Systemic Lupus Erythematosus (SLE): Information & Specialists

Systemic lupus erythematosus (SLE) is an autoimmune disease. These are diseases in which the immune system attacks the body’s own tissues. The body’s immune system includes lymphocytes and antibodies. These antibodies directed against the body itself (autoantibodies) primarily react with the nuclei of organ cells. They are therefore also referred to as antinuclear antibodies (ANA).

The autoantibodies travel through the bloodstream to all parts of the body. As a result, they can cause inflammation and damage in virtually all organs. In some cases, SLE is limited to the skin. More commonly, however, it also affects internal organs (systemic or visceral lupus).

SLE can occur at any age. However, young women between the ages of 16 and 40 are particularly affected. At this age, the female body produces sex hormones at particularly high levels. These hormones apparently facilitate the development of SLE.

Ultimately, the exact cause of SLE is unknown. It is likely that various factors interact.

Genetic predisposition and female hormones are considered contributing factors. Triggers include

• physical and psychological stress,
• infectious diseases,
• sunlight,
• pregnancy, and
• medications.

The inflammation occurring in the body leads to general symptoms of illness such as

• fever,
• fatigue, and
• exhaustion.

In addition, there are symptoms caused by the involvement of specific organs. These are listed below.

Skin:

• Redness and a burning sensation on the skin, often on the face, particularly on the cheeks and nose (butterfly rash),
• frequent sensitivity of the skin to sunlight,
• frequent hair loss

Joints:

• Joint pain and
• joint inflammation (arthritis)

Muscles:

• Muscle pain,
• rarely also muscle inflammation

Kidneys:

Mild kidney pain; usually, the patient does not feel the kidney inflammation! A urine test for red blood cells (erythrocytes) and protein is important

Lungs:

Pleurisy (pain when breathing)

Heart:

• Cardiac arrhythmias,
• pericarditis,
• Myocarditis, etc.

Central Nervous System (CNS):

• Migraine,
• word-finding difficulties,
• depression,
• Aggression ranging up to psychosis,
• Seizures

Blood vessels:

• Often a sudden blanching of the fingers (Raynaud’s),
• more rarely, inflammation of the blood vessels (vasculitis), usually affecting the fingers and causing skin hemorrhages

Blood: Decrease

• in white blood cells (leukocytes),
• red blood cells (erythrocytes), and
• platelets (thrombocytes).

Patients often do not notice these changes. However, they become apparent during a blood count as abnormalities in blood clotting, leading to an increased incidence of thrombosis.

In some cases, inflammation of the salivary and lacrimal glands (Sjögren’s syndrome) may also occur.

As a rule, a patient exhibits only some of these possible symptoms (e.g., skin and joints).

SLE usually progresses in flare-ups, with each flare-up lasting from a few weeks to several months. Between flare-ups, some patients are completely symptom-free. Others still have mild symptoms, such as reduced physical performance and joint pain. SLE is constantly active in only a few patients.

Some patients have more severe symptoms. Although skin inflammation and joint pain are very uncomfortable, they are not life-threatening.

Others may have few symptoms but are at high risk. This applies, for example, to patients with kidney inflammation. The kidneys are vital organs, so in rare cases, SLE can be life-threatening.

In most cases, SLE continues to progress in the way each individual experiences it. Patients can expect that, in the event of another flare-up, the same organs will be affected.

The intensity of the disease decreases over the years; flare-ups become less frequent and less severe.

There are two main forms of treatment:

• acute drug therapy during an active flare-up, and
• prophylaxis (prevention), which is intended to prevent another flare-up.

Drug therapy for systemic lupus erythematosus

Drug therapy aims to

• relieve the patient’s symptoms—for example, with a medication for joint pain—and
• regulate the disease so that the immune system, which has become unbalanced, returns to equilibrium.

In very mild cases, treatment with an antirheumatic drug is sufficient. However, cortisone is often required. The dose is higher during a flare-up and can be reduced afterward. If possible, cortisone is eventually discontinued entirely. If the patient benefits from it, they are often given a low maintenance dose.

Other medications used include:

• antimalarial drugs (e.g., Resochin®), which are used particularly for skin and joint inflammation, as well as
• immunosuppressants, which are intended to suppress the malfunctioning immune system.

The best-known are Imurek® and Endoxan®. Whether they are used depends on the inflammatory activity of the SLE and the severity of organ involvement. Gold and Azulfidine®, which are effective for chronic polyarthritis, must not be taken in cases of SLE.

Measures to Prevent a Recurrence of SLE

Adopting appropriate lifestyle habits can have a positive impact on the course of the disease.

1. Physical and psychological stress

Patients with SLE have a highly unstable immune system that cannot cope with extreme stress. This can trigger new disease flares. Therefore, a moderate lifestyle is of the utmost importance.

This applies to both physical and mental stress. Light physical activity is permitted. Sports that lead to exhaustion are not recommended. Avoid unnecessary conflicts and do not let professional ambition consume you. Find the right balance in all things.

2. Nutrition

The “right balance” applies just as much to your diet. Eat as sparingly as possible. Being overweight is very detrimental. Avoid any one-sided diets; instead, eat as varied a diet as possible.

Too much fruit and salad can also be harmful—eat them in moderation! Consume only as much protein as your body needs. However, there is no specific diet that cures this disease.

3. Infectious Diseases

Infections caused by viruses or bacteria are the most common cause of an SLE flare-up. As far as possible, avoid any situations associated with an increased risk of infection. If you become ill, see a doctor promptly so that a developing infection can be treated.

Certain antibiotics can trigger an SLE flare-up; for example, sulfonamides must not be taken. Therefore, you must not take them. If you are taking cortisone, do not reduce the dose during an infectious illness. It is often even advisable to increase the dose.

4. Sunlight

Sunlight—more specifically, ultraviolet light—can trigger an SLE flare-up. People with sun-sensitive skin are particularly susceptible to this. Therefore, avoid sunlight and protect your skin with special sunscreen. Your doctor can advise you on this.

You should also avoid tanning salons.

5. Pregnancy

SLE can worsen during pregnancy. Women with SLE are also more likely to experience miscarriages and premature births than healthy women. However, the risk of birth defects is not higher.

Do not plan a pregnancy until the disease has been inactive for at least 6 months. You should also take only a low dose of corticosteroids. For patients who have gone through a severe phase of organ involvement—such as kidney involvement—the SLE should have been in remission for at least 1 to 2 years.

6. Birth Control

Certain female sex hormones (estrogens) can exacerbate SLE. When choosing birth control pills, therefore, opt for progestin-only formulations without estrogens (the so-called “mini-pill”).

You can also use other methods of contraception. However, with the IUD, keep in mind that inflammation can occur more frequently.

7. Surgery

If you are scheduled for surgery, you must inform the surgeon about your condition and treatment. The surgeon will contact an internist to discuss your medication regimen.