SLE stands for Systemic Lupus Erythematosus. This is an autoimmune disease. The mechanism of development of pathology is a violation of the functioning of B and T-lymphocytes. These are cells of the immune system that malfunction and lead to excessive production of antibodies. In other words, the body's defenses begin to mistakenly attack their own tissues, mistaking them for foreign ones. The immune complexes formed by antibodies and antigens settle in the kidneys, skin and serous membranes. As a result, the body starts the development of a number of inflammatory processes. The following describes the symptoms of SLE disease, diagnosis and treatment of the disease, as well as possible complications.
Reasons
Currently, the exact etiology of the pathology has not been established. During the diagnosis of SLE, antibodies to the Epstein-Barr virus were found in the biomaterial of most patients. Made by doctorsconclusion that systemic lupus erythematosus is viral in nature.
In addition, doctors have established some more patterns:
- The most susceptible to the disease are people who, for various reasons, are forced to stay in regions with unfavorable temperature conditions for a long time.
- At risk are people whose close relatives suffer from an illness. Thus, genetic predisposition is also a provoking factor.
- According to the results of numerous studies, SLE is a kind of reaction of the body to the active vital activity of stimuli. The latter can be any pathogenic microorganisms. However, the failure of the immune system does not occur after a single irritation, but against the background of regular negative effects.
- There is a version that the development of systemic lupus erythematosus occurs when the body is intoxicated with certain chemical compounds.
Some doctors believe that SLE is hormonal. However, this theory has not been supported by relevant studies. Nevertheless, any hormonal disorders worsen the course of the disease. Smoking and drinking alcohol are also risk factors.
Regardless of the causes of SLE (systemic lupus erythematosus), the diagnosis and treatment of the disease are carried out according to the standard algorithm.
Clinical manifestations
Pathology is characterized by a wide range of symptoms. SLE is chronic, that is, episodes of exacerbation are regularly replacedperiods of remission. The disease affects most organs and systems, causing characteristic clinical manifestations.
The main symptoms of the disease:
- Permanent feeling of tiredness.
- Weight loss.
- Fast onset of fatigue.
- Increased body temperature.
- Reduced efficiency.
- Arthritis. The knees, wrists, and knuckles of the fingers are most commonly affected.
- Osteoporosis.
- Pain and weakness in muscle tissue.
- Erythema on exposed skin. The face, shoulders and neck are usually affected.
- Alopecia in a limited area (in most cases, hair loss occurs in the temporal areas).
- Photosensitization.
- Mucosal lesions.
- Pleurisy.
- Lupus pneumonitis, which is characterized by shortness of breath and a cough that produces bloody sputum.
- Pulmonary hypertension.
- Pericarditis.
- Pulmonary embolism.
- Myocarditis.
- Kidney damage.
- Headache.
- Hallucinations.
- Psycho-emotional instability.
- Neuropathy.
- Painful sensations in the epigastric zone.
- Nausea.
- Anemia.
This is not the whole list of clinical manifestations. The disease can affect any internal organs, causing symptoms characteristic of their defeat. Since the disease does not have specific signs, differential diagnosis of SLE is mandatory. Just onbased on the results of a comprehensive examination, the doctor can confirm the development of the disease and draw up a treatment regimen.
Diagnostic criteria
Doctors have developed a list of the main clinically significant manifestations of pathology. The disease is confirmed if the patient has at least 4 out of 11 conditions.
SLE diagnosis criteria:
- Arthritis. It has a peripheral character without the formation of erosion. Manifested by pain and swelling. A small amount of fluid is visualized in the joint area.
- Discoid rash. It has an oval or annular shape. The color of the rash is red. The contours of the plaques are uneven. Scales can be found on the surface of the spots, which are difficult to separate.
- The defeat of the mucous membranes. It manifests itself in the form of painless manifestations in the oral cavity or nasopharynx.
- High UV sensitivity.
- The presence of a specific rash on the cheeks and wings of the nose. Outwardly, it resembles the outlines of a butterfly.
- Kidney damage. It is characterized by excretion of protein from the body along with urine.
- The defeat of the serous membranes. Manifested by pain in the chest, the intensity of discomfort increases on inspiration.
- CNS disorder characterized by muscle cramps and psychosis.
- Changes in blood. Detected during the diagnosis of SLE by analysis.
- Changes in the functioning of the immune system.
- Increase in the rate of specific antibodies in biological material.
Determining the disease activity index
SLEDAI system is used in the diagnosis of SLE. It involves an assessment of the course of the pathology according to 24 parameters. Each of them is expressed in points (points).
SLEDAI evaluation criteria:
- The presence of convulsive seizures, not accompanied by impaired consciousness - 8 points.
- Psychosis - 8.
- Changes in the brain of an organic nature (disorientation in space, memory impairment, insomnia, incoherent speech) - 8.
- Inflammation of the optic nerve - 8.
- Primary lesion of cranial nerve cells - 8.
- Headache that persists even after taking narcotic analgesics - 8.
- Impaired blood circulation in the brain - 8.
- Vasculitis - 8.
- Arthritis - 4.
- Myositis - 4.
- Cylinders in urine - 4.
- More than 5 RBCs in urine - 4.
- Protein in urine - 4.
- More than 5 white blood cells in urine - 4.
- Inflammation of the skin - 2.
- Alopecia - 2.
- Ulcerative lesions of the mucous membranes - 2.
- Pleurisy - 2.
- Pericarditis - 2.
- Compliment reduction C3 or C4 - 2.
- Positive antiDNA - 2.
- Increased body temperature - 1.
- Decrease in blood platelets - 1.
- Decrease in white blood cells - 1.
The maximum score is 105 points. It indicates an extremely high degree of disease activity, when all major systems are affected. Doctors draw the same conclusion.with a result of 20 or more points. With a total of less than 20 points, it is customary to speak of a mild or moderate degree of activity.
Laboratory diagnosis of SLE
In order to confirm or exclude the development of the disease, doctors prescribe many tests. Diagnosis of SLE by blood tests is possible, but in any case, it is necessary to conduct a number of instrumental studies.
Laboratory methods:
- ANA test. It implies the detection of antinuclear factor. If its titer exceeds 1:160, it is customary to talk about the development of an autoimmune pathology in the body.
- AntiDNA. Antibodies are found in half of patients.
- Anti-Sm. A test that detects antibodies to a specific Smith antigen.
- Anti-SSA (SSB). These are antibodies to proteins. They are not specific for SLE, they can also be found in other systemic pathologies.
- Anticardiolipin test.
- Blood test for antihistones.
- The presence of markers of the inflammatory process (increased ESR and C-reactive protein).
- Decreased compliment level. This is a group of proteins that are directly involved in the formation of the immune response.
- Complete blood count is not significant in the laboratory diagnosis of SLE. There may be a slight decrease in the level of lymphocytes, red blood cells, platelets and white blood cells.
- Urine examination. In SLE, proteinuria, pyuria, cylindruria, and hematuria are observed.
- Biochemical blood test. Alarming results are: increased creatinine, ASAT, ALAT andcreatine kinase.
Even if the tests are disappointing in the diagnosis of SLE, in any case, instrumental methods are prescribed. Based on the results of a comprehensive examination, the disease is confirmed or excluded.
Instrumental Methods
To diagnose SLE, the doctor prescribes:
- X-ray of the joints. Allows you to detect minor changes in bone structures.
- X-ray and CT scan of the chest.
- Angiography and nuclear magnetic resonance. The study allows you to identify lesions of the nervous system.
- Echocardiography. Performed to assess the functioning of the heart muscle.
Special investigations may be ordered if necessary. During the diagnosis of SLE, doctors often resort to lumbar puncture, skin and kidney biopsy.
Differential Diagnosis
Based on detailed examination and careful history taking. Also important in diff. the diagnosis of SLE is the establishment of the pathogenesis of the patient's clinical manifestations. This is due to the fact that in many cases the symptoms are associated with the course of another disease, which significantly affects the choice of treatment regimen.
Systemic lupus erythematosus must be differentiated from:
- Anemia.
- Hypothyroidism.
- Viral infection.
- Intoxication of the body while taking medications.
- Rosa acne.
- Dermatitis.
- Photosensitive eczema.
- Persistent monoarthritis.
- Aseptic necrosis.
- Heart failure.
- Diabetes mellitus.
- Hypertension.
- Infectious diseases of the genitourinary system.
- Renal vascular thrombosis.
- Brain tumors.
- Infectious pathologies of the central nervous system.
- Meningitis.
- Multiple sclerosis.
- Miliary TB.
Thus, in order to make an accurate diagnosis, the most correct assessment of symptoms is necessary, reflecting the degree of activity of the underlying disease.
Treatment
Despite significant progress in finding an effective method of therapy, it is impossible to get rid of the disease. The goal of all activities is to stop the acute stage, get rid of unpleasant symptoms and prevent the development of complications.
SLE is diagnosed and treated by a rheumatologist. If necessary, he draws up a referral for a consultation with other specialists of a narrow profile.
The standard treatment regimen for systemic lupus erythematosus includes the following items:
- Reception and intravenous administration of glucocorticosteroids (for example, Prednisolone).
- Combined pulse therapy. It implies the simultaneous administration of a cytostatic and a glucocorticosteroid. The first include the following drugs: Methotrexate, Cyclophosphamide.
- Taking anti-inflammatory drugs (Aertal, Nimesil).
- Administration of drugs related to the aminoquinoline series ("Plaquenil").
- The intake of biological agents that affectmechanisms of development of autoimmune pathologies. These drugs are effective, but very expensive. Examples of funds: "Gumira", "Rituximab", "Embrel".
- Taking anticoagulants, diuretics, antiplatelet agents, potassium and calcium supplements.
In severe SLE, the doctor decides whether extracorporeal treatments (plasmapheresis and hemosorption) are appropriate.
Without exception, all patients should avoid getting into stressful situations and stay in direct sunlight for a long time.
Forecast
It directly depends on the timeliness of the visit to the doctor and the severity of the disease. Systemic lupus erythematosus in its acute form develops at lightning speed, most of the internal organs are affected almost instantly. Fortunately, this situation is extremely rare, it always leads to complications and often causes death.
The chronic variant is considered the most favorable. This is due to the fact that the disease progresses slowly, the internal organs are affected gradually. However, chronic SLE can lead to irreversible consequences. In most cases, this is due to ignoring the problem and not following the recommendations of the attending physician.
Life-threatening complications include: kidney failure, myocardial infarction, cardiosclerosis, pericarditis, cardiac and respiratory failure, thromboembolism and pulmonary edema, intestinal gangrene, stroke, internal bleeding.
Bconclusion
Systemic lupus erythematosus is an autoimmune disease. The pathogenesis of the disease has not yet been established, however, it is known that the mechanism for the development of pathology lies in an erroneous attack on the body's own cells' defense system.
SLE has no specific signs, there are so many clinical manifestations of the disease that a thorough comprehensive examination is necessary. Diagnosis of pathology involves the implementation of laboratory and instrumental techniques, as well as the differentiation of the disease from other possible pathologies.
