SLE (systemic lupus erythematosus) is a disease currently diagnosed in several million people on our planet. Among patients there are elderly people, breast-fed infants and adults. Doctors have not yet been able to establish the causes of the pathology, although the factors that stimulate the disease have been studied. SLE cannot be completely cured, but it is not a death sentence. Measures and methods have been developed to help stabilize the condition of patients and provide them with a long, full life.
What is hard currency: key points
Some consider the treatment of SLE disease to be unpromising. The prognosis of this pathology in a patient often causes panic when a person finds out that a complete recovery cannot be achieved. In order not to be so scary, you should understand the essence of the pathological condition. The term is used to denote an autoimmune disease in which the body's cells attack other healthy structures, forming aggressive components, lymphocytic clones. This is due to the malfunctioning of the immune system, which, for various reasons, accepts normal elements as targets.
Currently, among other autoimmune pathologies, SLE is considered one of the most complex. A distinctive feature is the formation of antibodies to the body's DNA. The disease covers almost all tissues and organs, various cells get damaged in the most unpredictable places, which leads to the inflammatory process. The most typical areas of localization of inflammation are the kidneys, heart, blood vessels, and connective tissues.
About a hundred years ago, with the symptoms of SLE, they could not offer treatment. Man was considered doomed. Currently, a wide variety of medicines has been developed to increase survival, alleviate manifestations, and reduce internal damage. In total, this helps to improve the quality of life of people with such a diagnosis. Around the beginning of the last century, SLE was the cause of rapid death; by the middle of the century, survival rate reached 50%. Currently, 96% of patients live for five years, and 76% live for fifteen years. The probability of death is adjusted by gender, ethnicity, place of residence. Black men suffer the most severe SLE.
Terminology features
The discrepancy in reviews of the treatment of SLE in Europe, America and Russia is associated with some difference in terminology. In particular, in English-language scientific works, lupus is called not only SLE, but also a number of other pathological conditions, that is, there it is a collective term. Most often, it implies SLE, since this form is the most widespread. I must admit that about five million people suffer from various types of lupus. In addition to SLE, neonatal, drug, and skin types are isolated.
With cutaneous pathological processes occur only in the skin, so the disease does not go into a systemic form. There are subacute cases, discoid. A drug disease is provoked by drugs, resembles SLE during the course, but does not require a therapeutic course - it is enough to cancel the drug that provoked the pathology.
The nuances of manifestations
It is possible to suspect that treatment of SLE is necessary if the nose bridge, cheeks are covered with a rash. The form of rashes resembles a butterfly, which gave the name of the pathology. However, such a manifestation is not observed in 100% of cases. The specific set of symptoms depends on the characteristics of the body. Even in one patient, the symptoms may gradually change, and the disease itself will either weaken or become active again. The predominant percentage of symptoms is nonspecific, which complicates the diagnosis.
Usually, the need for treatment of SLE is identified when the patient goes to the doctor with a nonspecific set of symptoms, of which the most pronounced is febrile fever, in which the temperature exceeds 38.5 degrees. On examination, swelling of the joints is visible, this area responds with pain, the body aches. The patient has enlarged lymph nodes, a person quickly gets tired, weakens. Some have ulcers in the oral cavity, hair falls out, and gastrointestinal tract malfunctions. Headaches, a depressed mental state are possible. All this reduces working capacity, excludes a person from an active public life. Sometimes, against the background of SLE, cognitive failures, psychoses, and affective disturbances, myasthenia gravis, and problems with movement coordination develop.
Disease indexing
Modern methods of treating SLE differ in effectiveness and efficiency, so it was decided to introduce indexing systems to assess the adequacy of the chosen therapy. About a dozen indices have been introduced that allow you to control the progress of symptoms for a given time period. Each of the violations receives an initial score, and the final summation helps to clearly determine how severe the case is. This method of assessment was first applied in the 80s of the last century, and later studies have confirmed its reliability and accuracy.
SLE treatment is practiced in Israel, Russia, America and other countries with sufficient medical capacities. In our country, people with this diagnosis are ready to be admitted to the MHRC, Children's Clinical Hospital, in the KNPPZ im. Tareeva, RAMS, RDKB, CDKB FMBA. However, such a diversity of institutions does not mean an impeccable level of assistance. Unfortunately, the availability of drugs is relatively low, especially related to the newest and most effective developments. The price of treatment for a year is from 600,000 rubles or more, which is associated with the high cost of medicines. It will take many years to take medicines.
Past and present
Currently, SLE is a disease whose treatment is aimed at alleviating the manifestations. At the same time, one cannot count on a full recovery. Medications help take immunity under control. A competent set of tools is the key to long-term remission, that is, SLE becomes for a person just a chronic disease. When the state changes, the attending physician selects a new course. As a rule, several specialists work with the patient at once - a multidisciplinary group. Attract doctors specializing in diseases of the blood, kidneys, heart, skin, nervous system. Rheumatologists, psychiatrists take part in the treatment of SLE. In Western countries, family doctors are involved in the process.
The complexity and complexity of the pathogenesis explains the problem of selecting an adequate treatment for SLE. Targeted drugs are being actively developed, but statistics show that one should not count on a miracle. A huge number of seemingly promising developments at the stage of clinical trials have already shown their inefficiency. Currently, the classic course of treatment is formed by a complex of non-specific drugs.
What will help
Preparations for the treatment of SLE are several groups. First, the patient is prescribed oppressive immune systems, thereby correcting the increased activity of cells. Cytostatic agents are popular: Methotrexate, Cyclophosphamide. Sometimes prescribed "Azathioprine", in other cases, stop at "Mycophenolate mofetil." These same agents have found active application in antitumor treatment; they are used to control the division of too active cells. The main feature of their treatment is the abundance of severe negative effects on different systems and organs.
Corticosteroid drugs are used to treat SLE. They are shown during the acute phase. To this group belong non-specific agents that inhibit the foci of inflammation. Their task is to facilitate the autoimmune reaction. Corticosteroids have been used in the treatment of SLE since the middle of the last century. At one time, it was they who became a new step in alleviating the condition of patients. Today it is almost impossible to imagine a treatment of the disease without the use of corticosteroids - there is virtually no alternative to them. However, one must remember the many serious negative effects on the body. The most commonly prescribed drugs containing prednisone, methylprednisolone.
Aggravation and remission
In 1976, for the first time, pulse therapy was used to treat SLE in the acute phase. Its effectiveness was quite high, so the approach is relevant at the present time. The point is in the patient receiving pulsed "Cyclophosphamide", "Methylprednisolone." Over the next decades, the scheme was improved by developing a gold standard for the treatment of SLE. Not without drawbacks - the side effects are rather severe, and for some groups of patients, pulse therapy is categorically not recommended. It does not suit, for example, people with high blood pressure. This indicator is difficult to control. Pulse therapy is not indicated for systemic infection of the body, as there is a high probability of metabolic problems, impaired behavioral reactions.
Treatment of SLE in children and adults during remission involves the use of antimalarial drugs. The practice of their use in this pathology is quite lengthy. A lot of information has been accumulated confirming the effectiveness of such a program. Anti-malarial compositions well help people suffering from skin lesions localized in the musculoskeletal system. The best known substance is hydroxychloroquine, which inhibits the production of alpha IFN. The use of such a tool in the treatment of SLE allows for a long time to reduce the activity of pathology, to alleviate the condition of internal systems and organs. During pregnancy, hydroxychloroquine significantly improves outcomes. The use of the drug prevents thrombosis - a fairly frequent complication of blood vessels. Currently, among other clinical recommendations in the treatment of SLE, antimalarial medicines are one of the basic conditions for the stability of the condition for all patients. However, do not forget about possible side effects. There is a risk of retinopathy, poisoning of the body, which is especially characteristic of individuals with impaired functioning of the liver and kidneys.
Science does not stand still
The previously described is a classic version of the therapeutic course, but do not neglect the new in the treatment of SLE. Now patients are available several targeted funds. The most effective interact with B cells. This is Rituximab, Belimumab.
"Rituximab" contains mouse antibodies that have proven themselves in lymphomas formed by B cells. The substance selectively fights against mature cells of this type, reacts with the protein of the CD20 membrane. Studies have been conducted that showed that the drug is effective in SLE, especially in severe form. They resort to the drug if the symptoms are expressed in the work of the kidneys, circulatory system, there are manifestations on the skin. However, two main controlled trials with random sampling did not confirm the high efficacy of the drug. Currently, Rituximab is not included in the clinical recommendations for the treatment of SLE.
Belimumab has established itself as a more effective and reliable tool. Studies have shown that BAFF / BLYS in blood serum in the case of the disease in question increases when compared with indicators of a healthy person. BAFF is an element of the signaling cascade that triggers autoreactive cell structures. This element determines cell maturation, reproduction, and the generation of immunoglobulin. Belumumab contains antibodies of the same name that bind BAFF to neutralize its effects. As the practice of treating SLE in Israel, America, Europe and Russia has shown, the substance is safe, well tolerated by patients. Events dedicated to determining the quality of Belimumab lasted seven years. It has been established that among the side effects most often is a mild, moderate infection that is not life threatening to the patients. Officially, Belimumab has been the primary treatment for SLE since 1956.
Features and Therapy
Presumably, treatment of SLE directed to the first type of interferon will be effective. A number of antibodies to them have already shown good results in the framework of the tests, but the final testing has yet to be organized. Actively investigated the effectiveness of abatacept. This compound is able to inhibit mutual reactions at the cellular level, due to which immunity tolerance is stabilized. Presumably, in the future, SLE therapy will be practiced with the use of anticytokines - these are currently under development and testing. Of particular interest to the scientific community are the preparations Etanercept, Infliximab.
The market is filled with a variety of tools that are supposedly effective in the treatment of SLE. Reviews of Transfactor, for example, claim that this substance helped put on its feet, completely cure lupus, despite the officially proven incurability of the disease. Before using any generic drugs, non-specific substances and additives, you should consult your doctor. Failure to choose formulations can cause health and life hazards.
Folk remedies
Is it possible to practice the treatment of SLE with folk remedies? Of course, certain approaches have been invented, but you should not expect special effectiveness from them. This is due to the characteristics of the disease, because only the most modern means can cope with disorders at the cellular level, and even those are still not effective enough. Unfortunately, no medicinal herbs and infusions can cure SLE. In agreement with the doctor, some recipes can be used to relieve specific symptoms. The choice should be strictly individual. It always depends on the nuances of the course of the disease.
Sanatorium treatment with SLE at the stage of remission can improve the quality of life of the patient. A full recovery cannot be achieved in this way, but being in comfortable conditions, in an ecologically clean environment with the practice of specific procedures and taking medications recommended by your doctor is the key to improving a person's well-being. A well-chosen sanatorium course will help to consolidate remission.
Pathogenesis
For a long time, scientists did not know what the pathogenesis of SLE is. In recent years, it has been established that there are several mechanisms that trigger the disease. The main factor is the work of immunity, the immune response. When examining patients, approximately 95% of patients manage to identify autoantibodies that attack the body's cells due to their erroneous recognition as foreign structures. Currently, the main cells with which the danger is associated are type B, which produce active autoantibodies. They are indispensable for adaptive immunity, produce signaling cytokines. It is believed that with increased cell activity, SLE develops, since too many autoantibodies are generated that attack the antigens in the blood serum in membranes, cytoplasm, and cell nuclei. This explains the clinical manifestations of SLE. The situation is complicated by the fact that the cells generate inflammatory mediators, transmit data to T-lymphocytes not about foreign structures, but about the elements of their own body.
The pathogenesis of SLE has two aspects: active lymphocytic apoptosis, decreased quality of processing of autophagy by-products. This stimulates an immune response directed to the cells of your body.
Where the trouble comes from
Despite the refinement of the pathogenesis, at present it has not been possible to determine precisely for what reasons SLE begins. It is believed that the disease is multifactorial, appears with the complex influence of several aspects.
Scientists are particularly interested in heredity as an impetus for the development of SLE. In many respects, the variability in ethnic, gender affiliation indicates the relevance of this aspect. It has been established that among women, SLE occurs up to ten times more often than in men, and the peak incidence is the age group of 15-40 years, that is, the entire reproductive period.
Ethnicity, as can be seen from the statistics, determines the severity of the course, the prevalence of the disease, the likelihood of death. A butterfly-like rash is a fairly common manifestation in white-skinned patients. In dark-skinned people, a severe course with a tendency to frequent relapses is more often diagnosed. Afro-Caribbean, African-American more often than others, SLE disrupts the functioning of the kidneys. The discoid form is wider among black people.
Statistics suggest that heredity and genetic characteristics are an important factor in the etiology of SLE.
Difficulties in the development of drugs
To confirm the theory of genetic predisposition, a method of genome-wide associative search was developed and applied, within which thousands of variants of genomes and phenotypes are compared. The information of patients with SLE is investigated. This technology allowed the identification of 60 loci, divided into several categories. Some are associated with congenital features, others are genetic factors that affect adaptive immunity. It has been established that an impressive percentage of loci is characteristic not only of SLE, but also of other autoimmune diseases.
It is assumed that data on human genetics can be used to identify the level of risk of developing SLE. Perhaps genetic information in the future will simplify the diagnosis of the disease and help to more effectively choose methods of treatment. The specificity of the disease is such that initial complaints rarely help to establish an accurate diagnosis, so a lot of time is lost. Choosing an appropriate therapeutic course is also rarely successful the first time, because the variability of responses to different drugs is too great.
Today, genetic tests have not yet found application in clinical practice - they have yet to be finalized and made more accessible. Forming a predisposition model, it is necessary to take into account the characteristics of genes, mutual reactions, the number of cytokines, markers, and other indicators. In addition, the model should include an analysis of epigenetic features.
Provocative factors
Presumably, ultraviolet radiation affects the development of SLE. The light of our luminary often provokes rashes, redness. Probably infection plays a role. There is a theory that explains autoimmune responses to viral mimicry. Perhaps the provocateurs are not specific viruses, but the features of a typical method of controlling an organism against invasion.
It was not possible to formulate exactly whether smoking and drinking influence the likelihood of developing SLE. The first, perhaps, increases the danger, the second, as can be seen from some studies, reduces it, but there is no confirmed information.
Case clarification
As indicated above, SLE has no specific signs. If the patient's condition is difficult to explain with other reasons, there is a suspicion of lupus. The patient is sent for laboratory blood tests, determination of antinuclear bodies, LE cells. If the tests show the presence of antibodies to DNA, the diagnosis is considered confirmed.