Systemic Lupus Erythematosus (SLE) Disease

Lupus may sound familiar to you if you heard about Selena Gomez, an American celebrity who has been very vocal about her battle with this disease. Lupus is not widely known to common folk; therefore, her condition has helped raise much-needed awareness.

What is Systemic Lupus Erythematosus (SLE)?

Systemic lupus erythematosus (SLE) is the most prevalent type of lupus. SLE disease is an autoimmune disorder characterised by the immune system attacking its tissues, leading to widespread inflammation and tissue damage in the impacted organs. It can impact the joints, skin, brain, lungs, kidneys, and blood vessels.

What are the symptoms?

Individuals with SLE may encounter various symptoms, with skin symptoms being among the most common:

• Rashes across cheeks (butterfly rash)
• Arthritis
• Photosensitivity (sensitivity to light)
• Swollen glands 
• Hair loss 
• Painless sores in the mouth and nose 
• Fever 
• Seizure 
• Fatigue
• Raynaud's phenomenon - fingers and toes become white/pale or blue-purplish

Some adults may have a period of SLE symptoms—named flares—which may occur every so often, with years between occurrences, and may subside at times, known as remission. However, other adults may go through SLE flares more often throughout their lives.

What are the causes or risk factors?

• Gender: Although anyone can develop lupus, it more often affects women. Women have a significantly higher likelihood, about nine to ten times, of developing systemic lupus erythematosus compared to men.
• Environmental triggers: Exposure to environmental factors, such as viral infections, sunlight, specific medications, and smoking, may initiate lupus in susceptible individuals.
• Genetics: Relatives of individuals with lupus have a higher chance of developing lupus.

How is SLE diagnosed?

Diagnosing SLE can be challenging because its symptoms often mimic those of other conditions, and they can vary widely from person to person. The diagnosis is usually based on a combination of clinical symptoms and laboratory tests. 

Antinuclear Antibody (ANA) test

ANA test is the most common initial test for lupus. A positive ANA test indicates that the immune system is producing antibodies that attack the body's own tissues. However, a positive ANA alone is not definitive for lupus, as it can occur in other autoimmune diseases or even in healthy individuals.

Specific autoantibody tests

Tests for specific autoantibodies, such as anti-double-stranded DNA (anti-dsDNA) and anti-Smith (anti-Sm) antibodies, can help confirm a lupus diagnosis, as these are more specific to the disease.

Complement protein level test

Low levels of complement proteins (C3, C4) in the blood may indicate lupus, as they are often consumed during immune responses.

Blood count and urinalysis

A complete blood count (CBC) may reveal anaemia, low white blood cell count, or low platelet count. Urinalysis can detect blood or protein in the urine, which may indicate kidney involvement (lupus nephritis).

There is a chance for SLE to be misdiagnosed if only a blood test is used for diagnosis. Due to how challenging the diagnosis can be, it is crucial to consult a rheumatologist for an accurate diagnosis. Rheumatologists use specific criteria to classify SLE for research purposes at times.

How is SLE treated?

Although SLE cannot be cured, it can be treated. The treatment of SLE is highly individualised and focuses on managing symptoms, preventing flare-ups, and minimising organ damage.

Since lupus can affect different parts of the body, treatment plans are tailored to the specific needs and symptoms of each patient.

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications are taken to relieve pain, swelling, and fever associated with lupus.
• Corticosteroids: These are anti-inflammatory drugs used to reduce inflammation and immune activity. They are often prescribed in higher doses during severe flare-ups and tapered down as symptoms improve.
• Immunosuppressants: These are medications that suppress the immune system that are taken for individuals with serious lupus affecting the nervous system, kidney, or other organs. They may also be taken if corticosteroids do not improve the condition, or if symptoms worsen when corticosteroids are stopped.

What are the potential complications?

Common complications linked to SLE include:

• Lupus nephritis 
• Blood clots
• Anaemia
• Damage to lung tissue 
• Skin scarring
• Joint deformities
• Severely low platelet count
• Inflammation of the intestines 
• Inflammation of blood vessels 
• Stroke
• Inflammation of the heart, increased risk of cardiovascular disease
• Pregnancy complications

How to prevent an SLE flare?

• Sun protection: It is crucial to protect yourself from the sun as exposure to ultraviolet (UV) light can lead to or worsen lupus symptoms. Wear sunscreen and avoid being exposed to the sun directly if possible. 

• Diet and nutrition: Most individuals with lupus do not need a special diet but should strive to consume a well-balanced diet. A well-balanced diet is low in fat, high in fruits, vegetables, and whole grains, and involves an average amount of meat, poultry, and fish. Consult your doctor and determine whether your diet modification is necessary. 

• Exercise: It can be tough to exercise when your lupus leads to fatigue and other symptoms like breathing problems. However, you can lose muscle strength if you are constantly inactive, which can demotivate you in the long run. You can engage in small amounts of gentle movement that can be good for your health. Activities that are of lower impact and lead to strengthening and stretching of muscles are preferred, which include walking, tai chi, yoga, Pilates, low-impact aerobics, and swimming. 

• Avoid smoking: Cigarette smoking has been linked to symptom flare ups in individuals with lupus and comes with various negative health issues. Quitting smoking is a challenge, but your doctor can help you overcome this. 

• Be aware of possible medication allergy: Allergies to antibiotics are more prevalent in individuals with lupus, especially antibiotics that contain sulfonamide. Ensure that any doctor treating you for a medical condition is aware of your lupus, so they can prescribe appropriate medication.

Make an appointment at Pantai Hospitals

If you or a loved one is living with SLE, it is important to take steps in managing the disease. Remember, you are not alone. 

A dedicated and expert team of rheumatologists at Pantai Hospitals is available for consultation to provide the best care and assistance. Get in touch with us to today if you have concerns or questions regarding SLE. We assure you the best possible care tailored to your specific needs.

Pantai Hospitals have been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.