Is It Systemic Lupus Erythematosus (SLE) or Another Type?
Lupus is a chronic autoimmune disease, in which the body produces proteins called autoantibodies, which attack the body’s own cells and tissues. The resulting inflammation can lead to arthritis and rash, among other symptoms, and can damage organs such as the kidneys, heart, and brain. () Up to 1.5 million Americans may have lupus. () It is most commonly diagnosed in women of childbearing age, although men can also develop the disease. (3)
About 70 percent of people diagnosed with lupus have what is called systemic lupus erythematosus, although several other subtypes exist. (4) Here are some of the most important differences between the types of the disease.
Systemic Lupus Erythematosus
Systemic lupus erythematosus, or SLE, can potentially affect the whole body. But not all tissues and organs are affected in every individual. “No two patients are the same,” says Stuart D. Kaplan, MD, the chief of rheumatology at South Nassau Communities Hospital in Oceanside, New York. Some people may have mild disease, while other have more severe lupus.
Common SLE Symptoms
Common systemic lupus erythematosus symptoms include a rash, arthritis, fever, and fatigue, says Roberto Caricchio, MD, the interim section chief of rheumatology at Temple University Hospital and the director of the Temple Lupus Clinic at the Lewis Katz School of Medicine in Philadelphia.
Headaches and sun sensitivity are other common symptoms. People with lupus may also have anemia (low red blood cell count) and a condition called edema (swelling of the hands, arms, feet, legs, and around the eyes). (5,6)
More serious complications can include:
How Doctors Test for It
Rheumatologists use various laboratory tests and criteria to diagnose systemic lupus erythematosus and prescribe a personalized medication regimen based the patient’s symptoms, says Dr. Caricchio.
Systemic Lupus Erythematosus Treatment
Medications can include nonsteroidal anti-inflammatory drugs, or NSAIDs, corticosteroids, antimalarial drugs such as hydroxychloroquine, which may modulate the immune system, says Dr. Kaplan.
Belimumab, a targeted drug, and chemotherapy, which can suppress the immune system, are among other medications used to treat systemic lupus erythematosus, says Caricchio.
With proper management, up to 90 percent of patients will have a normal life expectancy, according to the Lupus Foundation of America. (7)
It’s important for people living with systemic lupus erythematosus to know that they can maintain a good quality of life.
“What I tell patients is that my job is to help them get to the place where they can participate in the activities they like,” says Stacy Ardoin, MD, a rheumatologist at the Ohio State University Wexner Medical Center in Columbus. In addition to recommending that patients regularly visit their rheumatologist to manage the disease, she encourages them to get enough sleep and to exercise regularly — at least 150 minutes per week — which can help boost heart health as well as mental health.
Cutaneous Lupus Erythematosus
About 10 percent of lupus patients have a subtype called cutaneous lupus erythematosus, which develops as a skin rash.
It’s important to know that some people with this subtype of lupus do go on to develop systemic lupus erythematosus. It happens in about 10 percent of people with cutaneous lupus erythematosus. (8) And experts suspect this is the natural progression of some variants of the disease (meaning there’s not much you can do to stop that from happening). If you do have cutaneous lupus erythematosus it is important to see your doctor regularly and adhere to any treatment instructions, Caricchio notes, so that treatment can be altered as necessary (and as early as possible) to identify and manage symptoms that do progress.
A common variation of cutaneous lupus is discoid lupus, which refers to the appearance of a round, raised, red, and scaly rash that does not itch. The rash typically appears on the face and scalp and can cause scaring and hair loss.
“A dermatologist typically manages discoid lupus,” says Caricchio. Patients with this type of lupus also need to be carefully monitored for the development of systemic disease, according to a paper first published online February 1, 2019, in Clinical Rheumatology. (9)
Treatment for cutaneous lupus erythematosus can include topical steroids or steroids or antimalarial drugs injected directly into rash lesions. (10) Topical creams containing Prograf (tacrolimus) or Elidel (pimecrolimus) that modulate the skin’s immune response, may also help manage discoid lupus. (11) Oral thalidomide, which affects the immune response, may be an effective treatment in severe cases, says Caricchio. People with discoid lupus have a good life expectancy.
Subacute Cutaneous Lupus Erythematosus
Subacute cutaneous lupus erythematosus is another form of cutaneous erythematosus. The skin rash is red and scaly or can appear with ringed edges. Patients can have organ involvement such as fluid around the heart and lungs, but this is generally milder than with systemic lupus erythematosus, says Caricchio.
The same topical remedies used for discoid lupus tend to be used to manage subacute cutaneous lupus erythematosus. People with subacute cutaneous lupus erythematosus usually have a good prognosis, but they need to be monitored for problems with their organs. ()
Because both forms of cutaneous lupus can be aggravated by sunlight, patients also need to avoid sun exposure.
Drug-Induced Lupus Erythematosus
Some drugs can cause lupus, resulting in symptoms such as rash, joint pain and inflammation, hair loss, and fever. This form of lupus, called drug-induced lupus erythematosus (an overreaction to the medication) is temporary. Typically, symptoms appear after a drug is taken for three to six months. (13,14)
“Lab tests can often confirm the diagnosis,” says Caricchio, adding that once medications are discontinued, the symptoms usually go away. Patients usually make a full recovery. ()
The most common medications that cause the condition are isoniazid (an antibiotic used to treat tuberculosis), hydralazine (used for high blood pressure), andprocainamide (a drug prescribed for heart rhythm problems). Other drugs that may lead to drug-induced lupus include the acne medication minocycline and some antiseizure medications, Dr. Ardoin adds.
If symptoms persist, doctors may prescribe, NSAIDs for arthritis, steroid creams to treat skin rashes, and antimalarial drugs to treat skin and arthritis.
More rarely, doctors will prescribe high doses of corticosteroids and immunosuppressants if drug-induced lupus erythematous is causing nephritis or inflammation around the heart or lungs. Physicians may also recommend avoiding sun exposure, which can exacerbate symptoms.
Neonatal lupus is a condition resulting from autoantibodies passing from a pregnant woman who has lupus or a related condition through the placenta and to the baby developing in the womb, explains Virginia Pascual, MD, the director of the Drukier Institute for Children’s Health at Weill Cornell Medicine in New York City. Not all pregnancies in women with lupus or a related condition, though, will necessarily result in a baby being born with neonatal lupus.
The symptoms newborns with neonatal lupus experience, such as decreased platelets and rash, are temporary. However, a rare condition called heart block, or abnormal heart rhythm, can result in heart problems or even death, Dr. Pascual says.
Doctors don’t know how to prevent neonatal lupus, but if you do have lupus and get pregnant, Kaplan suggests seeing a high-risk maternal-fetal medicine specialist to help monitor your risk through your pregnancy. Your doctor should order a fetal echocardiogram 18 to 24 weeks into your pregnancy to detect a heart block (which can be treated with a pacemaker implanted in utero or at birth), Kaplan explains.
Video: Systemic lupus erythematosus (SLE) - causes, symptoms, diagnosis & pathology
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