Lupus (SLE: Systemic lupus erythematosus)
Summary for LUPUS (treatment protocols for Autoimmune Conditions)
Systemic lupus erythematosus (SLE) is an autoimmune disease affecting many systems of the body. Symptoms and signs include severe vasculitis (inflammed blood vessels), renal involvement, and lesions of the skin and nervous system. Patients are thought to have a genetic susceptibility for the production of pathogenic autoantibodies and immune complexes, triggered by one or more factors, such as viral infections, hormonal imbalance, extreme stress, exhaustion, pregnancy or high sun exposure.
Immune abnormalities result in inflammation and cellular injury. Lupus is characterised by periods of both chronic disease and remission. Hormonal influences play an important role in this auto-immune condition. Oestrogen is shown to inhibit the normal apoptosis and therefore the persistence of auto-reactive T-cells involved in SLE autoimmunity, whereas testosterone supports normal T-cell apoptosis (normal cell death). It is thought that oestrogen may trigger and exacerbate SLE in females aged 10-50 years (90% of all cases), which explains why menopause is generally associated with reduction in severity of the condition.
Risk factors for SLE including:
- Familial (genetic) predisposition
- Oestrogen is known to predispose females to SLE (90% of cases) and exacerbate activity of SLE
- Certain medications (such as some antidepressants and antibiotics)
- Extreme stress (as a trigger to exacerbations)
- Excessive exposure to ultra violet (sun) light
- Some infections, such as cytomegalovirus (CMV), parvovirus, hepatitis C and Epstein Barr Virus
- High toxic / antigenic load (due to endogenous (microbial) and environmental / chemical toxicity)
Common signs and symptoms of SLE include the following:
- Dermatological manifestations: malar rash, discoid lupus, alopecia, ulcers
- Musculoskeletal manifestations: joint pain, arthritis, joint deformities, muscle pain and stiffness
- Haematological manifestations: anaemia, low platelet and white blood cell counts, antiphospholipid syndrome
- Cardiac manifestations: pericarditis, myocarditis and endocarditis
- Pulmonary manifestations: pleuritis, pleural effusion, lupus pneumonitis, chronic diffuse interstitial lung disease, pulmonary hypertension, pulmonary emboli, pulmonary haemorrhage
- Renal involvement: painless haematuria or proteinuria, renal impairment, renal failure, membranous glomerulonephritis with “wire loop” abnormalities
- Neurological manifestations: depression, anxiety, confusion, headaches, migraine, cognitive dysfunction, seizures or psychosis
- Other manifestations: fever, fatigue, nausea, vomiting, abdominal pain, photosensitivity.