Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects multiple organs and tissues in the body. Autoimmune diseases occur when the immune system mistakenly attacks its own cells, causing inflammation and damage. SLE can affect the skin, joints, kidneys, brain, heart, lungs, blood vessels, and other parts of the body.

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What causes SLE?

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The exact cause of SLE is unknown, but it is believed to be influenced by a combination of genetic, environmental, and hormonal factors. Some people may have a genetic predisposition to develop SLE, which may be triggered by certain infections, drugs, sunlight, or other factors. SLE is more common in women than in men, and it usually develops between the ages of 15 and 45.

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What are the signs and symptoms of SLE?

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The signs and symptoms of SLE vary from person to person and may change over time. Some of the most common signs and symptoms include:

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• Fatigue
• Fever
• Joint pain, stiffness, and swelling
• A butterfly-shaped rash on the face or rashes elsewhere on the body
• Skin lesions that worsen with sun exposure
• Fingers and toes that turn white or blue in cold or stress (Raynaud's phenomenon)
• Shortness of breath
• Chest pain
• Dry eyes
• Headaches, confusion, and memory loss

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SLE is characterised by periods of flares, when the symptoms worsen, and remissions when the symptoms improve or disappear. The frequency and severity of flares and remissions vary from person to person.

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How is SLE diagnosed?

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SLE can be difficult to diagnose because its signs and symptoms mimic those of other diseases. There is no single test that can definitively diagnose SLE, but a combination of clinical criteria and laboratory tests can help confirm the diagnosis. Some of the criteria and tests used to diagnose SLE are:

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• The American College of Rheumatology (ACR) criteria: A set of 11 criteria that include clinical manifestations (such as rash, arthritis, oral ulcers) and laboratory findings (such as positive antinuclear antibody test, low blood cell counts). A person needs to have at least four of these criteria to be diagnosed with SLE.

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• The Systemic Lupus International Collaborating Clinics (SLICC) criteria: A newer set of criteria that include more specific clinical manifestations (such as lupus nephritis, neuropsychiatric lupus) and laboratory findings (such as low complement levels, positive anti-dsDNA test). A person needs to have at least four of these criteria with at least one clinical criterion and one immunologic criterion to be diagnosed with SLE.

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• The antinuclear antibody (ANA) test: A blood test that detects antibodies that bind to the nucleus of cells. ANA is present in about 95% of people with SLE, but it can also be found in people with other autoimmune diseases or healthy people. Therefore, a positive ANA test alone is not sufficient to diagnose SLE.
• Other antibody tests: Blood tests that detect specific antibodies that are associated with SLE, such as anti-dsDNA, anti-Sm, anti-RNP, anti-Ro, and anti-La. These antibodies are more specific for SLE than ANA, but they are not present in all people with SLE.

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• Other blood tests: Blood tests that measure the levels of blood cells (such as red blood cells, white blood cells, and platelets), inflammation markers (such as erythrocyte sedimentation rate and C-reactive protein), kidney function (such as creatinine and urea), liver function (such as alanine aminotransferase and aspartate aminotransferase) and complement components (such as C3 and C4). These tests can help assess the extent of organ involvement and disease activity in SLE.

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• Urinalysis: A urine test that detects protein, blood, or cellular casts in the urine. These findings can indicate kidney damage due to SLE.

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• Biopsy: A procedure that involves taking a small sample of tissue from an affected organ (such as skin, kidney, or brain) and examining it under a microscope. A biopsy can help confirm the diagnosis of SLE and determine the type and severity of organ damage.

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How is SLE treated?

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There is no cure for SLE, but treatments can help control the symptoms, prevent flares, reduce organ damage, and improve quality of life. The treatment of SLE depends on the type and severity of symptoms, the organ involvement, and the response to previous treatments. Some of the common treatments for SLE are:

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• Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications that reduce pain and inflammation in the joints and muscles. Examples include ibuprofen, naproxen, and celecoxib.
• Antimalarials: Medications that were originally used to treat malaria, but have been found to be effective in treating skin rashes, joint pain, fatigue, and preventing flares in SLE. Examples include hydroxychloroquine and chloroquine.
• Corticosteroids: Medications that suppress the immune system and reduce inflammation in various organs. Examples include prednisone, methylprednisolone, and dexamethasone. Corticosteroids can be taken orally, injected, or applied topically, depending on the site of inflammation.
• Immunosuppressants: Medications that inhibit the immune system and prevent it from attacking the body's own tissues. Examples include azathioprine, methotrexate, cyclophosphamide, and mycophenolate mofetil. Immunosuppressants are usually used for severe cases of SLE or when corticosteroids are not effective or cause serious side effects.
• Biologics: Medications that target specific molecules or cells involved in the immune response. Examples include belimumab, which blocks a protein called B-lymphocyte stimulator (BLyS) that promotes the survival of B cells that produce antibodies; and rituximab, which depletes B cells from the blood. Biologics are usually used for refractory cases of SLE or when other treatments fail or cause serious side effects.

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How can I live well with SLE?

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Living with SLE can be challenging, but there are ways to cope with the disease and improve your well-being. Some of the strategies to live well with SLE are:

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• Follow your treatment plan: Take your medications as prescribed by your doctor, and report any side effects or changes in your symptoms. Do not stop or change your medications without consulting your doctor.
• Monitor your health: Keep track of your symptoms, flares, blood tests, and other health indicators. This can help you and your doctor adjust your treatment plan as needed.
• Seek support: Join a support group, talk to a counsellor or therapist, or reach out to your family and friends for emotional support. You are not alone in your journey with SLE.
• Educate yourself: Learn more about SLE, its causes, symptoms, complications, and treatments. This can help you understand your condition better and make informed decisions about your health care.
• Adopt a healthy lifestyle: Eat a balanced diet, exercise regularly, get enough sleep, manage stress, quit smoking, and limit alcohol consumption. These habits can help boost your immune system, reduce inflammation, prevent infections, and improve your mood.
• Protect yourself from the sun: Wear sunscreen, sunglasses, hats, and clothing that covers your skin when you go outside. Avoid sun exposure during peak hours (10 a.m. to 4 p.m.). Sunlight can trigger or worsen skin rashes and other symptoms of SLE.
• Prevent infections: Wash your hands frequently, avoid contact with sick people, get vaccinated as recommended by your doctor, and take antibiotics as prescribed if you have an infection. Infections can trigger or worsen flares of SLE.

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Sources

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[1] CDC. Systemic Lupus Erythematosus (SLE). https://www.cdc.gov/lupus/facts/detailed.html

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[2] Mayo Clinic. Lupus - Symptoms & causes. https://www.mayoclinic.org/diseases-conditions/lupus/symptoms-causes/syc-20365789