Systemic lupus erythematosus

Disease description

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by damage to organs and tissues due to systemic inflammation. The core of the pathology lies in a disruption of immune regulation processes.

The name “systemic lupus erythematosus” comes from the characteristic skin rashes that resemble wolf bites. Lupus is diagnosed in women ten times more often than in men, with a peak incidence between the ages of 18 and 35.

SLE can have varying courses. In some cases, the disease progresses rapidly, affecting vital organs in a short time, while in others it develops slowly, with symptoms increasing over the course of several years. It begins with general malaise and fever, followed by possible skin rashes, joint pain, swollen lymph nodes, and dysfunction of the heart, kidneys, lungs, and nervous system. The disease has a wave-like course, with alternating periods of exacerbation and remission.

Symptoms of lupus

• General symptoms: patients may experience fever, weight loss, general weakness, loss of appetite, and hair loss.
• Skin: in 60% of patients, a red “butterfly” rash appears on the face; rashes occur on exposed areas of the body, such as the chest, back, and elbows; discoid (large focal) rashes; inflammation of small vessels (capillaritis), necrosis of fingertips, livedo reticularis — a bluish-purple net-like pattern on the skin.
• Mucous membranes: lupus spots on the palate, painless mouth ulcers, and inflammation of the lips.
• Joints: 90% of patients experience joint pain (arthralgia) or joint inflammation (arthritis).
• Bones: 10-15% of patients develop aseptic necrosis of the femoral head, leading to bone destruction.
• Muscles: muscle pain and chronic muscle inflammation (polymyositis) occur in 30-40% of patients.
• Serous membranes: inflammation of the membranes of the lungs (pleuritis), heart (pericarditis), and peritoneum (peritonitis) is seen in 30-50% of patients.
• Respiratory system: pneumonitis, pulmonary hemorrhage, pulmonary fibrosis, elevated pressure in the pulmonary artery, and pulmonary infarction are possible.
• Heart: inflammation of all heart membranes, including endocarditis and myocarditis, as well as the rare Libman-sacks verrucous endocarditis.
• Kidneys: 70-75% of patients develop nephritis — inflammation of the kidneys, which can lead to serious complications.

Lupus is characterized by seasonal flare-ups, with relapses occurring more frequently in summer and autumn, when symptoms become more pronounced.

Pregnancy with lupus

Pregnancy in patients with systemic lupus erythematosus was previously considered too risky due to the high likelihood of miscarriage. However, advances in modern medicine have changed this. Now women with SLE can carry and deliver a healthy child: physicians in top medical centers minimize the risks of complications.

Pregnancy should be planned during remission, when the disease is inactive. This significantly reduces risks for both the mother and the fetus. It is crucial that the woman be under constant medical supervision throughout pregnancy: for this reason, pregnancy management and childbirth in European countries are in high demand.

Methods of diagnosis and treatment of lupus

Diagnosis

A rheumatologist is a specialist who diagnoses and treats systemic autoimmune diseases such as lupus. During the visit, the rheumatologist thoroughly questions the patient, examines the skin and mucous membranes, and assesses gait and joint mobility. the doctor also carefully examines the cardiovascular, respiratory, skeletal, and muscular systems to detect any possible damage.

Since systemic lupus erythematosus can resemble other diseases (such as arthritis or even diabetes), the diagnosis is based on specific criteria established by a board of rheumatologists. Laboratory test results play an important role in confirming the diagnosis and excluding other potential conditions.

• Blood tests: one of the primary diagnostic tools. They detect antibodies to double-stranded dna (anti-dsDNA), antinuclear antibodies (ANA), complement levels, and inflammation markers (CRP, ESR).
• Urinalysis: helps identify kidney involvement.
• Imaging methods: X-ray, ultrasound, MRI, or CT are used to assess the condition of internal organs.
• Kidney biopsy: performed when lupus nephritis is suspected to determine the extent of damage.

Treatment

Treatment of systemic lupus erythematosus aims to relieve symptoms:

1. Anti-inflammatory drugs: nonsteroidal anti-inflammatory drugs (NSAIDS) help reduce joint pain and inflammation.
2. Glucocorticoids: hormones that suppress inflammatory processes. They are often used in acute periods for rapid disease control.
3. Immunosuppressive agents: methotrexate, azathioprine, and mycophenolate are used to suppress the immune system and control disease progression.
4. Targeted drugs: block specific molecular mechanisms that cause inflammation. An example is belimumab, which inhibits the b-lymphocyte protein and helps suppress immune activity without broad immunosuppression.

Innovations of global clinics

Car-t cell therapy for systemic lupus erythematosus is an innovative treatment based on modifying the patient’s own t-cells. These cells are “reprogrammed” in the laboratory to recognize and destroy the cells that cause inflammation. The main goal of this method is to reset the immune system, which helps reduce its aggressive activity and stop the destruction of healthy tissues.