Systemic lupus erythematosus

Systemic lupus erythematosus: frequency

Systemic lupus erythematosus can develop in both adults and children. Women, especially of reproductive age, are about ten times more likely to be affected than men. The disease is often detected before the age of 30 years.

In children, systemic lupus erythematosus occurs predominantly between the ages of 11 and 15 years, sometimes even earlier. Girls are significantly more likely to get SLE than boys.

Statistically, systemic lupus erythematosus affects about 40 out of every 100,000 people.

Systemic lupus erythematosus: symptoms

What symptoms of Systemic Lupus Erythematosus can cause, read in the article Lupus Erythematosus – Symptoms.

Systemic lupus erythematosus: causes

What causes systemic lupus erythematosus exactly is unclear. However, several factors seem to be involved, especially genetic changes. External factors that stress or stimulate the immune system may eventually trigger systemic lupus erythematosus; even an existing disease surge can get worse. These external factors include:

• Infections with viruses or bacteria
• Intense sunlight
• Extreme climate change
• Extreme mental stress
• Hormonal changes (for example, during puberty, pregnancy and menopause)

Systemic lupus erythematosus: diagnosis

The diagnosis of “systemic lupus erythematosus” can be difficult because the disease often begins insidiously. In addition, the symptoms are so diverse and often unspecific that they can also point to other diseases. Systemic lupus erythematosus is also relatively rare and therefore little known. To make matters worse, in addition to the “pure” lupus disease, there are also mixed forms with other rheumatic diseases.

If there is a suspicion of “systemic lupus erythematosus” patients should be examined by a specialist, ie a rheumatologist or pediatric rheumatologist. Because of the many symptoms, working with other specialists makes sense, for example, with the dermatologist, a heart and kidney specialist or a gynecologist. The extensive examinations necessary for the diagnosis of “systemic lupus erythematosus” can also be performed in hospital (for example in children).

Conversation and physical examination

The doctor will first have a detailed conversation with the patient (for children with the parents) about the medical history (anamnesis). This is followed by a physical examination.

blood test

Various laboratory examinations, some of which are very specific, help in the diagnosis of “systemic lupus erythematosus”. A blood sample from the patient is examined for specific antibodies. These antibodies are antibodies which are directed against the genetic material (DNA). Physicians also refer to them as antinuclear antibodies (ANA). These antibodies can detect different types in the blood, where the doctor can detect a lupus disease.

Furthermore, the blood test often shows a lack of white blood cells (leukocytes) and platelets (platelets) and anemia (anemia). The blood cell lowering rate (BSG) is often accelerated.

Further investigations

The blood tests are followed by numerous other studies to assess the extent of systemic lupus erythematosus and the involvement of individual organs. For example, elevated blood pressure and protein in the urine may indicate involvement of the kidneys (lupus nephritis), which requires appropriate testing. If necessary, for example, X-ray and ultrasound examinations are performed, the fundus is examined and / or the lung function is checked.

Criteria catalog simplifies the diagnosis

Because systemic lupus erythematosus can cause so many and often difficult-to-interpret symptoms, American rheumatologists have created a catalog of criteria to simplify the diagnosis. Accordingly, there is a suspicion of SLE when there are four out of eleven symptoms. These include, for example, the butterfly-like skin flushing in the face, repeated ulcers in the mouth without any other cause, unclarified joint swelling, rib or pleurisy, pericarditis and detection of certain antibodies.

Systemic lupus erythematosus: treatment

Systemic lupus erythematosus can not be treated causally – neither in children nor in adults. Only symptomatic therapy is possible, ie a treatment of the disease symptoms. The individual therapy plan depends on which organs are affected and how active the illness is.

drugs

The aim of this treatment is to reduce the inflammation and the excess activity of the immune system. There are four different substance groups available:

• Non-steroidal anti-inflammatory drugs (NSAIDs): If systemic lupus erythematosus is mild, such anti-inflammatory drugs are often sufficient. They also have analgesic and antipyretic and prevent the clumping of platelets.
• Glucocorticoids (“Cortisone”): They have a strong anti-inflammatory effect and are often given in high doses over a short period of time in acute episodes of illness (shock therapy or pulse therapy).
• immunosuppressants: They reduce the activity of the immune system, which is overactive in SLE. Examples are azathioprine, cyclosporin and cyclophosphamide.
• chloroquine: This drug is especially prescribed when systemic lupus erythematosus skin and joints. He is also suitable as an alternative to cortisone in mild disease.

Accompanying measures

The drug treatment of lupus can be supplemented by further measures. These include physical therapies (such as cold treatment of swollen, sore joints, or respiratory therapy for respiratory problems), lowering blood pressure, or avoiding sunlight.

Systemic lupus erythematosus: disease course and prognosis

Systemic lupus erythematosus is usually chronic-relapsing-type. Months or years can pass between successive episodes of disease. In many patients, the relapses also become more rare and weaker over time – with increasing age, systemic lupus erythematosus can be mitigated.

Curable is systemic lupus erythematosus neither in children nor in adults. The disease can be kept at bay with the help of various medicines, so that as few inflammatory processes as possible develop in the body. The earlier systemic lupus erythematosus is treated, the better the course of the disease can be influenced. In most cases, patients need to be treated throughout their lives.

Life expectancy

Life expectancy in systemic lupus erythematosus has increased due to improved treatment options. Experts believe that 90 percent of patients will survive ten or more years if treated appropriately. However, the quality of life of many patients is limited: those affected suffer from constant tiredness, skin changes and infections or are dependent on regular blood dialysis. The most common cause of death in SLE is no longer the disease itself, but the resulting complications.

complications

Systemic lupus erythematosus can cause severe and sometimes life-threatening complications:

• Nephritis: Over time, it can cause renal function to worsen (kidney failure) or be completely lost (kidney failure). Those affected then need regular blood dialysis or a kidney transplant.
• Cardiovascular diseases: Systemic lupus erythematosus promotes vascular calcification and thus cardiovascular disease.
• Inflammation of the spinal cord: It causes paralysis of the legs and (more rarely) of the arms and can lead to paraplegia if not treated quickly.
• Inflammation of the optic nerve: If she is not discovered and treated in time, blindness threatens.
• Increased risk of infection: SLE patients are particularly susceptible to infections caused by viruses, bacteria and fungi. If these are not treated consistently, there is a risk of organ damage.
• Increased susceptibility to malignant diseases

Systemic lupus erythematosus: prevention

The chronic inflammatory autoimmune disease of systemic lupus erythematosus can not be prevented. However, various factors are known that can trigger a disease boost. To prevent this, you should follow the following advice:

• Avoid overweight
• Do without nicotine
• Drink alcohol only moderately
• Pay attention to a balanced, low-fat diet
• Exercise regularly and exercise in moderation (even with complaints such as joint pain)
• No unprotected stay in the sun or under UV light (use sunscreen with high sun protection factor!)
• Avoid infection, especially when taking immunosuppressants

Psychological factors also influence the course of the disease. Especially chronic diseases such as systemic lupus erythematosus can depress the mood and make it depressed. This in turn triggers stress, which in the long term can have a negative effect on the hormone balance, the immune system and thus also the course of the disease. A positive attitude towards life is therefore very important for patients. Relaxation techniques (biofeedback, autogenic training, etc.) and / or conversation with a psychologist are helpful here. Also the visit to a self-help group “Systemic lupus erythematosus“Can be useful.