Systemic Lupus Erythematosus (SLE) is a chronic, inflammatory disease in which a person's immune system attacks and injures the body's own organs and tissues. It is the opposite of what takes place in cancer or AIDS. The body’s defenses don’t falter or flag but become hyperactive, fiercely assaulting an individual’s own tissues as if those tissues were offending intruders, foreign agents that must be destroyed or expelled. In Lupus, the body overreacts to an unknown stimulus and makes too many antibodies, or proteins directed against body tissue. Thus, Lupus is called an “autoimmune disorder” (auto meaning self).
Also, unlike AIDS, lupus is not transmissible from one individual to another; in no case has contagion even been suspected. It may affect the skin, joints, kidneys, and other organs. Almost every system of the body can be affected. In the United States, it is estimated that nearly one million people suffer from Lupus. Though many people are not even familiar with the disease, it is estimated that more people have Lupus than multiple sclerosis, cystic fibrosis, cerebral palsy, sickle cell anemia, leukemia and are HIV positive combined.
Description
The body's immune system is a network of cells and tissues responsible for clearing the body of invading organisms, like bacteria, viruses, and fungi. Antibodies are special immune cells that recognize these invaders, and begin a chain of events to destroy them. In an autoimmune disorder like SLE, a person's antibodies begin to identify the body's own tissues as foreign. Cells and chemicals of the immune system damage the tissues of the body. The reaction that occurs in tissue is called inflammation. Inflammation includes swelling, redness, increased blood flow, and tissue destruction.
In SLE, some of the common antibodies that normally fight diseases are thought to be out of control. These include antinuclear antibodies, which are directed against the cell structure that contains genetic material (the nucleus), and anti-DNA antibodies, which are directed against genetic material (DNA).
Although lupus has been diagnosed in both small children and senior citizens, and can occur in both males and females of all ages, but ninety percent (90%) of diagnosed Lupus patients are women (particularly those in their childbearing years between the ages of 15 and 45, with a mean onset age of twenty-nine or thirty). During these years of highest incidence, the female-to-male ratio is at least ten to one. The disease is also more prevalent among minorities. African Americans are more likely than Caucasians to develop SLE. 1 in 205 African American women are affected, as opposed to only 1 in 400 white women.
Occasionally, such medications as hydralazine and procainamide can cause symptoms very similar to SLE. This condition is called drug-induced lupus. Drug-induced lupus usually disappears after the patient stops taking the particular medication.
Diagnosis
Diagnosis of SLE can be somewhat difficult. Many people visit three, four, or more doctors before lupus is either confirmed or eliminated from consideration. Even in the case of the person the site is created in behalf of, the initial diagnosis for the swelling of the feet was said to be “tight shoes”. Many Lupus patients look very healthy, but surveys have shown that newly diagnosed patients have had symptoms or signs for an average of 3 years. There are no definitive tests for diagnosing SLE. Many of the symptoms and laboratory test results of SLE patients are similar to those of patients with other diseases, including rheumatoid arthritis, multiple sclerosis, and various nervous system and blood disorders.
Laboratory tests that are helpful in diagnosing SLE include several tests for a variety of antibodies commonly elevated in SLE patients (including antinuclear antibodies, anti-DNA antibodies, etc.). A blood test called the lupus erythematosus cell preparation (or LE prep) test is also performed. The LE prep is positive in 70-80% of all patients with SLE. SLE patients tend to have low numbers of red blood cells (anemia) and low numbers of certain types of white blood cells. The erythrocyte sedimentation rate (ESR), a measure of inflammation in the body, tends to be quite elevated. Samples of tissue (biopsies) from affected skin and kidneys show characteristics of the disease.
The American Rheumatism Association developed a list of symptoms used to diagnose SLE.
Research supports the idea that people who have at least four of the 11 criteria (not necessarily simultaneously) are extremely likely to have SLE. The criteria are:
• butterfly rash
• discoid rash
• photosensitivity
• mouth ulcers
• arthritis
• inflammation of the lining of the lungs or the lining around the heart
• kidney damage, as noted by the presence of protein or other abnormal substances called casts in the urine
• seizures or psychosis
• the presence of certain types of anemia and low counts of particular white blood cells
• the presence of certain immune cells, anti-DNA antibodies, or a falsely positive test for syphilis
• the presence of antinuclear antibodies
Tests to determine the presence of these disease manifestations may vary, but will include some of the following:
• antinuclear antibody (ANA) panel including anti-DNA and anti-Smith antibodies, with the latter two tests generally positive in lupus alone
• characteristic skin rash or lesions
• chest x-ray showing pleuritis or pericarditis
• listening to the chest with a stethoscope to reveal heart friction rub or pleural friction rub
• urinalysis to show blood, casts, or protein in the urine
• CBC showing a decrease in some cell types
• kidney biopsy
• neurological examination
This disease may also alter the results of the following tests:
• WBC count
• serum globulin electrophoresis
• rheumatoid factor
• urine protein
• serum protein electrophoresis
• mononucleosis spot test
• ESR
• cryoglobulins
• Coombs' test - direct
• complement component 3 (C3)
• complement
• antithyroid microsomal antibody
• antithyroglobulin antibody
• antimitochondrial antibody
• anti-smooth muscle antibody
Expectations (prognosis)
The outcome for people with SLE has improved over recent years. Many of those affected have mild illness. Women with SLE who become pregnant are often able to carry the pregnancy safely to term and deliver normal infants, provided severe kidney or heart disease is not present and the SLE is being managed. The presence of anti-phospholipid antibodies may increase the possibility of pregnancy loss.
The 10-year survival rate for lupus patients exceeds 85%. People with severe involvement of the brain, lungs, heart and kidney have the worst prognosis in terms of overall survival and disability.
Treatment
The disease has multiple symptoms with variable severity, which determines individual treatment. There is no cure for SLE.
Mild disease (rash, headaches, fever , arthritis, pleurisy, and pericarditis) requires little therapy. Nonsteroidal anti-inflammatory medications (NSAIDS) are used to treat arthritis and pleurisy. Corticosteroid creams are used to treat skin rashes. Antimalarial drugs (hydroxychloroquine ) and low dose corticosteroids are sometimes used for skin and arthritis symptoms.
Sensitivity to light is treated by protective clothing, sunglasses and sunscreen.
Severe or life-threatening manifestations (hemolytic anemia, extensive heart or lung involvement, kidney disease, central nervous system involvement) often requires treatment by both rheumatologists and specialists in the specific area. Corticosteroids or medications to suppress the immune system may be prescribed to control the various symptoms. Some health care professionals use cytotoxic drugs (drugs that block cell growth) to treat people who do not have a good response to corticosteroids or who are dependent on high doses of corticosteroids.
A number of alternative treatments may also help reduce symptoms.
• Acupuncture can relieve pain in joints and muscles.
• Chinese herbals are chosen based on treatment principles and the patients specific symptoms. A simple decoction for the treatment of SLE joint and kidney problems is Lei Gong Teng (Caulis tripterygii), Ji Xue Teng (Caulis spatholobi), and Gan Cao (Radix glycyrrhizae). Chinese patent medicines for SLE include Qin Jiao Wan (Gentiana Macrophylla Pill) and Kun Ming Shan Hai Tang Pian (Tripterygii Tablet).
• DHEA (dehydroepiandrosterone) treatment, in a small study, led to disease improvement and reduction in the use of corticosteroids.
• Diet. The SLE patient should drink plenty of water and eat a well balanced diet of whole, unprocessed foods that are low in fat and high in fiber. Mackerel, sardines, and salmon contain the beneficial fatty acid omega-3. Caffeine, sugar, alcohol, red meats, and alfalfa sprouts should be avoided. Because food allergies can be associated with SLE, an elimination/change in diet can help identify the offending foods (often wheat, dairy products, and/or soy).
• Enzyme therapy treats SLE with 10X U.S.P. of digestive enzymes, protease, lipase, amylase, and cellulase to improve digestion of foods, based on the theory that a leaky gut causes SLE.
• Exercise can reduce fatigue, reduce muscle weakness, speed weight loss, and increase energy, stamina, and confidence.
• Probiotic treatment using Lactobacillus species to restore a healthy balance of bacteria in the intestines.
• Stress management techniques, such as guided imagery, meditation, hypnotherapy, and yoga, can reduce stress that exacerbates SLE.
• Supplements commonly recommended for SLE patients include vitamins B, C, and E, beta-carotene, bioflavonoids, selenium, zinc, magnesium, a complete trace mineral supplement, glutamine, gammaoryzanol, 1-butyrate, fructooligosaccharides (FOS), and omega-3 fatty acids (fish oil). Vitamin A is believed to help improve discoid skin rashes.
• Support groups for SLE patients can provide emotional and social help.
Expected results
The prognosis for patients with SLE varies, depending on the organ systems most affected and the severity of inflammation. Some patients have long periods of remission with mild or no symptoms. About 90-95% of patients are still living after two years with the disease, 82-90% after five years, 71-80% after 10 years, and 63-75% after 20 years. The most likely causes of death during the first 10 years include infections and kidney failure. During years 11-20 of the disease, the development of abnormal blood clots is the most common cause of death.
For pregnant SLE patients, about 30% of the pregnancies end in miscarriage and about 25% of all babies are born prematurely. Most babies born to mothers with SLE are normal. Rarely, babies develop a condition called neonatal lupus, which is characterized by a skin rash, liver or blood problems, and a serious heart condition.
Prevention
There are no known ways to avoid developing SLE. However, it is possible for a patient who has been diagnosed with SLE to prevent flares of the disease. Recommendations to prevent flares include decreasing sun exposure, getting sufficient sleep, eating a healthy diet, decreasing stress, and exercising regularly.
Allopathic treatment
Treatment depends on the organ systems affected and the severity of the disease. Patients with a mild form of SLE can be treated with nonsteroidal anti-inflammatory drugs, or NSAIDs, like ibuprofen (Motrin, Advil) and aspirin. More severely ill patients with potentially life-threatening complications (including kidney disease, pericarditis, or nervous system complications) will require treatment with more potent drugs, including steroid medications and possibly other drugs that decrease the activity of the immune system (immunosuppressant drugs). Kidney failure may require the blood to be filtered by a machine (dialysis) or even a kidney transplantation.
