healthy.
Skin changes in systemic lupus erythematosus, characteristic of childhood. The rash is hemorrhagic in nature, resembles a measles rash, leaves pigment spots that do not pass for a long time.
