Welcome to an explanation of systemic lupus erythematosus (SLE) - a chronic autoimmune disease that can affect various organs in the body. We've got you covered with all the essential information you need to understand this condition better and find the answers you're looking for.
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can be likened to a bug in the body's complex computer software. In this analogy, the immune system, which serves as the body's antivirus software, experiences a glitch. Then the immune system starts attacking the body's own tissues, much like an overzealous antivirus program mistaking important system files as threats and deleting them.
This results in a disease that can potentially affect every organ and tissue in the body, leading to a wide range of different clinical manifestations. That is why SLE can be tricky to diagnose since its symptoms can vary widely between people and may come and go. The disease, often referred to as lupus, is systemic, meaning it can affect multiple organ systems in the body. Treatment for SLE focuses on controlling the immune system's overactivity and managing symptoms to improve the patient's quality of life.
Causes of systemic lupus erythematosus (SLE)
The causes of SLE are multifactorial, involving a combination of genetic predisposition, environmental triggers, and hormonal factors. These genetic vulnerabilities can be activated by various environmental factors, such as sunlight, infections (Epstein-Barr virus in particular), and certain medications. Stress has also been linked to a 50% increased risk of developing lupus, further emphasising the complex interplay of factors in the onset of this disease.1
Signs and symptoms of systemic lupus erythematosus (SLE)
The symptoms of SLE can vary greatly from person to person, they may come and go over time, and some may be transient while others become permanent. Some of the most common symptoms include:
- Feeling very tired
- Experiencing joint pain and swelling
- Having skin rashes (especially a characteristic malar rash – a butterfly-shaped rash on the cheeks and nose)
- Having a fever
Other symptoms may include:
- Chest pain
- Hair loss
- Sensitivity to sunlight (photosensitivity) which worsens skin lesions
- Mouth ulcers
- Swollen lymph nodes1
In more severe cases, SLE can affect the kidneys, heart, lungs, and brain. The disease has episodes of illness when symptoms are worse, known as flares, and periods when symptoms improve, called remission.2
Diagnosis of systemic lupus erythematosus (SLE)
Diagnosing SLE is complicated because signs and symptoms vary so widely between individuals, flare and subside, and overlap with many other illnesses and conditions. There is no single diagnostic test, instead, diagnosis involves combining assessments of clinical symptoms and signs, and laboratory findings. The American College of Rheumatology (ACR) has established a list of 11 criteria – clinical and immunologic, and the diagnosis of lupus is usually made if a patient has at least four of these criteria which include:
- Malar rash (a butterfly-shaped rash on the cheeks and nose)
- Discoid rash (a coin-shaped rash)
- Photosensitivity (skin reactions to sunlight)
- Mouth ulcers
- Kidney disorder
- Neurological disorder
- Signs of problems with blood cells and the immune system
Management and treatment for systemic lupus erythematosus (SLE)
SLE management involves a combination of lifestyle changes, prevention of comorbidities, and the use of immunomodulators and immunosuppressants. This is because the treatment for lupus often involves medications to control inflammation and the immune response, as well as treatments to manage high blood pressure and other symptoms.
SLE treatment is very individualised and may include nonsteroidal anti-inflammatory medicines (NSAIDs), corticosteroids, immunosuppressive agents, and antimalarial drugs, such as Hydroxychloroquine which is an important component of SLE treatment since it has been found to minimise flares, enhance survival, and lower the risk of organ damage.1
These treatments aim to control the existing symptoms and prevent disease flares. Your physician may often change medications and dosages in response to symptoms flaring and subsiding.
How can I prevent systemic lupus erythematosus (SLE)?
Currently, there's no known way to prevent SLE. However, once the disease has been diagnosed, certain measures can help prevent lupus flares, such as avoiding sunlight, preventing infections, and avoiding certain medications.4 It's important for lupus patients to work closely with their healthcare provider to manage their symptoms effectively and prevent complications.
How common is systemic lupus erythematosus (SLE)?
SLE is a fairly common disease that affects millions of people throughout the world. It is more frequent in those assigned female at birth (AFAB) compared to those assigned male at birth. It can occur at any age, though it is most commonly diagnosed in individuals aged 15 to 44.2 It is also estimated to be more common in people of non-white ethnicities.4
Who is at risk of getting systemic lupus erythematosus (SLE)?
Those with a family history of SLE or other autoimmune diseases are at increased risk of developing the disease.4 Those people AFAB of childbearing age are particularly at risk, as are people of certain racial and ethnic groups. The disease is also more common in people with a history of certain other autoimmune conditions, such as rheumatoid arthritis and coeliac disease.4
What are the coping and support strategies for people with systemic lupus erythematosus (SLE)?
Coping with SLE involves managing stress and maintaining a healthy lifestyle. Psychological support and stress management strategies may be beneficial for patients, helping them to navigate the challenges of living with this disease.3 The Lupus Foundation of America and Lupus UK offer resources and support for people living with lupus, including tips for managing stress and maintaining a healthy lifestyle.3
How to plan a pregnancy when you have systemic lupus erythematosus (SLE)?
If you have SLE, planning a pregnancy requires careful consideration. Before attempting to conceive, it is critical to talk with your doctor. They can help you understand the risks and develop a plan.5
Certain factors can increase pregnancy risks for patients with SLE. These include disease activity, history of lupus-related kidney problems, presence of certain antibodies in your blood, and high blood pressure. It's advised to only plan a pregnancy when your lupus has been in remission for at least four months.5
Before trying to conceive, your doctor will assess your disease activity, check for kidney disease, test for certain antibodies, and review your medications. Some lupus medications aren't safe during pregnancy, so you might need to change your treatment.5
There are a few health conditions that can make pregnancy too risky for patients with SLE. Therefore, if you have SLE and are considering pregnancy, it's crucial to discuss this with your doctor. They can help you understand the risks and develop a plan to manage your health.5
When should I see a doctor?
If you're experiencing unexplained rashes, ongoing fever, persistent aching or fatigue, or any other symptoms that might be associated with SLE, it's time to see your doctor.4 Early diagnosis and treatment can help prevent serious complications and aid more effective management of the disease.
Systemic lupus erythematosus (SLE) is a defect in the body's immune system, causing it to mistakenly attack its own tissues. This complex autoimmune disease can affect any organ or tissue in the body, and its development involves a combination of genetic, environmental, and hormonal factors.
The symptoms of SLE are diverse and can range from fatigue and skin rashes to more severe complications involving various organs such as the kidneys. SLE is diagnosed using a combination of clinical symptoms and laboratory results. The management of SLE is primarily focused on controlling symptoms, preventing disease flares, and improving the patient's quality of life. Effective coping and support strategies, such as stress management and maintaining a healthy lifestyle, can significantly help patients manage this disease. Early detection and intervention in SLE are crucial to preventing serious complications.
- Fava A, Petri M. Systemic lupus erythematosus: diagnosis and clinical management. J Autoimmun [Internet]. 2019 Jan [cited 2023 Jul 24];96:1–13. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6310637/
- Zucchi D, Elefante E, Schilirò D, Signorini V, Trentin F, Bortoluzzi A, et al. One year in review 2022: systemic lupus erythematosus. Clin Exp Rheumatol. 2022 Jan;40(1):4–14. Available from: https://pubmed.ncbi.nlm.nih.gov/35088691/
- Song H, Fang F, Tomasson G, Arnberg FK, Mataix-Cols D, Fernández de la Cruz L, et al. Association of stress-related disorders with subsequent autoimmune disease. JAMA [Internet]. 2018 Jun 19 [cited 2023 Jul 24];319(23):2388–400. Available from: https://doi.org/10.1001/jama.2018.7028
- Zucchi D, Silvagni E, Elefante E, Signorini V, Cardelli C, Trentin F, et al. Systemic lupus erythematosus: one year in review 2023. Clin Exp Rheumatol. 2023 May;41(5):997–1008. Available from: https://pubmed.ncbi.nlm.nih.gov/37133502/
- Jones A, Giles I. Fertility and pregnancy in systemic lupus erythematosus. Indian Journal of Rheumatology [Internet]. 2016 Nov [cited 2023 Jul 24];11(Suppl 2):S128. Available from: https://journals.lww.com/ijru/Fulltext/2016/11002/Fertility_and_Pregnancy_in_Systemic_Lupus.4.asp
- Petri M, Orbai A, Alarcón GS, Gordon C, Merrill JT, Fortin PR, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis & Rheumatism [Internet]. 2012 [cited 2023 Oct 22]; 64(8):2677–86. Available from: https://onlinelibrary.wiley.com/doi/10.1002/art.34473.