Systemic Lupus Erythematosus (SLE)

Academically known as Systemic Lupus Erythematosus (SLE), lupus is one of the many autoimmune disorders and it’s affecting various tissues in the body. The immune system is mistakenly attacking healthy tissue which results in a series of apparently unrelated health issues. The symptoms experienced by sufferers vary in intensity greatly, and the disease is oftentimes undiagnosed until advanced stages. Because the initial symptoms are apparently unrelated, many specialists don’t run tests for lupus until later. Common symptoms include swollen joints, hair loss, swollen lymph nodes, chest pain, tiredness, and one of the first symptoms, rashes, especially on the face, in the form of a butterfly. The causes of lupus remain unknown. Many specialists seem to believe that a combination of genetical and environmental factors are leading to the diseases’ debut. This is explained by the cases of pairs of twins, in which there is a chance of 25% for one to have it, if their siblings are already diagnosed with it. Also, environmental factors, such as sunlight, smoking, female sex hormones, Vitamin D deficiency and certain illnesses caused by infections can contribute to developing this autoimmune disease.


Lupus Overview & Facts

As the Lupus Foundation of America states, approximately more than a million and a half of Americans are suffering from lupus. According to the same foundation, people of African, Asian and Native American descendance are more likely to suffer from it. This is proving the genetical hypothesis when it comes to the factors that lead to the apparition and evolution of SLE. Sex seems to be another determinant factor. Although both men and women are suffering from the condition, more than 90% of the patients are women. Female hormones seem to have their contribution, since most of the women able to bear a child (aged 15 to 45) are more likely to suffer from it.


Types of Lupus

There are four types of lupus. Below we will be presenting all of those.

  • Systemic lupus erythematosus – is the most common type of lupus. This is why many people are speaking of when referring to “lupus”. With symptoms varying between mild and severe, systemic lupus is affecting a series of organ systems. Some of the most frequent symptoms for this type of lupus are as it follows: inflammation of the kidneys, is preventing the body to eliminate toxins from the blood. The type of lupus that is affecting the kidneys is also known as lupus nephritis. Many sufferers with this subdivision shortly have severe kidney issues, dialysis being necessary. Inflammation of the nervous system and the brain is yet another symptom lupus sufferers experience. This subdivision is causing severe memory issues, headaches and ultimately, strokes. Inflammation in the brain is causing oftentimes behaviour changes, high fever, strokes, and is highly dangerous. Hardening and constriction of the arteries is another symptom that will most certainly lead to heart attacks.
  • Cutaneous lupus erythematosus – is a form of lupus that is strictly limited to skin-related issues. It can cause a variety of rashes and bumps on the skin, but the most common type of rash in this affection is not itchy at all. It is only red, scaly and raised. Another very common type of rash in this branch of lupus is the butterfly rash. This one appears in the form of a butterfly, on the bridge of the nose and cheeks. Of course, there appear other types of rashes and sores in cutaneous lupus, especially in the areas where the skin is the most exposed to sunlight or fluorescent light. However, sores in the mouth, nose or vagina are pretty common in cutaneous lupus. These skin issues can develop into hair loss, as they can affect the scalp as well, depigmentation or hyperpigmentation. Unfortunately, 10% of those suffering from cutaneous lupus are prone to develop the systemic type as well. But it is worth mentioning the fact that most probably, those with cutaneous lupus already have systemic lupus. Only that they have the rashes as a main symptom.
  • Druginduced lupus – is caused by a series of prescription drugs. Drug-induced lupus has similar symptoms to systemic lupus, but fortunately, these symptoms do not affect major organ systems. Prescription drugs for hypertension (Hydralazine), irregular heart beat (Procainamide) or tuberculosis (Isoniazid) seem to be linked to this type of lupus. Worth noting is the fact that this type of lupus is most common in men, because they seem to use this type of medication more frequently.
  • Neonatal lupus – although associated with the “lupus” particle, this is not a real type of lupus. It appears in the babies of the women who have lupus and it’s a reaction of the mother’s antibodies that are perceiving the baby as an intruder in the womb. All symptoms with which the baby is born (rashes, a low blood cell count, liver issues) disappear completely within a few months.

Because the most common type of lupus is the systemic one, the rest of this article will be treating that particular type.


Lupus Symptoms & Signs

Like in any other disorders, the symptoms vary greatly from individual to individual. The number of these symptoms in one particular person can vary as well, from several to nearly all related symptoms. Because it mimics the symptoms of various other illnesses, it has receiver the rightful surname of “the great imitator”. The symptoms are unpredictable and vary incredibly from person to person. Because of this, SLE is oftentimes used as a differential diagnosis. Common initial symptoms, which can remain unlinked to lupus by medical staff are:

  • A high fever;
  • Muscle pain;
  • Joint pain;
  • Malaise;

Because these symptoms are oftentimes associated with other disorders, many specialists tend to always lose from sight the association of symptoms, which is otherwise suggestive. Also, worth mentioning is the fact that men and women tend to have different symptoms. While in men the most common symptoms are associated with heart issues, blood pressure issues and strokes, women’s symptoms seem to revolve around arthritis, psychiatric issues and low blood cell count. Below are presented some of the most common lupus signs and symptoms.

  • The vast majority with lupus shows skin-related symptoms. These symptoms include sores, rashes and irritation. Oftentimes divided into three subcategories of cutaneous lupus, specialists differentiate between acute cutaneous lupus, subacute cutaneous lupus and chronic cutaneous lupus. Individuals with chronic cutaneous lupus oftentimes show large, red, scaly and raised patches on their skin, without being itchy. Also associated with skin-related symptoms, patients with lupus may also suffer from skin pigmentation issues or even hair loss.
  • MUSCLE AND BONES. Very commonly, patients with lupus seek medical attention for muscle and bone-related issues. Some of the most affected are the small joints and the muscles in the wrist or hand. However, lupus-associated arthritis is less disabling than rheumatoid arthritis. Approximately only 8-9% of those with lupus arthritis will develop deformities of the hand due to their illness. This lupus symptom will also make young women more exposed to bone fractures.
  • Another sign of lupus is anaemia. It is present in more than 50% of lupus sufferers. While a low blood cell count may be associated with the medication prescribed for lupus, it is also a preliminary sign of this disorder. Also, in many lupus patients their main disorder is oftentimes associated with the antiphospholipid antibody syndrome. Also, an antibody (the anti-cardiolipin antibody)found in those suffering from SLE can give a false-positive syphilis diagnosis in blood tests.
  • SLE is also known for causing severe heart-related issues. Most commonly, it is associated with an inflammation of the lining surrounding the heart, commonly known as pericarditis. Also, it is associated with myocarditis, an inflammation of the muscle of the heart. Also, very common, endocarditis in the case of the patients with SLE is of non-infectious cause.
  • Issues with the lungs can also be a lupus symptom. Pleurisy in SLE can give in some cases a shrinking lung syndrome. Associated conditions with lupus are pneumonitis, pulmonary hypertension, pulmonary emboli, pulmonary haemorrhage and other various lung-related issues.
  • As previously mentioned, in many cases, lupus can lead to serious kidney-related issues, problems that shortly lead to dialysis. In lupus, the toxins in the blood are not eliminated, entering the kidneys.
  • In lupus, quite frequently patients experience neuropsychiatric symptoms of lupus. SLE is quite notorious for affecting the central and peripheral nervous system. A very common neurological symptom of lupus is headache. The right approach on lupus-related headaches is still unknown, being up to the present time a matter of controversy. Other common neuropsychiatric disorders associated with lupus are mood disorders, cognitive disorders, anxiety, depression, psychosis, and personality disorders in some extreme cases. Also, another disturbing sign of lupus is a raised intracranial hypertension. The neurological disorders associated with lupus have the highest rates of mortality and morbidity, which makes them the most studies, in the hope of decreasing the numbers of deaths associated with it.
  • Only approximately 75% of the women with lupus that remain pregnant seem to be able to deliver the foetus alive. Also, in those cases, neonatal lupus is very frequent in the babies born from women with lupus. While neonatal lupus is not lupus per se, babies show symptoms of lupus that usually disappear within a few months from birth.
  • SYSTEMIC SYMPTOMS OF LUPUS. Fatigue is one of the most common symptoms of lupus. Also, other frequent systemic signs of lupus are anaemia, depression, poor sleep quality etc.


Lupus Diagnosis

In order to determine if a patient is suffering from lupus, they must be presenting one or more of the symptoms above. A series of laboratory tests and diagnostic criteria is used.

  • Laboratory Tests – in order to confirm the lupus diagnosis, there are routinely performed are the antinuclear antibody testing and anti-extractable nuclear antigen (anti-ENA) form the mainstay of serologic testing. Also, in many cases, as additional testing procedures, there are performed the following: complement system levels, electrolytes and kidney function, liver enzymes, and complete blood count.
  • Diagnostic criteria – in many cases, the lupus diagnosis is made based on the American College of Rheumatology (ACR) criteria. If four in eleven symptoms were met in the same patient, they were very likely to be suffering from lupus. The criteria are as described below:
  • Malar rash;
  • Discoid rash;
  • Serositis;
  • Oral ulcers;
  • Arthritis;
  • Photosensitivity;
  • Blood—hematologic disorders;
  • Renal disorders;
  • Positive testing for antinuclear antibodies;
  • Positive testing for immunologic tests;
  • Neurologic symptoms – seizures or psychosis


Lupus Treatment & Care

The treatment for lupus is still developed, specialists trying to create more effective drugs for this disorder. Worth mentioning is the fact that lupus cannot be cured, the treatment prescribed having the only purpose of managing the symptoms. In many cases, the treatment prescribed is with the purpose of reducing the severity of patient’s flares and preventing those. Lupus treatment and care recommendations revolve around prescribing medication, lifestyle changes, kidney transplantation in some severe cases, and implementing management of pregnancy strategies, in the case of the women suffering from it.

  • Because lupus is the root of a variety of symptoms, including failure of various organ systems, management strategies must be based on each patient’s symptoms and their severity.
  • Disease-modifying antirheumatic drugs are prescribed in order to keep under control the number and severity of the flares, and decrease the frequency with which steroid are used. When flares appear, specialists prescribe corticosteroids, hydroxychloroquine and immunosuppressants.
  • Immunosuppressive drugs are used in order to regulate the activity of patient’s immune system. This will make the condition’s management attempts more successful, because they decrease the frequency of the episodes that one has, as well as the severity of their symptoms. Unfortunately, in many cases, patients will develop other conditions, as aggravated side-effects of the drugs. People following a therapy with steroids will oftentimes develop Type I and Type II diabetes, Cushing’s syndrome, increased appetite, round face, puffiness etc.
  • Analgesia – given the fact that most people suffering from lupus struggle with severe episodes of chronic pain, analgesia is oftentimes prescribed. Over-the-counter painkillers have proven ineffective in those with SLE, while diclofenac and indomethacin are not indicated. These two increase the prospect of suffering from a kidney failure in the future significantly. Unfortunately, in patients suffering from lupus opioids are prescribed. This treatment for lupus – associated pain is leading in many cases to opioid tolerance, abuse and dependency, ultimately.
  • Intravenous immunoglobulins – is in many cases used in order to manage better the organ systems.
  • LIFESTYLE CHANGES. Maybe one of the most important lifestyle changes that one must adopt in order to manage better their condition is avoiding sunlight exposure. Sunlight is in all cases exacerbating the skin-related symptoms associated with lupus. In order to avoid sun exposure, many lupus sufferers lead a life of isolation in the safety of their houses.
  • KIDNEY TRANSPLATATION. This is a last resort action for those who have end-stage kidney failure associated with lupus.
  • MANAGEMENT STRATEGIES DURING PREGNANCY. While children born from mothers suffering from lupus will no longer show symptoms after a few months from delivery, mothers should always remain under medical surveillance during their entire pregnancy.


Lupus Causes

The causes that lead to lupus are not entirely known. Many specialists think, however, that it’s an association of environmental and genetical factors. For instance, African-Americans, Asian-Americans and Native Americans seem to be more prone to develop the condition than their fellow Europeans. Also, women are more likely to develop it, especially between the ages they are able to bear a child. Feminine hormones seem to be a factor when it comes to the condition’s debut, but also usage of certain drugs. For instance, drugs used for treating various heart, blood pressure or seizure problems seem to contribute to the debut and evolution of the disease, just like certain drugs used for treating tuberculosis do.


Living with Lupus

Besides proper medications, specialists give some tips and tricks for living with lupus well. Below is a short list of Dos and DON’Ts for those suffering from lupus.

  • DO take your medication as prescribed;
  • DO get all the necessary lab tests;
  • DO visit your doctor for the scheduled appointments;
  • DO educate yourself about the disease;
  • DO exercise. Physical activity seems to improve the symptoms associated with lupus.
  • DON’T smoke. Patients suffering from lupus must quit smoking as soon as a diagnosis is pronounced.
  • DON’T about sunscreen. Since most lupus patients suffer from skin reactions, it is important for them to avoid sunlight and apply a generous coat of sunscreen.



While lupus is not a treatable disease, it can be managed with care and guidance from a specialist. Those suffering from lupus should always attend their scheduled appointments and take their medication as prescribed.

AAOM Editor

Academic Association of Medicine is the go to resource for all health related issues. We are an independent body that seeks to offer general information on various health topics and unbiased reviews on health products.

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