You can have lupus without a rash

Systemic lupus erythematosus (SLE)

overview

Systemic lupus erythematosus (SLE) is a worldwide disease that occurs in all ethnic groups. Its frequency is 1: 2000-1: 5000 (one sick person in two to five thousand people). Women are about nine times more likely to be affected than men. Most often the disease begins between the ages of 15 and 50. Patients of African descent are about five times more likely to be ill than Europeans.

General properties

In SLE, the body's own immune system attacks various organs of the body for unknown reasons. This causes inflammation in these organs, which is responsible for the symptoms.

Scientists have already identified some possible triggering or contributing factors, but in most cases the cause cannot be precisely identified. SLE is not a hereditary disease, but certain hereditary factors can promote the development of the disease (such as the inherited inability to function of a protein in the blood called C1 complement, which plays an important role in the immune system). Female sex hormones also seem to play a role in the development of the disease, e.g. B. some hormonal contraceptives, d. H. "the pill". It is therefore important that SLE patients refrain from using hormonal contraception. One of the causes is a (possibly banal, unnoticeable) infection, such as Pfeiffer's glandular fever. It is therefore particularly important for SLE patients to avoid infections. Light, especially ultraviolet light, almost always worsens the disease. Therefore, patients should protect themselves from the sun and avoid going to the solarium.

Due to the derailment of the immune response to an infection, the immune system produces antibodies against the body's own proteins, which bind to one another, so that so-called immune complexes are formed. These are distributed throughout the body via the bloodstream and can be deposited in organs that are well supplied with blood. The result is inflammation in these organs and possibly a functional impairment.

Symptoms

There can be very different courses in SLE. Not every patient gets all of the symptoms, and certainly not all of them at once and immediately.

Typically, patients feel tired, have a slight fever, unexplained weight loss, slight hair loss, and swelling of the lymph glands. You suddenly become sensitive to the sun and develop organ symptoms as follows:

Butterfly-shaped reddening of the cheeks and nose is typical for the skin of SLE patients. Scaling and small wounds are common side effects. As a rule, the skin changes heal without a trace, but rarely the skin can also change with scarring. Often the skin symptoms only appear about 2-3 weeks (!) After exposure to the sun, which is why many patients do not notice the connection to sunlight. The redness can also appear in other areas exposed to light (e.g. on the chest, on the back of the hands and on the fingers). The red discoloration of the nail folds is particularly typical. When exposed to cold, the small finger vessels can become painful and narrow, with some or all of the fingers suddenly turning white; this so-called Raynaud phenomenon also occurs in other diseases and even in healthy people.

Small redness or ulcers may appear on the lining of the mouth.

You can find pictures of changes in the skin and mucous membranes on the DermIS.net website.

Joint and muscle pain, or joint swelling, occurs in most patients. The pain can be caused by inflammation of the joints, tendons and muscles. The joints of the fingers, hands and knees are most frequently affected.

A decrease in various cells and the appearance of certain antibodies (the so-called antinuclear antibodies, abbreviated to ANA) may occur in the blood. On the lungs, pleurisy or, more rarely, pneumonia ("lupus pneumonia") can develop due to the inflammation of small vessels.

The heart is also sometimes affected. For example, an inflammation of the pericardium can occur, in which fluid accumulates between the heart muscle and the pericardium, and in rare cases the heart valves can also be destroyed.

The kidneys are often involved and, if left untreated, the inflammation can soon lead to impaired kidney function, ultimately to kidney failure and requiring dialysis. Early detection, regular medical check-ups and compliance with the prescribed therapy are therefore important.

The nervous system can also be affected; the most common symptoms include: Depression, difficulty concentrating, seizures, or impaired sensation.

Both SLE and its treatment can be dangerous to the mother and her fruit during pregnancy. Pregnancy in patients with SLE must be planned very carefully and the mother should be cared for by a specialist who is experienced with the disease. This is especially true if the patient has Ro / SS-A autoantibodies in the blood which can cause dangerous cardiac arrhythmias in the fetus during pregnancy.

Diagnosis

Diagnosis and treatment have to happen quickly, which is why an in-patient clarification is required. Usually a careful physical examination is started, after which blood is drawn, urine is collected, X-rays of the chest and joints are made, an EKG is carried out, a skin sample is taken, ultrasound examinations (abdomen, heart) and, if necessary, other examinations (such as light testing, neurological tests) Special examinations) carried out.

therapy

If left untreated, the disease can be very severe and even life-threatening. Today, however, the treatment options are so good that a patient who follows the advice of doctors can usually lead a normal life and not face life-threatening consequences.

In the beginning, the disease almost always has to be treated with medication, later (after years) the SLE “burns out” and less and less therapy is necessary, in the end it can usually be dispensed with. The course of SLE is very individual, the activity very variable, the relapses of disease and the involvement of the organs unpredictable and fateful. That is why the therapy is completely individual and there is no uniform scheme. In general, anti-inflammatory drugs (systemic glucocorticosteroids or "cortisone supplements"), antimalarials, and / or immunosuppressants (azathioprine, cyclophosphamide, cyclosporine, etc.) are prescribed to eliminate the excessive, overreacting autoimmune response.

prevention

A very important, therapeutic and preventive measure is consistent light protection. First and foremost, situations with intense sunshine (e.g. holidays by the sea, excursions in summer without shade, boat trips) should be avoided. Second, adequate sun protection should be provided by wearing appropriate clothing (cap or hat and closed clothing both in winter and in summer), and thirdly with absolutely sun-blocking sun creams (e.g. above a sun protection factor of 30) that should also be water-resistant if possible.

Please don't forget that the sun shines during the day even when the sky is overcast (that's why it's light outside)! The solar radiation is of course much weaker in cloudy weather than in clear skies, but scientific studies have shown that in clear skies 3 minutes, and in cloudy skies 10 minutes are enough to activate the symptoms of SLE within 2-3 weeks. The windows of the apartment, office or car allow relatively little ultraviolet light through, but with SLE the light sensitivity is usually so strong that even this small amount of radiation can have a disease-activating effect.

Certain medications, especially the estrogen-containing pill, SLE inducers, and light sensitivity inducers should be avoided.