Systemic Lupus Erythematosis
• Systemic-affects many organs
• Lupus- the classic rash can actually give a severe red scaly facial appearance called lupine or wolf like
• Erythematosis-refers to the general redness of the rash of the face and body
SLE is an autoimmune disease where the immune system attacks the bodies own tissues resulting in inflammation and damage. It affects about 4000 Australians with one being diagnosed every day. Any part of the body can be affected, especially the skin, kidneys and joints. 90% of patients are women and this is thought to reflect the hormonal influence of the disease. There is a 4X risk of SLE for women when a first degree relative is affected.
Symptoms
Most commonly a woman presents to the doctor with joint problems, skin rash and general symptoms of tiredness. Commonly there is a history of autoimmune disease in the family and a blood test called an ANA test is then ordered to try to confirm the likelihood of the illness.
There are numerous other symptoms of SLE which include:
• Cheek rash
• Ring shaped rash on the body
• sensitivity to UV light
• arthritis
• mouth ulcers
• inflammation of lungs, heart, kidney
• Seizures, personality change
• Blood related abnormalities
Treatment
This of course depends on the symptoms present. All patients need to be educated about their illness and the need for avoidance of sunlight with regular sunscreen and other measures. Due to the risk of cardiac inflammation all patients need to have cardiovascular risk factors aggressively reduced by treating weight excess, high blood pressure and cholesterol in particular. Rashes are treated with steroid cream but in more severe cases may require oral treatment.
With joint problems specialist intervention is often needed and with other severe symptoms contribution by renal, cardiac and dermatological specialists is normal. Steroids and immunosuppressants are the main treatment options.
Drug Induced SLE
Numerous drugs have been shown to induce Lupus symptoms such as minocycline the common antibiotic used for acne. It will resolve with stopping the offending drug.
Pregnancy and Lupus
Generally speaking the main risk of SLE and pregnancy is the higher risk of miscarriage. 20% will not reach 40 weeks or will have a complication. Pregnancy is best when planned in a stable patient. There seems to be no increased risk of having SLE flare ups during pregnancy and most drugs can be continued.
Some tests in the mother (anti Ro/La antibodies) can predict the likelihood of complications in the baby such as neonatal lupus syndrome (rash, hepatitis and abnormal heart rate) with a mortality rate of 25-30%. Testing for anticardiolipin or lupus anticoagulant in a woman can also detect a syndrome called the antiphospholipid syndrome. When found in SLE a positive test can be associated with thrombosis and increased rate of miscarriage.
Patients can be treated with low dose aspirin and heparin to maintain a viable pregnancy in 70% of women who have previously suffered a miscarriage for this reason. Also these women should not ever be prescribed the oral contraceptive pill or other hormonal contraceptives because of the much greater risk of blood clots. It is important to note that not only SLE patients can have the antiphospholipid syndrome which is a contributor to stroke. DVT and miscarriage in people under 45.
Further information: www.lupusnsw.org.au
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