Systemic lupus erythematosus: (SLE)

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Systemic lupus erythematosus: (SLE)

What is systemic lupus erythematosus (SLE)?

Systemic lupus erythematosus (SLE) is the most common form of lupus, and can cause multi-organ inflammation and damage. SLE is a chronic autoimmune disease with no cure. SLE usually involves random flare-ups and symptoms that may last for a few weeks or several months and then go into remission. Symptoms can range from minor to life-threatening. 

Who can develop SLE?

SLE can occur at any time but is most commonly seen in young women during their reproductive years. SLE also occurs in males but is 10 times less common than in females. SLE is more prevalent in Individuals of African, Hispanic and Asian descent.

What organs are affected by SLE?

SLE most commonly affects the skin, joints and kidneys, but can also involve the heart, lungs, brain and blood vessels.

Causes

What causes SLE?

The cause of SLE is not well understood. It is believed genetics, hormones, and environmental factors (stress), may all play a role in the development of SLE. If you have SLE, the body’s immune system exhibits dysregulation and attacks normal, healthy tissue. This leads to persistent or chronic inflammation, and can lead to organ failure if left untreated.

What are risk factors for SLE?

The following risk factors place you more at risk of developing SLE:

  • Gender - Women are more prone to developing SLE (9-10 times more than men).
  • Race - Minorities appear to develop SLE more than whites/Caucasians.
  • Age - SLE is more prominent between the ages of 15-45.

What are other medical conditions that may coincide with SLE?

Other autoimmune diseases that may occur with SLE are:

  • Sjogren’s syndrome
  • Antiphospholipid syndrome
  • Thyroiditis (Hashimoto’s)
  • Hemolytic anemia 
  • Idiopathic thrombocytopenic purpura

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Initial Visit

$75

Follow Up

Symptoms

What are the symptoms of SLE?

Many symptoms of SLE are nonspecific. They can vary from person to person and change over time. Some examples include:

  • Fever
  • Fatigue
  • Weight loss
  • Blood clots
  • Hair loss
  • Heartburn
  • Abdominal pain 
  • Poor circulation
  • Miscarriages
  • Butterfly shaped rash (malar rash)
  • Red, raised oval rash (discoid rash)
  • Mouth sores
  • Arthritis
  • Inflammation of lung (pleuritis)
  • Inflammation of heart (pericarditis)
  • Kidney failure
  • Seizures
  • Strokes
  • Psychosis
  • Sun sensitivity
  • Memory impairment or cognitive decline
  • Eye disease
  • Swelling of the feet 

Can other health issues arise from SLE?

Chronic inflammation caused by SLE can also lead to coronary artery disease and strokes in younger individuals. Chronic kidney inflammation can lead to advanced kidney disease and a need for dialysis. Both of these complications may lead to premature death. Early diagnosis and treatment of SLE is key to preventing serious and maintaining a good quality of life. 

If you want to learn more about common symptoms of SLE and how to more easily identify them and communicate them to your doctor, visit The US in Lupus website at: 

https://www.usinlupus.com/basics-of-lupus/common-lupus-symptoms 

You will be able to get an emailed copy of the questionnaire you fill out, and can share it with your doctor.

Diagnosis

How is SLE diagnosed?

An accurate diagnosis of SLE would normally involve an experienced healthcare professional, in this case a rheumatologist. Experienced rheumatologists are available for consultation at TeleMed2U. SLE is complex and can mimic many other illnesses or autoimmune disorders. Symptoms can be nonspecific and slow to develop. Therefore, an experienced rheumatologist is often needed to establish a diagnosis.

Are there any diagnostic tests that can be performed to confirm SLE?

Some blood tests can be helpful in diagnosing SLE. These include: 

  • CBC (complete blood count)-  SLE can cause anemia (low red blood cells), Neutropenia (low white blood cell count) and thrombocytopenia (low platelet count)
  • ANA (antinuclear antibodies)- An antibody test that is positive in the majority of SLE patients. If negative, then the diagnosis of SLE is highly unlikely. If positive, you still need other manifestations of lupus to establish a diagnosis. Up to 25% of the general population can have a positive ANA blood test without having lupus.
  • Anti-dsDNA (anti-double-strand DNA)- This is a very specific test (usually only positive in patients with lupus). A positive test may also indicate that SLE involves the kidneys.
  • Anti-Sm (anti-Smith)- Another specific antibody test available to help with the diagnosis of lupus but only positive in about 30% of lupus patients.
  • Antiphospholipid antibodies- Used to help with the diagnosis of lupus and are positive in about 60% of cases. A positive antiphospholipid antibody test indicates susceptibility to formation of blood clots.

Various imaging tests can be used in the diagnosis of SLE. Some include:

  • Chest x-ray- Used to look for fluid or inflammation in the lungs or heart due to SLE.
  • Echocardiogram- Provides real-time images of the heartbeat to determine if there are problems with the heart valves due to inflammation or pericarditis.

Biopsies may also be recommended to daid in diagnosis and distinguish SLE from other conditions. Biopsies may include:

  • Skin biopsy- can help determine if certain rashes or skin conditions are due to SLE or other medical conditions.
  • Kidney biopsy- helps to determine the type of damage found in the kidneys and can guide treatment.

Treatment

What are some treatment options for SLE?

Because SLE is a chronic disease, there is no cure for the condition. The primary goal of treatment is to control inflammation, manage symptoms and prevent organ damage. This is done by suppressing the immune system to stop inflammation. Although there is no cure for SLE, early intervention can be greatly beneficial, helping patients function at a high level and lead relatively normal lives. While medications are the most common method for the management of SLE, TeleMed2U rheumatologists also offer integrative, holistic treatment approaches based upon a “S.E.N.S.E.” - ible approach: Stress management, Exercise, Nutrition, Sleep & positive social Engagements. 

PLEASE VISIT THE US IN LUPUS WEBSITE FOR MORE INFORMATION ABOUT HOW YOU CAN BECOME ACTIVELY INVOLVED IN CUSTOMIZING YOUR OWN LUPUS TREATMENT PLANS: https://www.usinlupus.com/living-with-lupus/ 

IF YOU NEED HELP ENGAGING (TALKING) WITH YOUR LOVED ONES, MEDICAL PROFESSIONALS OR OTHER MEMBERS OF YOUR HEALTHCARE TEAM ABOUT YOUR LUPUS, PLEASE VISIT THE US IN LUPUS WEBSITE AT: https://www.usinlupus.com/talking-about-lupus/ 

Medications currently available for the treatment of SLE include: 

  • Antimalarial drugs - commonly used for the treatment and prevention of SLE symptoms such as arthritis, fatigue, rashes, and mouth sores. 
  1. Plaquenil (hydroxychloroquine)*
  • Corticosteroids - a stronger anti-inflammatory designated for more serious complications related to SLE such as inflammation affecting the heart, lung, or kidneys.
  1. prednisone*
  2. methylprednisolone (Medrol)
  • Immunosuppressants - also helpful with more serious complications from SLE. Suppress the immune symptoms to treat and prevent SLE complications.
  1. azathioprine (Imuran)
  2. mycophenolate mofetil (Cellcept)
  3. methotrexate (Trexall, Xatmep)
  4. cyclophosphamide (Cytoxan)
  5. rituximab (Rituxan)
  6. leflunomide (Arava)
  7. Voclosporin* (Lupkynis) 
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) - mostly used to control pain, swelling, and fever associated with SLE symptoms. Both over-the-counter and prescription options are available.
  1. ibuprofen (Advil, Motrin)
  2. naproxen sodium (Aleve)
  3. Aspirin*
  • Biologics- an intravenous treatment used for milder forms of SLE and approved for use in both adults and children.
  1. belimumab* (Benlysta)

*FDA APPROVED

What are the best methods for successful treatment, and for living with SLE?

SLE is a very manageable disease, and treatment options have improved over the years, allowing individuals to live longer with better quality of life. Some things that can help achieve longevity which include:

  • Exercise - having a regular exercise program will help prevent serious complications due to SLE like heart disease. It can also help better manage arthritis symptoms by keeping the joints flexible.
  • Prenatal consultation - having children may be complicated while suffering from SLE. Pregnancies are considered high risk, so careful planning prior to getting pregnant should be done to avoid any complications or miscarriages.
  • Avoid excessive sunlight -  avoiding sunlight as much as possible will help reduce SLE rashes from developing. Wear as much protective clothing, sunglasses, and sunscreen as possible when outdoors.
  • Develop a support system - a strong network of qualified specialists such as the experts at TeleMed2U should be used to better manage SLE. Have family and loved ones educated on the disease so they can help support you with this chronic illness. If you want to connect with other patients with lupus and learn from their personal experiences, check out the Lupus Buddy Program from the Lupus Foundation of Northern California:  https://www.lfnc.org/lupus-buddy.html 
  • Education- being educated on the disease is important in establishing an effective medication regimen and in learning to avoid potential triggers which can exacerbate the condition. Staying engaged and speaking regularly to your healthcare providers will also help better manage the disease.

SLE is a complicated autoimmune disease but treatments are improving. Learn more about treatment options for successful management of SLE, from our highly-qualified professionals at TeleMed2U.

Information

Medically reviewed by:

Dr Roy Kedem, MD

Dr Zenon Andreou studied medicine at University College London, graduating in 2006. His postgraduate training was in hospitals in and around London and he trained for four years in Otolaryngology before completing his training in General practice

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Without Insurance

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Initial Visit

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Follow Up