The acronym SLE stands for "systemic lupus erythematosus." This is a disease that is autoimmune in nature. The mechanism of the development of pathology is a violation of the functioning of B and T-lymphocytes. These are cells of the immune system, the malfunctioning of which leads to excessive production of antibodies. In other words, the body's defenses begin to erroneously 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. Symptoms of SLE disease , diagnosis and treatment of the disease, as well as possible complications are described below.
Causes
At present, the exact etiology of the pathology has not been established. In the process of diagnosing SLE in most patients, antibodies to Epstein-Barr virus were detected in the biomaterial. Doctors concluded that systemic lupus erythematosus has a viral nature.
In addition, doctors established some more patterns:
- The disease is most susceptible to people who, for various reasons, are forced to stay in regions with adverse temperature conditions for a long time.
- At risk are people whose close relatives suffer from the disease. Thus, genetic predisposition is also a provoking factor.
- According to the results of numerous studies, SLE is a peculiar reaction of the body to the active life of stimuli. The latter may be any pathogenic microorganisms. However, a malfunction in 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 during intoxication of the body with certain chemical compounds.
Some doctors believe that SLE is hormonal in nature. However, this theory is not confirmed by relevant studies. Nevertheless, any hormonal disorders worsen the course of the disease. Risk factors are also smoking and drinking alcohol.
Regardless of the causes of SLE (systemic lupus erythematosus), the diagnosis and treatment of the disease is 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 replaced by periods of remission. The disease affects most organs and systems, provoking the occurrence of characteristic clinical manifestations.
The main symptoms of the disease:
- Constant feeling of tiredness.
- Weight loss.
- The rapid onset of fatigue.
- Elevated body temperature.
- Decrease in working capacity.
- Arthritis. Most often, the knees, wrists and joints of the fingers are affected.
- Osteoporosis.
- Painful sensations and weakness in muscle tissue.
- Erythema in exposed skin. Typically, the face, shoulders and neck are affected.
- Alopecia in a limited area (in most cases, hair loss occurs in the temporal zones).
- Photosensitivity.
- Damage to the mucous membranes.
- Pleurisy.
- Lupus pneumonitis, which is characterized by shortness of breath and cough, accompanied by discharge of sputum with an admixture of blood.
- Pulmonary hypertension.
- Pericarditis.
- Pulmonary embolism.
- Myocarditis.
- Damage to the kidneys.
- Headache.
- Hallucinations.
- Psycho-emotional instability.
- Neuropathy.
- Pain in the epigastric zone.
- Nausea.
- Anemia.
This is not an entire list of clinical manifestations. The disease can affect any internal organs, causing symptoms characteristic of their defeat. Since the ailment does not have specific signs, differential diagnosis of SLE is mandatory. Only on the basis of 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 at least 4 of 11 conditions are found in the patient.
Diagnostic criteria for SLE:
- Arthritis. It has a peripheral character without the formation of erosion. It manifests itself as painful sensations 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. On the surface of the spots you can find scales that are difficult to separate.
- Damage to the mucous membranes. It manifests itself in the form of painless manifestations in the oral cavity or nasopharynx.
- High sensitivity to ultraviolet.
- The presence of a specific rash on the cheeks and wings of the nose. Outwardly, it resembles the shape of a butterfly.
- Damage to the kidneys. It is characterized by the elimination of protein from the body with urine.
- The defeat of the serous membranes. It manifests itself as pain in the chest area, the intensity of uncomfortable sensations intensifies on inspiration.
- Disruption of the central nervous system, characterized by muscle cramps and psychosis.
- Blood changes. Identified during the diagnosis of SLE by analysis.
- Changes in the functioning of the immune system.
- An increase in the rate of specific antibodies in biological material.
Determination of disease activity index
In the diagnosis of SLE, the SLEDAI system is used. It implies an assessment of the pathology by 24 parameters. Each of them is expressed in points (points).
Evaluation criteria for the SLEDAI system:
- The presence of convulsive seizures that are 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 damage to cranial nerve cells - 8.
- Headache that does not recede even after taking narcotic analgesics - 8.
- Disturbed blood circulation in the brain - 8.
- Vasculitis - 8.
- Arthritis - 4.
- Myositis - 4.
- Cylinders in urine - 4.
- More than 5 red blood cells in the urine - 4.
- Protein in urine - 4.
- More than 5 white blood cells in the urine - 4.
- Inflammation of the skin - 2.
- Alopecia - 2.
- Ulcerative lesions of the mucous membranes - 2.
- Pleurisy - 2.
- Pericarditis - 2.
- Reduced compliment C3 or C4 - 2.
- Positive antiDNA - 2.
- Elevated body temperature - 1.
- Reducing platelet levels in the blood - 1.
- WBC reduction - 1.
The maximum result is 105 points. It indicates an extremely high degree of disease activity when all major systems are affected. Doctors make 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 a lot of tests. Diagnosis of SLE by blood tests is possible, but in any case, a number of instrumental studies are necessary.
Laboratory methods:
- ANA test. It implies the identification 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 in the course of which antibodies to a particular Smith antigen are detected.
- Anti-SSA (SSB). These are antibodies to proteins. For SLE are nonspecific, they can also be detected with other systemic pathologies.
- Analysis for anticardiolipin.
- Blood test for antihistones.
- The presence of markers of the inflammatory process (increased ESR and C-reactive protein).
- A decrease in the level of compliment. This is a group of proteins directly involved in the formation of the immune response.
- A complete blood count is not significant in the laboratory diagnosis of SLE. The level of lymphocytes, red blood cells, platelets and white blood cells may slightly decrease.
- Urinalysis When SLE is observed: proteinuria, pyuria, cylindruria and hematuria.
- Blood chemistry. Alarming results are: increased creatinine, ASAT, ALAT and creatine kinase.
Even if in the diagnosis of SLE, the analyzes are disappointing, 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 of the chest organs.
- Angiography and nuclear magnetic resonance. The study reveals lesions of the nervous system.
- Echocardiography. It is carried out in order to assess the functioning of the heart muscle.
If necessary, specific studies may be prescribed. During the diagnosis of SLE, doctors often resort to spinal puncture, biopsy of the skin and kidneys.
Differential diagnosis
Based on a detailed examination and a thorough history taking. Also important in diff. the diagnosis of SLE has 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 medication.
- Pink eels.
- Dermatitis.
- Photosensitive eczema.
- Persistent monoarthritis.
- Aseptic necrosis.
- Heart failure.
- Diabetes mellitus.
- Arterial hypertension.
- Infectious diseases of the genitourinary system.
- Renal vascular thrombosis.
- Brain tumors.
- Infectious pathologies of the central nervous system.
- Meningitis
- Multiple Sclerosis.
- Miliary tuberculosis.
Thus, to make an accurate diagnosis, the most accurate assessment of symptoms, reflecting the degree of activity of the underlying disease, is necessary.
Treatment
Despite significant success in finding an effective method of therapy, it is impossible to get rid of the disease. The goal of all measures is to relieve the acute stage, get rid of unpleasant symptoms and prevent the development of complications.
Rheumatologist is involved in the diagnosis and treatment of SLE. If necessary, he draws up a referral for 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 glucocorticosteroid. The first drugs include the following: Methotrexate, Cyclophosphamide.
- Reception of anti-inflammatory drugs (Aertal, Nimesil).
- The introduction of drugs related to the aminoquinoline series ("Plaquenil").
- Acceptance of biological agents that affect the development mechanisms of autoimmune pathologies. These drugs are effective, but very expensive. Examples of funds: Gumira, Rituximab, Embrell.
- Reception of anticoagulants, diuretics, antiplatelet agents, potassium and calcium preparations.
In severe SLE, the doctor decides on the feasibility of extracorporeal treatment methods (plasmapheresis and hemosorption).
All patients without exception need to avoid getting into stressful situations and be in direct sunlight for a long time.
Forecast
It directly depends on the timeliness of contacting a doctor and the severity of the disease. Systemic lupus erythematosus in acute form develops with lightning speed, most of the internal organs are affected almost instantly. Fortunately, such a situation is extremely rare, it always leads to complications and often causes death.
The chronic option is considered the most favorable. This is due to the fact that the disease progresses slowly, internal organs are affected gradually. However, SLE in chronic form can lead to irreversible consequences. In most cases, this is due to ignoring the problem and non-compliance with the recommendations of the attending physician.
Life-threatening complications include: renal failure, myocardial infarction, cardiosclerosis, pericarditis, cardiac and respiratory failure, thromboembolism and pulmonary edema, intestinal gangrene, stroke, internal bleeding.
Finally
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 consists in an erroneous attack of the protective system of the body's own cells.
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.