Systemic Lupus Erythematosus (SLE) – Definition, Causes, and Prevention.

Definition

Systemic lupus erythematosus (SLE), or lupus, is an autoimmune disease in which a person’s immune system attacks various organs or cells of the body, causing damage and dysfunction. Lupus is called a multisystem disease because it can affect many different tissues and organs in the body.

Some patients with lupus have a very mild disease, which can be treated with simple medications, whereas others can have serious, life-threatening complications. Lupus is more common in women than men, and for reasons that are not precisely understood, its peak incidence is after puberty.

Pathophysiology

It is primarily an antigen-driven immune-mediated disease characterized by high-affinity IgG antibodies to double-stranded (ds) DNA as well as nuclear proteins. Tolerance to self-antigens in the B-cell pool is maintained by several mechanisms, one of which is via regulatory and helper T cells.

Pathophysiology of SLE

Several mechanisms have been proposed, by which T-cell dysregulation of B cells may arise, resulting in autoimmunity. One attractive but unconfirmed hypothesis is that persistently high levels of exposure to endogenous nuclear material in SLE may arise from apoptotic cells, which if not cleared may result in the persistence of nuclear and cytoplasmic material. These potentially can be modified to antigens, provoking an immune response.

Causes

The exact cause of SLE isn’t known, but several factors have been associated with the disease.

Genetics: The disease isn’t linked to a certain gene, but people with lupus often have family members with other autoimmune conditions.

Environmental triggers can include: Ultraviolet rays, certain medications, Viruses, Physical or emotional stress, Trauma

Sex and hormones: SLE affects women more than men. Women also may experience more severe symptoms during pregnancy and with their menstrual periods. Both of these observations have led some medical professionals to believe that the female hormone estrogen may play a role in causing SLE.

Risk factors

  • Female gender
  • Age 15 to 45 years
  • African/Asian descent in Europe and US
  • Drugs
  • Sun exposure
  • A family history of SLE
  • Tobacco smoking

Symptoms

Symptoms vary from person to person and may come and go. Everyone with SLE has joint pain and swelling at some time. Some develop arthritis. SLE often affects the joints of the fingers, hands, wrists, and knees. Other common symptoms include:

  • Chest pain when taking a deep breath.
  • Fever with no other cause.
  • General discomfort, uneasiness, or ill feeling (malaise).
  • Hair loss.
  • Weight loss.
  • Mouth sores.
  • Sensitivity to sunlight.
  • Skin rash: A “butterfly” rash develops in about half the people with SLE. The rash is mostly seen over the cheeks and bridge of the nose. It can be widespread. It gets worse in sunlight.
  • Swollen lymph nodes

Symptoms of SLE

Other symptoms depend on which part of the body is affected:

  • Brain and nervous system: Headaches, numbness, tingling, seizures, vision problems, and personality changes
  • Digestive tract: Abdominal pain, nausea, and vomiting
  • Heart: Valve problems, inflammation of the heart muscle
  • Lung: Buildup of fluid in the pleural space, difficulty breathing
  • Skin: Patchy skin color and fingers that change color when cold (Raynaud phenomenon)
  • Kidney: Swelling in the legs

Complications

Inflammation caused by SLE can affect many areas of your body, including:

  • Lupus can cause serious kidney damage, and kidney failure is one of the leading causes of death among people with lupus.
  • Brain and central nervous system. If your brain is affected by lupus, you may experience headaches, dizziness, behavior changes, vision problems, and even strokes or seizures. Many people with lupus experience memory problems and may have difficulty expressing their thoughts.
  • Blood and blood vessels. Lupus may lead to blood problems, including anemia and increased risk of bleeding or blood clotting. It can also cause inflammation of the blood vessels (vasculitis).
  • Having lupus increases your chances of developing an inflammation of the chest cavity lining (pleurisy), which can make breathing painful. Bleeding into lungs and pneumonia also are possible.
  • Lupus can cause inflammation of your heart muscle, your arteries or heart membrane (pericarditis). The risk of cardiovascular disease and heart attacks increases greatly as well.
  • People with lupus are more vulnerable to infection because both the disease and its treatments can weaken the immune system.
  • Having lupus appears to increase your risk of cancer; however, the risk is small.
  • Bone tissue death (avascular necrosis). This occurs when the blood supply to a bone diminishes, often leading to tiny breaks in the bone and eventually to the bone’s collapse.
  • Pregnancy complications.

Diagnosis and Test

Your doctor will do a physical exam to check for typical signs and symptoms of lupus, including:

  • Sun sensitivity rashes, such as a malar or butterfly rash
  • Mucous membrane ulcers, which may occur in the mouth or nose
  • Arthritis, which is swelling or tenderness of the small joints of the hands, feet, knees, and wrists
  • Hair loss
  • Hair thinning
  • Signs of cardiac or lung involvement, such as murmurs, rubs, or irregular heartbeats

No one single test is diagnostic for SLE, but screenings that can help your doctor come to an informed diagnosis include:

  • Blood tests, such as antibody tests and a complete blood count
  • A urinalysis
  • A chest X-ray
  • Your doctor might refer you to a rheumatologist, which is a doctor who specializes in treating joint and soft tissue disorders and autoimmune diseases.

Treatment and medications

No cure for SLE exists. The goal of treatment is to ease symptoms. Treatment can vary depending on how severe your symptoms are and which parts of your body SLE affect. The treatments may include:

  • Anti-inflammatory medications for joint pain and stiffness, such as these options available online
  • Azathioprine (AZA) is used for the treatment of a wide spectrum of SLE manifestations
  • Steroid creams for rashes
  • Corticosteroids to minimize the immune response
  • Antimalarial drugs for skin and joint problems
  • Disease-modifying drugs or targeted immune system agents for more severe cases

Adjunctive therapies

Vitamin D insufficiency and deficiency are more common in patients with SLE than in the general population. Vitamin D supplementation may decrease disease activity and improve fatigue. In addition, supplementation may improve endothelial function, which may reduce cardiovascular disease.

Natural remedies

Natural remedies for SLE include:

Alkaline Detox Diet

Refrain from gluten, legumes, and grains as they can be inflammatory. These foods contain proteins known as lectins, which act as a natural pesticide for crops and can wreak havoc on the lining of your gut. Eliminate dairy and ALL processed foods from your diet. Avoid fruits as they can cause a spike in blood sugar which can also cause inflammation.

Gut Health

It’s important to build our defense in your gut again to prevent further toxic burden. By supplementing foods and nutraceuticals that supply your gut with good defense (probiotics, prebiotic foods, and immunoglobulins), your body can establish balance and harmony again.

Brain Health

Manage stress by cultivating a mindful practice of meditation and living daily.

Lupus Supplements and Natural Herbs

Because of the leaky gut, which not only lets the toxins in, but it also limits the number of nutrients to properly be absorbed into our bodies. For this reason, it’s important to support the immune system with supplements such as vitamin D, omega-3 fish oils, curcumin, multivitamins, probiotics, and glutathione.

Prevention and Cure

Primary Prevention

  • As SLE is a multisystem autoimmune disease with unclear etiology and complex immune dysregulation, there are as yet no preventive strategies.
  • Recent European League Against Rheumatism (EULAR) guidelines suggest low-dose aspirin may be considered for primary prevention of thrombosis and miscarriage in patients with SLE and antiphospholipid antibodies.

Secondary Prevention

Immunizations have implications for people who have SLE:

  • Tetanus toxoid, pneumococcal, and Haemophilus influenzae B vaccines have been demonstrated to be safe and effective when given to SLE patients
  • The influenza vaccine has also been shown to be safe but has reduced the efficacy
  • Several case reports document concerns that hepatitis B vaccination may lead to an exacerbation of SLE, so it is not recommended
  • Live vaccines (shingles, yellow fever, intranasal influenza) are not to be used because of underlying or imposed immunosuppression.

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