SYSTEMIC LUPUS ERYTHEMATOSUS (PART-3):- DIAGNOSIS OF SLE.

INTRODUCTION:-

SYSTEMIC LUPUS ERYTHEMATOSUS (SLE), IS THE MOST COMMON TYPE OF LUPUS. SLE IS AN AUTOIMMUNE DISEASE IN WHICH THE IMMUNE SYSTEM ATTACKS ITS OWN TISSUES, CAUSING WIDESPREAD INFLAMMATION AND TISSUE DAMAGE IN THE AFFECTED ORGANS. IT CAN AFFECT THE JOINTS, SKIN, BRAIN, LUNGS, KIDNEYS, AND BLOOD VESSELS.

PATHOGENESIS:-

LUPUS RESULTS FROM A BREAKDOWN OF THE NORMAL DISEASE-FIGHTING FUNCTION OF THE IMMUNE SYSTEM. INSTEAD OF PRODUCING ANTIBODIES THAT ATTACK INFECTIOUS ORGANISMS, THE BODY PRODUCES ANTIBODIES—CALLED AUTOANTIBODIES—THAT REACT WITH COMPONENTS OF THE BODY'S OWN TISSUES.

PATHOLOGY:-

SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) IS A SYNDROME CHARACTERIZED BY ORGAN DAMAGE THAT RESULTS FROM THE DEPOSITION OF IMMUNE COMPLEXES. THE IMMUNE COMPLEXES FORM WHEN AUTOANTIBODIES ARE MADE AGAINST THE NUCLEIC ACIDS AND PROTEIN CONSTITUENTS OF THE NUCLEUS OF CELLS.
SYMPTOMS CAN VARY AND CAN CHANGE OVER TIME. COMMON SYMPTOMS INCLUDE:
SEVERE FATIGUE
JOINT PAIN
JOINT SWELLING
HEADACHES
A RASH ON THE CHEEKS AND NOSE, WHICH IS CALLED A “BUTTERFLY RASH”
HAIR LOSS
ANEMIA
BLOOD-CLOTTING PROBLEMS
FINGERS TURNING WHITE OR BLUE AND TINGLING WHEN COLD, WHICH IS KNOWN AS RAYNAUD’S PHENOMENON

RISK FACTORS:-

GENETICS
THE DISEASE ISN’T LINKED TO A CERTAIN GENE, BUT PEOPLE WITH LUPUS OFTEN HAVE FAMILY MEMBERS WITH OTHER AUTOIMMUNE CONDITIONS.
ENVIRONMENT
ENVIRONMENTAL TRIGGERS CAN INCLUDE:
ULTRAVIOLET RAYS
CERTAIN MEDICATIONS
VIRUSES
PHYSICAL OR EMOTIONAL STRESS
TRAUMA

CLINICAL MANIFESTATIONS:

THE PATIENTS WITH SLE MAY PRESENT WITH VARIOUS SYSTEMIC MANIFESTATIONS. THE GENERAL SYMPTOMS INCLUDE: FEVER, MALAISE, ARTHRALGIAS, MYALGIAS, HEADACHE, AND LOSS OF APPETITE AND WEIGHT. NONSPECIFIC FATIGUE, FEVER, ARTHRALGIA, AND WEIGHT CHANGES ARE THE MOST COMMON SYMPTOMS IN NEW CASES OR RECURRENT ACTIVE SLE FLARES.

DIAGNOSIS:

AT LEAST FOUR OF THE ELEVEN CRITERIA OF LUPUS FROM THE AMERICAN COLLEGE OF RHEUMATOLOGY ARE USUALLY PRESENT FOR LUPUS TO BE DIAGNOSED.
MALAR RASH – A BUTTERFLY SHAPED RASH ACROSS CHEEKS AND NOSE
SKIN RASH – RAISED RED PATCHES
PHOTOSENSITIVITY – UNUSUALLY STRONG REACTION TO SUN LIGHT, CAUSING A RASH OR FLARE
MOUTH OR NOSE ULCERS – USUALLY PAINLESS
NONEROSIVE ARTHRITIS – INFLAMMATION IN TWO OR MORE JOINTS.
CARDIO-PULMONARY INVOLVEMENT – INFLAMMATION OF THE HEART LINING AND/OR LUNGS
NEUROLOGIC DISORDER – SEIZURES AND/OR PSYCHOSIS
KIDNEY DISORDER – INCREASED PROTEIN OR CLUMPS OF RED CELLS IN URINE
BLOOD DISORDER – ANEMIA CAUSED BY DAMAGED RED CELLS, LOW WHITE CELLS OR LOW PLATELET COUNT
IMMUNOLOGICAL DISORDER – WHEN YOUR IMMUNE SYSTEM ATTACKS HEALTHY CELLS
ANTINUCLEAR ANTIBODIES (ANA) – POSITIVE BLOOD TEST NOT INDUCED BY DRUGS.

TREATMENT:-

SLE TREATMENT CONSISTS PRIMARILY OF IMMUNOSUPPRESSIVE DRUGS THAT INHIBIT ACTIVITY OF THE IMMUNE SYSTEM. HYDROXYCHLOROQUINE AND CORTICOSTEROIDS (E.G., PREDNISONE) ARE OFTEN USED TO TREAT SLE. THE FDA APPROVED BELIMUMAB IN 2011, THE FIRST NEW DRUG FOR SLE IN MORE THAN 50 YEARS.

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