Lupus (SLE)

What is Lupus?

Lupus, also known as Systemic Lupus Erythematosus (SLE) is an autoimmune disease. This inflammatory condition affects different organs throughout the body such as the kidneys, brain, heart, lungs, skin, blood cells, and joints. Mostly seen in young females between 20-40 years of age. There is an increased risk factor in African-Americans, Hispanics, and Native Americans. Some people are born with the predisposition of developing this condition which may be triggered by sun exposure, estrogen, infections, or other environmental factors. 

What are the symptoms of Lupus?

The triad of symptoms for SLE is fever, joint pain, and a malar rash. The symptoms might develop suddenly or slow and be mild or severe. The most common symptoms are:

  • Fatigue
  • Skin lesions worsen by sun exposure
  • Raynaud’s phenomenon
  • Chest pain
  • Shortness of breath
  • Dry eyes
  • Headaches 

How is Lupus diagnosed?

The diagnosis of lupus is based on clinical presentation as well as blood and urine tests. The screening test of choice is the Anti-nuclear antibodies (ANA) which is not very specific. There are more specific markers for lupus such as the anti-double-stranded DNA & anti-smith antibodies. A skin biopsy can also help confirm if the rash is lupus affecting the skin.  The diagnostic criteria contain 11 manifestations from which you need at least 4 to establish a diagnosis:

  1. Malar rash on face
  2. Photosensitivity 
  3. Discoid rash
  4. Mouth ulcers 
  5. Arthritis
  6. Serositis: pericarditis, pleuritic, peritonitis
  7. Hematologic: hemolytic anemia, low platelets,  low or high white blood cell count
  8. Renal disease: glomerulonephritis or protein in the urine
  9. Anti-nuclear antibody (ANA) positive
  10. Immunologic disorders: anti-double-stranded DNA, anti-smith, false-positive test for syphilis (RPR, VDRL) with negative FTA (marker for syphilis) 
  11. Neurologic: seizures or psychosis in absence of any other cause. 

How is Lupus treated?

Sunscreen use is recommended on all Lupus patients and the management depends on the level of organ involvement. For pain, fever or inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended. For mild but mostly moderate lupus, hydroxychloroquine or chloroquine are used in combination with a short term steroid such as prednisone. For severe lupus, immunosuppressant (methotrexate, azathioprine), as well as biologics (belimumab, rituximab) are often used. 

To learn more about this condition visit the American College of Rheumatology website

What are the differential diagnoses of Lupus?

  • Drug-induced lupus
  • Rosacea
  • Rheumatoid arthritis 
  • Lyme disease
  • Scleroderma

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