Studies of biochemical blood parameters in lupus erythematosus. Criteria for the diagnosis of systemic lupus erythematosus
Diagnosis of lupus erythematosus
General principles for diagnosing the disease
Diagnosis of systemic lupus erythematosus is exhibited on the basis of special developed diagnostic criteria, proposed by the American Association of Rheumatology or the domestic scientist Nasonova. Next, after making a diagnosis based on diagnostic criteria, additional examinations are performed - laboratory and instrumental, which confirm the correctness of the diagnosis and allow one to assess the degree of activity pathological process and identify affected organs.Currently, the most commonly used diagnostic criteria are American Association rheumatologists, not Nasonova. But we will present both schemes of diagnostic criteria, since in a number of cases domestic doctors use Nasonova’s criteria to diagnose lupus.
American Rheumatology Association Diagnostic Criteria the following:
- Rash in the area of the cheekbones on the face (there are red elements of the rash that are flat or slightly raised above the surface of the skin, spreading to the nasolabial folds);
- Discoid rashes (raised plaques above the surface of the skin with “black dots” in the pores, peeling and atrophic scars);
- Photosensitivity (the appearance of skin rashes after exposure to the sun);
- Ulcers on the oral mucosa (painless ulcerative defects localized on the mucous membrane of the mouth or nasopharynx);
- Arthritis (affecting two or more small joints, characterized by pain, swelling and swelling);
- Polyserositis (pleuritis, pericarditis or non-infectious peritonitis in the present or past);
- Kidney damage (the constant presence of protein in the urine in an amount of more than 0.5 g per day, as well as the constant presence of red blood cells and casts (erythrocyte, hemoglobin, granular, mixed) in the urine);
- Neurological disorders: seizures or psychosis (delusions, hallucinations) not caused by medications, uremia, ketoacidosis or electrolyte imbalance;
- Hematological disorders (hemolytic anemia, leukopenia with the number of leukocytes in the blood less than 1 * 10 9 , lymphopenia with the number of lymphocytes in the blood less than 1.5 * 10 9 , thrombocytopenia with the number of platelets less than 100 * 10 9 );
- Immunological disorders (antibodies to double-stranded DNA in an increased titer, the presence of antibodies to the Sm antigen, a positive LE test, a false-positive Wasserman reaction to syphilis for six months, the presence of an anti-lupus coagulant);
- Increased titer of ANA (antinuclear antibodies) in the blood.
Nasonova's criteria for lupus erythematosus include major and minor diagnostic criteria, which are listed in the table below:
| Large diagnostic criteria | Minor diagnostic criteria |
| "Butterfly on the Face" | Body temperature above 37.5 o C, lasting longer than 7 days |
| Arthritis | Unreasonable weight loss of 5 or more kg in a short period of time and disruption of tissue nutrition |
| Lupus pneumonitis | Capillaritis on the fingers |
| LE cells in the blood (less than 5 per 1000 leukocytes – single, 5 – 10 per 1000 leukocytes – moderate amount, and more than 10 per 1000 leukocytes – a large number) | Skin rashes such as hives or rashes |
| ANF in high credits | Polyserositis (pleurisy and carditis) |
| Werlhoff syndrome | Lymphadenopathy (increased lymphatic ducts and nodes) |
| Coombs-positive hemolytic anemia | Hepatosplenomegaly (enlarged liver and spleen) |
| Lupus jade | Myocarditis |
| Hematoxylin bodies in pieces of tissue from various organs taken during biopsy | CNS damage |
| A characteristic pathomorphological picture in the removed spleen (“bulbous sclerosis”), in skin samples (vasculitis, immunofluorescence of immunoglobulins on the basement membrane) and kidneys (glomerular capillary fibrinoid, hyaline thrombi, “wire loops”) | Polyneuritis |
| Polymyositis and polymyalgia (inflammation and muscle pain) | |
| Polyarthralgia (joint pain) | |
| Raynaud's syndrome | |
| Acceleration of ESR more than 200 mm/hour | |
| Decrease in the number of leukocytes in the blood to less than 4*10 9 /l | |
| Anemia (hemoglobin level below 100 mg/ml) | |
| Decrease in platelet count below 100*10 9 /l | |
| Increase in the amount of globulin proteins by more than 22% | |
| ANF in low credits | |
| Free LE bodies | |
| Positive Wasserman reaction in the confirmed absence of syphilis |
The diagnosis of lupus erythematosus is considered accurate and confirmed when any three major diagnostic criteria are combined, and one of them must be either “butterfly” or LE cells in large quantities, and the other two are any of the above. If a person has only minor diagnostic signs or they are combined with arthritis, then the diagnosis of lupus erythematosus is considered only probable. In this case, data from laboratory tests and additional instrumental examinations are required to confirm it.
The above criteria of Nasonova and the American Association of Rheumatology are the main ones in the diagnosis of lupus erythematosus. This means that the diagnosis of lupus erythematosus is made only on their basis. And any laboratory tests and instrumental examination methods are only additional, allowing one to assess the degree of activity of the process, the number of affected organs and the general condition of the human body. Based only on laboratory tests and instrumental methods examination, the diagnosis of lupus erythematosus is not made.
Currently, ECG, EchoCG, MRI, chest X-ray, ultrasound, etc. can be used as instrumental diagnostic methods for lupus erythematosus. All these methods make it possible to assess the degree and nature of damage in various organs.
Blood (test) for lupus erythematosus
Among the laboratory tests to assess the intensity of the process in lupus erythematosus, the following are used: - Antinuclear factors (ANF) – with lupus erythematosus are found in the blood in high titers no higher than 1: 1000;
- Antibodies to double-stranded DNA (anti-dsDNA-AT) – with lupus erythematosus are found in the blood of 90–98% of patients, but are normally absent;
- Antibodies to histone proteins - in lupus erythematosus are found in the blood, but are normally absent;
- Antibodies to the Sm antigen - with lupus erythematosus are found in the blood, but are normally absent;
- Antibodies to Ro/SS-A - in lupus erythematosus are detected in the blood if there is lymphopenia, thrombocytopenia, photosensitivity, pulmonary fibrosis or Sjögren's syndrome;
- Antibodies to La/SS-B – in lupus erythematosus are detected in the blood under the same conditions as antibodies to Ro/SS-A;
- Complement level – with lupus erythematosus, the level of complement proteins in the blood is reduced;
- The presence of LE cells - with lupus erythematosus they are found in the blood of 80 - 90% of patients, but are normally absent;
- Antibodies to phospholipids (lupus anticoagulant, antibodies to cardiolipin, positive Wasserman test in the confirmed absence of syphilis);
- Antibodies to coagulation factors VIII, IX and XII (normally absent);
- Increased ESR by more than 20 mm/hour;
- Leukopenia (decrease in the level of leukocytes in the blood less than 4 * 10 9 / l);
- Thrombocytopenia (decrease in the level of platelets in the blood less than 100 * 10 9 / l);
- Lymphopenia (decrease in the level of lymphocytes in the blood less than 1.5 * 10 9 / l);
- Increased blood concentrations of seromucoid, sialic acids, fibrin, haptoglobin, C-reactive protein of circulating immune complexes and immunoglobulins.
Diagnosis of lupus erythematosus, tests. How to distinguish lupus erythematosus from psoriasis, eczema, scleroderma, lichen and urticaria (recommendations from a dermatologist) - video
Treatment of systemic lupus erythematosus
General principles of therapy
Because the exact causes of lupus are unknown, there are no treatments that can completely cure the disease. As a result, only pathogenetic therapy, the goal of which is to suppress the inflammatory process, prevent relapses and achieve stable remission. In other words, the treatment of lupus erythematosus is to slow down the progression of the disease as much as possible, lengthen periods of remission and improve a person’s quality of life. The main drugs in the treatment of lupus erythematosus are glucocorticosteroid hormones(Prednisolone, Dexamethasone, etc.), which are used constantly, but depending on the activity of the pathological process and the severity of the person’s general condition, their dosage is changed. The main glucocorticoid in the treatment of lupus is Prednisolone. It is this drug that is the drug of choice, and it is for it that the exact dosages are calculated for various clinical options and activity of the pathological process of the disease. Dosages for all other glucocorticoids are calculated based on the dosages of Prednisolone. The list below shows dosages of other glucocorticoids equivalent to 5 mg Prednisolone:
- Betamethasone – 0.60 mg;
- Hydrocortisone – 20 mg;
- Dexamethasone – 0.75 mg;
- Deflazacort – 6 mg;
- Cortisone – 25 mg;
- Methylprednisolone – 4 mg;
- Paramethasone – 2 mg;
- Prednisone – 5 mg;
- Triamcinolone – 4 mg;
- Flurprednisolone – 1.5 mg.
So, at the first degree of activity pathological process Prednisolone is used in therapeutic dosages of 0.3 – 0.5 mg per 1 kg of body weight per day, at the second degree of activity– 0.7 – 1.0 mg per 1 kg of weight per day, and at the third degree– 1 – 1.5 mg per 1 kg of body weight per day. In the indicated doses, Prednisolone is used for 4 to 8 weeks, and then the dosage of the drug is reduced, but its use is never completely canceled. The dosage is first reduced by 5 mg per week, then by 2.5 mg per week, and after some time by 2.5 mg every 2 to 4 weeks. In total, the dosage is reduced so that 6–9 months after starting Prednisolone, its maintenance dose becomes 12.5–15 mg per day.
During a lupus crisis, involving several organs, glucocorticoids are administered intravenously for 3 to 5 days, after which they switch to taking drugs in tablets.
Since glucocorticoids are the main means of treating lupus, they are prescribed and used without fail, and all other medications are used additionally, selecting them depending on the severity of clinical symptoms and the affected organ.
Thus, with a high degree of activity of lupus erythematosus, with lupus crises, with severe lupus nephritis, with severe damage to the central nervous system, with frequent relapses and instability of remission, in addition to glucocorticoids, cytostatic immunosuppressants are used (Cyclophosphamide, Azathioprine, Cyclosporine, Methotrexate, etc.).
For severe and widespread skin lesions Azathioprine is used at a dosage of 2 mg per 1 kg of body weight per day for 2 months, after which the dose is reduced to a maintenance dose: 0.5 - 1 mg per 1 kg of body weight per day. Azathioprine is taken in a maintenance dosage for several years.
For severe lupus nephritis and pancytopenia(decrease in the total number of platelets, erythrocytes and leukocytes in the blood) use Cyclosporine at a dosage of 3 - 5 mg per 1 kg of body weight.
With proliferative and membranous lupus nephritis, with severe damage to the central nervous system Cyclophosphamide is used, which is administered intravenously at a dosage of 0.5 - 1 g per m2 of body surface once a month for six months. Then, for two years, the drug continues to be administered in the same dosage, but once every three months. Cyclophosphamide ensures the survival of patients suffering from lupus nephritis and helps control clinical symptoms that are not affected by glucocorticoids (CNS damage, pulmonary hemorrhage, pulmonary fibrosis, systemic vasculitis).
If lupus erythematosus does not respond to glucocorticoid therapy, then Methotrexate, Azathioprine or Cyclosporine are used instead.
With low activity of the pathological process with damage skin and joints Aminoquinoline drugs (Chloroquine, Hydroxychloroquine, Plaquenil, Delagil) are used in the treatment of lupus erythematosus. In the first 3 to 4 months, the drugs are used at 400 mg per day, and then at 200 mg per day.
With lupus nephritis and the presence of antiphospholipid bodies in the blood(antibodies to cardiolipin, lupus anticoagulant) drugs from the group of anticoagulants and antiplatelet agents (Aspirin, Curantil, etc.) are used. Mainly used acetylsalicylic acid in small doses – 75 mg per day for a long time.
Medicines from the group of non-steroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen, Nimesulide, Diclofenac, etc., are used as drugs to relieve pain and relieve inflammation in arthritis, bursitis, myalgia, myositis, moderate serositis and fever.
Besides medicines, for the treatment of lupus erythematosus, methods of plasmapheresis, hemosorption and cryoplasmasorption are used, which make it possible to remove antibodies and inflammatory products from the blood, which significantly improves the condition of patients, reduces the degree of activity of the pathological process and reduces the rate of progression of the pathology. However, these methods are only auxiliary, and therefore can only be used in combination with taking medications, and not instead of them.
To treat skin manifestations of lupus, it is necessary to externally use sunscreens with UVA and UVB filters and ointments with topical steroids (Fluorcinolone, Betamethasone, Prednisolone, Mometasone, Clobetasol, etc.).
Currently, in addition to these methods, drugs from the group of tumor necrosis factor blockers (Infliximab, Adalimumab, Etanercept) are used in the treatment of lupus. However, these drugs are used exclusively as a trial, experimental treatment, since today they are not recommended by the Ministry of Health. But the results obtained allow us to consider tumor necrosis factor blockers as promising drugs, since the effectiveness of their use is higher than that of glucocorticoids and immunosuppressants.
In addition to the described drugs used directly for the treatment of lupus erythematosus, this disease requires the use of vitamins, potassium compounds, diuretics and antihypertensive drugs, tranquilizers, antiulcers and other drugs that reduce the severity of clinical symptoms in various organs, as well as restorative normal exchange substances. For lupus erythematosus, you can and should additionally use any drugs that improve general health person.
Drugs for lupus erythematosus
Currently, the following groups of drugs are used to treat lupus erythematosus: - Glucocorticosteroids (Prednisolone, Methylprednisolone, Betamethasone, Dexamethasone, Hydrocortisone, Cortisone, Deflazacort, Paramethasone, Triamcinolone, Flurprednisolone);
- Cytostatic immunosuppressants (Azathioprine, Methotrexate, Cyclophosphamide, Cyclosporine);
- Antimalarial drugs - aminoquinoline derivatives (Chloroquine, Hydroxychloroquine, Plaquenil, Delagil, etc.);
- TNF alpha blockers (Infliximab, Adalimumab, Etanercept);
- Non-steroidal anti-inflammatory drugs (Diclofenac, Nimesulide,
Systemic lupus erythematosus– a chronic systemic disease, with the most pronounced manifestations on the skin; The etiology of lupus erythematosus is unknown, but its pathogenesis is associated with a violation of autoimmune processes, resulting in the production of antibodies to healthy cells body. Middle-aged women are more susceptible to the disease. The incidence of lupus erythematosus is not high - 2-3 cases per thousand people. Treatment and diagnosis of systemic lupus erythematosus is carried out jointly by a rheumatologist and a dermatologist. The diagnosis of SLE is made based on typical clinical signs, laboratory test results.
General information
Systemic lupus erythematosus– a chronic systemic disease, with the most pronounced manifestations on the skin; The etiology of lupus erythematosus is unknown, but its pathogenesis is associated with a violation of autoimmune processes, as a result of which antibodies are produced to healthy cells of the body. Middle-aged women are more susceptible to the disease. The incidence of lupus erythematosus is not high - 2-3 cases per thousand people.
Development and suspected causes of systemic lupus erythematosus
The exact etiology of lupus erythematosus has not been established, but most patients have antibodies to the Epstein-Barr virus, which confirms the possible viral nature diseases. Features of the body that result in the production of autoantibodies are also observed in almost all patients.
The hormonal nature of lupus erythematosus has not been confirmed, but hormonal disorders worsen the course of the disease, although they cannot provoke its occurrence. Women diagnosed with lupus erythematosus are not recommended to take oral contraceptives. In people with a genetic predisposition and in identical twins, the incidence of lupus erythematosus is higher than in other groups.
The pathogenesis of systemic lupus erythematosus is based on a violation of immunoregulation, when protein components of the cell, primarily DNA, act as autoantigens and, as a result of adhesion, even those cells that were initially free from immune complexes become targets.
Clinical picture of systemic lupus erythematosus
Lupus erythematosus affects connective tissue, skin and epithelium. Important diagnostic sign is a symmetrical lesion of large joints, and if joint deformation occurs, it is due to the involvement of ligaments and tendons, and not due to lesions of an erosive nature. Myalgia, pleurisy, pneumonitis are observed.
But the most striking symptoms of lupus erythematosus are observed on the skin, and it is based on these manifestations that the diagnosis is made in the first place.
On initial stages The disease lupus erythematosus is characterized by a continuous course with periodic remissions, but almost always becomes systemic. Erythematous dermatitis of the butterfly type is most often observed on the face - erythema on the cheeks, cheekbones and always on the dorsum of the nose. 
There is hypersensitivity to solar radiation– usually photodermatoses round shape, are multiple in nature. In lupus erythematosus, a feature of photodermatoses is the presence of a hyperemic corolla, an area of atrophy in the center and depigmentation of the affected area. The pityriasis scales that cover the surface of the erythema are tightly fused to the skin and attempts to separate them are very painful. At the stage of atrophy of the affected skin, the formation of a smooth, delicate alabaster-white surface is observed, which gradually replaces the erythematous areas, starting from the middle and moving to the periphery.
In some patients with lupus, the lesions spread to the scalp, causing complete or partial alopecia. If the lesions affect the red border of the lips and the mucous membrane of the mouth, then the lesions are bluish-red dense plaques, sometimes with pityriasis-like scales on top, their contours have clear boundaries, the plaques are prone to ulceration and cause pain while eating.
Lupus erythematosus has a seasonal course, and in the autumn-summer periods the skin condition worsens sharply due to more intense exposure to solar radiation.
In the subacute course of lupus erythematosus, psoriasis-like lesions are observed throughout the body, telangiectasia is pronounced, and livedio reticularis (a tree-like pattern) appears on the skin of the lower extremities. Generalized or alopecia areata, urticaria and skin itching are observed in all patients with systemic lupus erythematosus.
In all organs where there is connective tissue, pathological changes begin over time. With lupus erythematosus, all the membranes of the heart, renal pelvis, gastrointestinal tract and central nervous system are affected.
If, in addition to skin manifestations, patients suffer from periodic headaches, joint pain not related to injuries and weather conditions, there are disturbances in the functioning of the heart and kidneys, then based on the survey we can assume deeper and systemic disorders and examine the patient for the presence of lupus erythematosus. Abrupt change mood from a euphoric state to a state of aggression is also a characteristic manifestation of lupus erythematosus.
In elderly patients with lupus erythematosus skin manifestations, renal and arthralgic syndromes are less pronounced, but Sjogren's syndrome is more often observed - this is an autoimmune lesion connective tissue manifested by hyposecretion salivary glands, dryness and pain in the eyes, photophobia.
Children with the neonatal form of lupus erythematosus, born from sick mothers, already in infancy have an erythematous rash and anemia, so a differential diagnosis should be made with atopic dermatitis.
Diagnosis of systemic lupus erythematosus
If systemic lupus erythematosus is suspected, the patient is referred for consultation with a rheumatologist and dermatologist. Lupus erythematosus is diagnosed by the presence of manifestations in each symptomatic group. Criteria for diagnosis from the skin: butterfly erythema, photodermatitis, discoid rash; from the joints: symmetrical joint damage, arthralgia, “pearl bracelet” syndrome on the wrists due to deformation ligamentous apparatus; from the internal organs: serositis of various localizations, persistent proteinuria and cylindruria in urine analysis; from the central nervous system: convulsions, chorea, psychosis and mood swings; In terms of hematopoietic function, lupus erythematosus is manifested by leukopenia, thrombocytopenia, and lymphopenia.
The Wasserman reaction can be false-positive, like other serological tests, which sometimes leads to the prescription of inadequate treatment. If pneumonia develops, an X-ray of the lungs is performed; if pleurisy is suspected,
Patients with lupus erythematosus should avoid direct sunlight, wear clothing that covers the entire body, and apply creams with a high UV filter to exposed areas. Corticosteroid ointments are applied to the affected areas of the skin, since the use of non-hormonal drugs has no effect. Treatment must be carried out intermittently so that hormone-related dermatitis does not develop.
In uncomplicated forms of lupus erythematosus to eliminate pain in muscles and joints, non-steroidal anti-inflammatory drugs are prescribed, but aspirin should be taken with caution, as it slows down the blood clotting process. It is mandatory to take glucocorticosteroids, and the doses of the drugs are selected in such a way as to protect the internal organs from damage while minimizing side effects.
A method when stem cells are collected from a patient, and then immunosuppressive therapy is carried out, after which for recovery immune system stem cells are reintroduced, effective even in severe and hopeless forms of lupus erythematosus. With this therapy, autoimmune aggression in most cases stops, and the condition of the patient with lupus erythematosus improves.
Healthy lifestyle, giving up alcohol and smoking, adequate exercise stress, balanced diet and psychological comfort allow patients with lupus erythematosus to control their condition and prevent disability.
Systemic lupus erythematosus (SLE)– a chronic autoimmune disease caused by a disruption of the immune mechanisms with the formation of damaging antibodies to one’s own cells and tissues. SLE is characterized by damage to joints, skin, blood vessels and various organs (kidneys, heart, etc.).
Cause and mechanisms of disease development
The cause of the disease is not clear. It is assumed that viruses (RNA and retroviruses) serve as the trigger for the development of the disease. In addition, people have a genetic predisposition to SLE. Women get sick 10 times more often, which is due to the characteristics of their hormonal system (high concentration of estrogen in the blood). Proven protective effect regarding SLE male sex hormones (androgens). Factors that can cause the development of the disease can be a viral, bacterial infection, or medications.The mechanisms of the disease are based on dysfunction of immune cells (T and B lymphocytes), which is accompanied by excessive formation of antibodies to the body’s own cells. As a result of excessive and uncontrolled production of antibodies, specific complexes are formed that circulate throughout the body. Circulating immune complexes (CIC) settle in the skin, kidneys, and on the serous membranes of internal organs (heart, lungs, etc.) causing inflammatory reactions.
Symptoms of the disease
SLE is characterized by a wide range of symptoms. The disease occurs with exacerbations and remissions. The onset of the disease can be either immediate or gradual. General symptoms
- Fatigue
- Weight loss
- Temperature
- Decreased performance
- Fast fatiguability
Damage to the musculoskeletal system
- Arthritis – inflammation of the joints
- Occurs in 90% of cases, non-erosive, non-deforming, the joints of the fingers, wrists, and knee joints are most often affected.
- Osteoporosis – decreased bone density
- As a result of inflammation or treatment with hormonal drugs (corticosteroids).
- Muscle pain (15-64% of cases), muscle inflammation (5-11%), muscle weakness (5-10%)
Damage to mucous membranes and skin
- Skin lesions at the onset of the disease appear in only 20-25% of patients, in 60-70% of patients they appear later, in 10-15% skin manifestations of the disease do not occur at all. Skin changes appear on areas of the body exposed to the sun: face, neck, shoulders. The lesions have the appearance of erythema (reddish plaques with peeling), dilated capillaries at the edges, areas with excess or lack of pigment. On the face, such changes resemble the appearance of a butterfly, as the back of the nose and cheeks are affected.
- Hair loss (alopecia) occurs rarely, usually affecting the temporal areas. Hair falls out in a limited area.
- Increased skin sensitivity to sun rays(photosensitization), occurs in 30-60% of patients.
- Damage to the mucous membranes occurs in 25% of cases.
- Redness, decreased pigmentation, impaired nutrition of lip tissue (cheilitis)
- Pinpoint hemorrhages, ulcerative lesions of the oral mucosa
Respiratory system damage
Lesions from the respiratory system in SLE are diagnosed in 65% of cases. Pulmonary pathology can develop both acutely and gradually with various complications. The most common manifestation of damage to the pulmonary system is inflammation of the membrane covering the lungs (pleurisy). Characterized by chest pain and shortness of breath. SLE can also cause the development of lupus pneumonia (lupus pneumonitis), characterized by: shortness of breath, cough with bloody sputum. SLE often affects the blood vessels of the lungs, leading to pulmonary hypertension. Against the background of SLE, infectious processes in the lungs often develop, and it is also possible to develop serious condition as blockage of a pulmonary artery by a blood clot (pulmonary embolism).Damage to the cardiovascular system
SLE can affect all structures of the heart, the outer lining (pericardium), the inner layer (endocardium), the heart muscle itself (myocardium), valves and coronary vessels. The most common lesion occurs in the pericardium (pericarditis).- Pericarditis is an inflammation of the serous membranes covering the heart muscle.
- Myocarditis is inflammation of the heart muscle.
- Damage to the heart valves, most often the mitral and aortic valves are affected.
- Damage to the coronary vessels can lead to myocardial infarction, which can also develop in young people patients with SLE.
- Damage to the inner lining of blood vessels (endothelium) increases the risk of developing atherosclerosis. Defeat peripheral vessels manifests itself:
- Livedo reticularis (blue spots on the skin creating a grid pattern)
- Lupus panniculitis (subcutaneous nodules, often painful, may ulcerate)
- Thrombosis of blood vessels of the extremities and internal organs
Kidney damage
The kidneys are most often affected in SLE; in 50% of patients, lesions of the renal apparatus are detected. A common symptom is the presence of protein in the urine (proteinuria); red blood cells and casts are usually not detected at the onset of the disease. The main manifestations of kidney damage in SLE are: proliferative glomerulonephritis and mebranous nephritis, which manifests itself as nephrotic syndrome (proteins in the urine more than 3.5 g/day, decreased protein in the blood, edema).Damage to the central nervous system
It is assumed that disorders of the central nervous system are caused by damage to the blood vessels of the brain, as well as the formation of antibodies to neurons, to the cells responsible for protecting and nourishing neurons (glial cells), and to immune cells (lymphocytes).The main manifestations of damage to the nervous structures and blood vessels of the brain:
- Headache and migraine, most frequent symptoms for SLE
- Irritability, depression – rare
- Psychoses: paranoia or hallucinations
- Brain stroke
- Chorea, parkinsonism – rare
- Myelopathies, neuropathies and other disorders of nerve sheath (myelin) formation
- Mononeuritis, polyneuritis, aseptic meningitis
Damage to the digestive tract
Clinical lesions of the digestive tract are diagnosed in 20% of patients with SLE.- Damage to the esophagus, impaired swallowing, dilatation of the esophagus occurs in 5% of cases
- Ulcers of the stomach and 12th intestine are caused both by the disease itself and by the side effects of treatment
- Abdominal pain as a manifestation of SLE, and can also be caused by pancreatitis, inflammation of the intestinal vessels, intestinal infarction
- Nausea, abdominal discomfort, indigestion
- Hypochromic normocytic anemia occurs in 50% of patients, the severity depends on the activity of SLE. Hemolytic anemia is rare in SLE.
- Leukopenia is a decrease in leukocytes in the blood. Caused by a decrease in lymphocytes and granulocytes (neutrophils, eosinophils, basophils).
- Thrombocytopenia is a decrease in platelets in the blood. Occurs in 25% of cases, caused by the formation of antibodies against platelets, as well as antibodies to phospholipids (fats that make up cell membranes).
Diagnosis of SLE
Diagnosis of SLE is based on data clinical manifestations diseases, as well as on data from laboratory and instrumental studies. The American College of Rheumatology has developed special criteria that can be used to make a diagnosis - systemic lupus erythematosus.Criteria for the diagnosis of systemic lupus erythematosus
The diagnosis of SLE is made if at least 4 out of 11 criteria are present.
| Characteristics: without erosion, peripheral, manifested by pain, swelling, accumulation of slight fluid in the joint cavity |
| Red in color, oval, round or ring-shaped, plaques with uneven contours there are scales on their surface, dilated capillaries nearby, the scales are difficult to separate. Untreated lesions leave scars. |
| The oral mucosa or nasopharyngeal mucosa is affected in the form of ulcerations. Usually painless. |
| Increased sensitivity to sunlight. As a result of exposure to sunlight, a rash appears on the skin. |
| Specific butterfly rash |
| Constant loss of protein in urine 0.5 g/day, release of cell casts |
| Pleurisy is inflammation of the membranes of the lungs. It manifests itself as pain in the chest, intensifying with inspiration. Pericarditis – inflammation of the heart lining |
| Convulsions, Psychosis - in the absence of drugs that can provoke them or metabolic disorders (uremia, etc.) |
|
|
|
|
| Increased antinuclear antibodies (ANA) |
The degree of disease activity is determined using special SLEDAI indices ( Systemic lupus erythematosus Disease Activity Index). The disease activity index includes 24 parameters and reflects the state of 9 systems and organs, expressed in points that are summed up. The maximum is 105 points, which corresponds to very high disease activity.
Disease activity indices bySLEDAI
| Manifestations | Description | Punctuation |
| Pseudoepileptic seizure(development of seizures without loss of consciousness) | Must be excluded metabolic disorders, infections, medications that could provoke it. | 8 |
| Psychoses | Impaired ability to perform actions as usual, impaired perception of reality, hallucinations, decreased associative thinking, disorganized behavior. | 8 |
| Organic changes in the brain | Changes logical thinking, spatial orientation is impaired, memory, intelligence, concentration are reduced, incoherent speech, insomnia or drowsiness. | 8 |
| Eye disorders | Inflammation optic nerve excluding arterial hypertension. | 8 |
| Damage to cranial nerves | Damage to the cranial nerves detected for the first time. | |
| Headache | Severe, constant, may be migraine, not responding to narcotic analgesics | 8 |
| Cerebral circulatory disorders | Newly identified, excluding the consequences of atherosclerosis | 8 |
| Vasculitis-(vascular damage) | Ulcers, gangrene of the limbs, painful nodes on the fingers | 8 |
| Arthritis-(inflammation of joints) | Involvement of more than 2 joints with signs of inflammation and swelling. | 4 |
| Myositis-(inflammation skeletal muscles) | Muscle pain, weakness with confirmation of instrumental studies | 4 |
| Casts in urine | Hyaline, granular, erythrocyte | 4 |
| Red blood cells in urine | More than 5 red blood cells in the field of view, exclude other pathologies | 4 |
| Protein in urine | More than 150 mg per day | 4 |
| Leukocytes in urine | More than 5 white blood cells per field of view, excluding infections | 4 |
| Skin lesions | Damage inflammatory in nature | 2 |
| Hair loss | Increased lesions or complete hair loss | 2 |
| Ulcers of the mucous membranes | Ulcers on the mucous membranes and nose | 2 |
| Pleurisy-(inflammation of the membranes of the lungs) | Chest pain, pleural thickening | 2 |
| Pericarditis-( inflammation of the lining of the heart) | Detected on ECG, EchoCG | 2 |
| Declining compliment | Decreased C3 or C4 | 2 |
| AntiDNA | Positively | 2 |
| Temperature | More than 38 degrees C, excluding infections | 1 |
| Decreased platelets in the blood | Less than 150 10 9 /l, excluding medications | 1 |
| Decreased white blood cells | Less than 4.0 10 9 /l, excluding medications | 1 |
- Light activity: 1-5 points
- Moderate activity: 6-10 points
- High activity: 11-20 points
- Very high activity: more than 20 points
Diagnostic tests used to detect SLE
- ANA- screening test, specific antibodies to cell nuclei are determined, detected in 95% of patients, does not confirm the diagnosis in the absence of clinical manifestations of systemic lupus erythematosus
- Anti DNA– antibodies to DNA, detected in 50% of patients, the level of these antibodies reflects the activity of the disease
- Anti-Sm – specific antibodies to the Smith antigen, which is part of short RNAs, are detected in 30-40% of cases
- Anti –SSA or Anti-SSB, antibodies to specific proteins located in the cell nucleus, are present in 55% of patients with systemic lupus erythematosus, are not specific for SLE, and are also detected in other connective tissue diseases
- Anticardiolipin - antibodies to mitochondrial membranes (cell energy station)
- Antihistones– antibodies against proteins necessary for packaging DNA into chromosomes, characteristic of drug-induced SLE.
- Markers of inflammation
- ESR – increased
- C – reactive protein, increased
- Compliment level reduced
- C3 and C4 are reduced as a result of excessive formation of immune complexes
- Some people have a reduced level of compliment from birth, this is a predisposing factor to the development of SLE.
- General blood analysis
- Possible decrease in red blood cells, white blood cells, lymphocytes, platelets
- Analysis of urine
- Protein in urine (proteinuria)
- Red blood cells in urine (hematuria)
- Casts in the urine (cylindruria)
- White blood cells in urine (pyuria)
- Blood chemistry
- Creatinine – an increase indicates kidney damage
- ALAT, ASAT – an increase indicates liver damage
- Creatine kinase – increases with damage to the muscular system
- X-ray of joints
- X-ray and computed tomography of the chest
- Nuclear magnetic resonance and angiography
- Echocardiography
Specific procedures
- A spinal tap can rule out infectious causes of neurological symptoms.
- A kidney biopsy (analysis of organ tissue) allows you to determine the type of glomerulonephritis and facilitate the choice of treatment tactics.
- A skin biopsy allows you to clarify the diagnosis and exclude similar dermatological diseases.
Treatment of systemic lupus
Despite significant advances in modern treatment systemic lupus erythematosus, this task remains very difficult. Treatment aimed at eliminating main reason the disease was not found, just as the cause itself was not found. Thus, the principle of treatment is aimed at eliminating the mechanisms of disease development, reducing provoking factors and preventing complications. - Exclude physical and mental stressful conditions
- Reduce sun exposure and use sunscreen
- Glucocorticosteroids the most effective drugs in the treatment of SLE.
Dosage regimens:
- Inside:
- Initial dose of prednisolone 0.5 – 1 mg/kg
- Maintenance dose 5-10 mg
- Prednisolone should be taken in the morning, the dose is reduced by 5 mg every 2-3 weeks
- Intravenous administration of methylprednisolone in large doses (pulse therapy)
- Dose 500-1000 mg/day, for 3-5 days
- Or 15-20 mg/kg body weight
Indications for pulse therapy: young age, lightning fast lupus nephritis, high immunological activity, damage to the nervous system.
- 1000 mg methylprednisolone and 1000 mg cyclophosphamide on the first day
- Cytostatics: cyclophosphamide (cyclophosphamide), azathioprine, methotrexate, are used in complex treatment SCV.
- Acute lupus nephritis
- Vasculitis
- Forms refractory to treatment with corticosteroids
- The need to reduce corticosteroid doses
- High SLE activity
- Progressive or fulminant course of SLE
- Cyclophosphamide during pulse therapy is 1000 mg, then 200 mg every day until a total dose of 5000 mg is reached.
- Azathioprine 2-2.5 mg/kg/day
- Methotrexate 7.5-10 mg/week, orally
- Anti-inflammatory drugs
- Naklofen, nimesil, airtal, katafast, etc.
- Aminoquinoline drugs
- delagil, plaquenil, etc.
- Biological drugs are promising method treatment of SLE
- Anti CD 20 – Rituximab
- Tumor necrosis factor alpha – Remicade, Gumira, Embrel
- Other drugs
- Anticoagulants (heparin, warfarin, etc.)
- Antiplatelet agents (aspirin, clopidogrel, etc.)
- Diuretics (furosemide, hydrochlorothiazide, etc.)
- Calcium and potassium preparations
- Extracorporeal treatment methods
- Plasmapheresis is a method of purifying blood outside the body, in which part of the blood plasma is removed, and with it the antibodies that cause the disease SLE.
- Hemosorption is a method of purifying blood outside the body using specific sorbents (ion exchange resins, activated carbon, etc.).
What are the complications and prognosis for life with systemic lupus erythematosus?
The risk of developing complications of systemic lupus erythematosus directly depends on the course of the disease.Variants of the course of systemic lupus erythematosus:
1.
Acute course- characterized by a lightning-fast onset, a rapid course and the rapid simultaneous development of symptoms of damage to many internal organs (lungs, heart, central nervous system, and so on). The acute course of systemic lupus erythematosus, fortunately, is rare, since this option quickly and almost always leads to complications and can cause the death of the patient.
2.
Subacute course– characterized by a gradual onset, alternating periods of exacerbations and remissions, a predominance of general symptoms (weakness, weight loss, low-grade fever (up to 38 0
C) and others), damage to internal organs and complications occur gradually, no earlier than 2-4 years after the onset of the disease.
3.
Chronic course– most favorable course SLE, there is a gradual onset, damage mainly to the skin and joints, longer periods of remission, damage to internal organs and complications occur after decades.
Damage to organs such as the heart, kidneys, lungs, central nervous system, and blood, which are described as symptoms of the disease, in fact, are complications of systemic lupus erythematosus.
But we can highlight complications that lead to irreversible consequences and can lead to the death of the patient:
1. Systemic lupus erythematosus– affects the connective tissue of the skin, joints, kidneys, blood vessels and other structures of the body.
2. Drug-induced lupus erythematosus– unlike the systemic type of lupus erythematosus, a completely reversible process. Drug-induced lupus develops as a result of exposure to certain medications:
- Medicines for the treatment of cardiovascular diseases: phenothiazine groups (Apressin, Aminazine), Hydralazine, Inderal, Metoprolol, Bisoprolol, Propranolol and some others;
- antiarrhythmic drug - Novocainamide;
- sulfonamides: Biseptol and others;
- anti-tuberculosis drug Isoniazid;
- oral contraceptives;
- herbal preparations for the treatment of venous diseases (thrombophlebitis, varicose veins of the lower extremities, and so on): horse chestnut, venotonic Doppelgerz, Detralex and some others.
3. Discoid (or cutaneous) lupus erythematosus may precede the development of systemic lupus erythematosus. With this type of disease, the skin of the face is affected to a greater extent. Changes on the face are similar to those with systemic lupus erythematosus, but blood test parameters (biochemical and immunological) do not have changes characteristic of SLE, and this will be the main criterion for differential diagnosis with other types of lupus erythematosus. To clarify the diagnosis, it is necessary to carry out histological examination skin, which will help differentiate from diseases that are similar in appearance (eczema, psoriasis, cutaneous form of sarcoidosis and others).
4. Neonatal lupus erythematosus occurs in newborns whose mothers suffer from systemic lupus erythematosus or other systemic autoimmune diseases. At the same time, the mother SLE symptoms There may not be any, but when they are examined, autoimmune antibodies are detected.
Symptoms of neonatal lupus erythematosus In a child, they usually appear before the age of 3 months:
- changes on the skin of the face (often have the appearance of a butterfly);
- congenital arrhythmia, which is often determined by ultrasound of the fetus in the 2nd-3rd trimesters of pregnancy;
- lack of blood cells in a general blood test (decrease in the level of red blood cells, hemoglobin, leukocytes, platelets);
- identification of autoimmune antibodies specific for SLE.
5. The term “lupus” is also used for tuberculosis of the facial skin - tuberculous lupus . Skin tuberculosis is very similar in appearance to systemic lupus erythematosus. The diagnosis can be established by histological examination of the skin and microscopic and bacteriological examination of scrapings - mycobacterium tuberculosis (acid-fast bacteria) is detected.
Photo:
This is what tuberculosis of the facial skin or tuberculous lupus looks like.
Systemic lupus erythematosus and other systemic connective tissue diseases, how to differentiate?
Group systemic diseases connective tissue:- Systemic lupus erythematosus.
- Idiopathic dermatomyositis (polymyositis, Wagner's disease)– damage by autoimmune antibodies to smooth and skeletal muscles.
- Systemic scleroderma is a disease in which replacement occurs normal tissue connective tissue (non-functional), including blood vessels.
- Diffuse fasciitis (eosinophilic)- damage to the fascia - structures that are cases for skeletal muscles, while in the blood of most patients there is an increased number of eosinophils (blood cells responsible for allergies).
- Sjögren's syndrome– defeat various glands(tear, salivary, sweat, etc.), for which this syndrome is also called dry.
- Other systemic diseases.
Differential diagnosis of systemic connective tissue diseases.
| Diagnostic criteria | Systemic lupus erythematosus | Systemic scleroderma | Idiopathic dermatomyositis |
| Onset of the disease |
|
 Photo: Raynaud's syndrome |
|
| Temperature | Prolonged fever, body temperature above 38-39 0 C. | Long-term low-grade fever(up to 38 0 C). | Moderate prolonged fever (up to 39 0 C). |
| Patient's appearance (at the onset of the disease and in some of its forms, the patient’s appearance may not change in all these diseases) | Damage to the skin, mostly the face, “butterfly” (redness, scales, scars). The rash can be all over the body and on the mucous membranes. Dry skin, loss of hair and nails. Nails are deformed, striated nail plates. There may also be hemorrhagic rashes (bruises and petechiae) throughout the body.  | The face may acquire a “mask-like” expression without facial expressions, tense, the skin is shiny, deep folds appear around the mouth, the skin is motionless, tightly fused to deep-lying tissues. Often there is a disruption of the glands (dry mucous membranes, as in Sjögren's syndrome). Hair and nails fall out. On the skin of the limbs and neck there are dark spots against the background of “bronze skin”.  | A specific symptom is swelling of the eyelids, their color can be red or purple; on the face and décolleté there is a variety of rashes with redness of the skin, scales, hemorrhages, and scars. As the disease progresses, the face acquires a “mask-like appearance”, without facial expressions, tense, may be skewed, and drooping is often detected upper eyelid(ptosis).  |
| Main symptoms during the period of disease activity |
|
|
|
| Forecast | Chronic course, over time, more and more organs are affected. Without treatment, complications develop, life-threatening patient. With adequate and regular treatment, it is possible to achieve long-term, stable remission. | ||
| Laboratory indicators |
|
|
|
| Principles of treatment | Long-term hormonal therapy (Prednisolone) + cytostatics + symptomatic therapy and other drugs (see section of the article "Treatment of systemic lupus"). | ||
As you can see, there is not a single analysis that would completely differentiate systemic lupus erythematosus from other systemic diseases, and the symptoms are very similar, especially in the early stages. It is often enough for experienced rheumatologists to evaluate the skin manifestations of the disease to diagnose systemic lupus erythematosus (if present).
Systemic lupus erythematosus in children, what are the symptoms and treatment?
Systemic lupus erythematosus is less common in children than in adults. In childhood, the most common autoimmune disease is rheumatoid arthritis. SLE predominantly (in 90% of cases) affects girls. Systemic lupus erythematosus can occur in infants and early age, though rarely, greatest number cases of this disease occur during puberty, namely at the age of 11-15 years. Taking into account the peculiarities of immunity, hormonal levels, and the intensity of growth, systemic lupus erythematosus in children occurs with its own characteristics.
Features of the course of systemic lupus erythematosus in childhood:
- more severe course diseases , high activity of the autoimmune process;
- chronic course the disease occurs in children only in a third of cases;
- more common acute or subacute course diseases with rapid damage to internal organs;
- also isolated only in children acute or lightning-fast course SLE is an almost simultaneous lesion of all organs, including the central nervous system, which can lead to the death of a small patient in the first six months from the onset of the disease;
- frequent development of complications and high mortality;
- the most common complication is bleeding disorder in the form of internal bleeding, hemorrhagic rashes (bruises, hemorrhages on the skin), as a result - the development state of shock DIC syndrome – disseminated intravascular coagulation;
- Systemic lupus erythematosus in children often occurs in the form of vasculitis – inflammation blood vessels, which determines the severity of the process;
- children with SLE are usually malnourished , have a pronounced deficiency of body weight, up to cachexia (extreme degree of dystrophy).
1.
Onset of the disease acute, with an increase in body temperature to high numbers (over 38-39 0 C), with pain in the joints and severe weakness, sudden loss of body weight.
2.
Skin changes in the form of a “butterfly” are relatively rare in children. But, given the development of a lack of blood platelets, hemorrhagic rashes throughout the body (bruises for no reason, petechiae or pinpoint hemorrhages) are more common. Also, one of the characteristic signs of systemic diseases is hair loss, eyelashes, eyebrows, up to complete baldness. The skin becomes marbled and very sensitive to sunlight. There may be various rashes, characteristic of allergic dermatitis. In some cases, Raynaud's syndrome develops - a violation of blood circulation in the hands. In the oral cavity there may be ulcers that do not heal for a long time - stomatitis.
3.
Joint pain– typical syndrome of active systemic lupus erythematosus, pain is periodic. Arthritis is accompanied by the accumulation of fluid in the joint cavity. Over time, joint pain is combined with muscle pain and stiffness of movement, starting with the small joints of the fingers.
4.
For children formation of exudative pleurisy is characteristic(liquid in pleural cavity), pericarditis (fluid in the pericardium, the lining of the heart), ascites and other exudative reactions (dropsy).
5.
Heart damage in children it usually manifests itself as myocarditis (inflammation of the heart muscle).
6.
Kidney damage or nephritis develops much more often in childhood than in adulthood. Such nephritis relatively quickly leads to the development of acute renal failure (requiring intensive care and hemodialysis).
7.
Lung damage It is rare in children.
8.
In the early period of the disease in adolescents, in most cases there is damage to the gastrointestinal tract(hepatitis, peritonitis and so on).
9.
Damage to the central nervous system in children it is characterized by capriciousness, irritability, and in severe cases, seizures may develop.
That is, in children, systemic lupus erythematosus is also characterized by a variety of symptoms. And many of these symptoms are masked under the guise of other pathologies; the diagnosis of systemic lupus erythematosus is not immediately assumed. Unfortunately, timely treatment is the key to success in transitioning the active process into a period of stable remission.
Diagnostic principles systemic lupus erythematosus are the same as in adults, based mainly on immunological research(detection of autoimmune antibodies).
In a general blood test, in all cases and from the very beginning of the disease, a decrease in the number of all formed blood elements (erythrocytes, leukocytes, platelets) is determined, and blood clotting is impaired.
Treatment of systemic lupus erythematosus in children, as in adults, involves long-term use of glucocorticoids, namely Prednisolone, cytostatics and anti-inflammatory drugs. Systemic lupus erythematosus is a diagnosis that requires urgent hospitalization of the child in a hospital (rheumatology department, if severe complications develop - in the intensive care unit or intensive care unit).
In a hospital setting, a complete examination of the patient is carried out and the necessary therapy is selected. Depending on the presence of complications, symptomatic and intensive therapy. Given the presence of bleeding disorders in such patients, Heparin injections are often prescribed.
If treatment is started on time and regularly, you can achieve stable remission, while children grow and develop according to their age, including normal puberty. In girls, a normal menstrual cycle is established and pregnancy is possible in the future. In this case forecast favorable for life.
Systemic lupus erythematosus and pregnancy, what are the risks and treatment features?
As already mentioned, systemic lupus erythematosus most often affects young women, and for any woman the issue of motherhood is very important. But SLE and pregnancy are always a big risk for both the mother and the unborn baby. Risks of pregnancy for a woman with systemic lupus erythematosus:
1. Systemic lupus erythematosus
In most cases does not affect the ability to get pregnant
,
as well as long-term use of Prednisolone.
2. It is strictly forbidden to become pregnant while taking cytostatics (Methotrexate, Cyclophosphamide and others).
,
since these drugs will affect germ cells and embryonic cells; pregnancy is possible only no earlier than six months after discontinuation of these drugs.
3. Half
cases of pregnancy with SLE ends in birth healthy, full-term baby
. In 25%
cases such babies are born premature
, A in a quarter of cases
observed miscarriage
.
4. Possible complications of pregnancy with systemic lupus erythematosus,
in most cases associated with damage to the blood vessels of the placenta:
- fetal death;
- . Thus, in a third of cases, a worsening of the disease develops. The risk of such deterioration is greatest in the first weeks of the first or third trimester of pregnancy. And in other cases, there is a temporary retreat of the disease, but in most cases one should expect a severe exacerbation of systemic lupus erythematosus 1-3 months after birth. Nobody knows why will go the way autoimmune process.
6. Pregnancy can be a trigger in the development of systemic lupus erythematosus. Pregnancy can also provoke the transition of discoid (cutaneous) lupus erythematosus to SLE.
7. A mother with systemic lupus erythematosus can pass the genes on to her baby , predisposing him to develop a systemic autoimmune disease during his life.
8. The child may develop neonatal lupus erythematosus associated with the circulation of maternal autoimmune antibodies in the baby’s blood; this condition is temporary and reversible.- It is necessary to plan a pregnancy under the supervision of qualified doctors , namely a rheumatologist and gynecologist.
- It is advisable to plan a pregnancy during a period of stable remission chronic course of SLE.
- In acute cases systemic lupus erythematosus with the development of complications, pregnancy can have a detrimental effect not only on health, but also lead to fatal outcome women.
- And if, nevertheless, pregnancy occurs in period of exacerbation, then the question of its possible preservation is decided by doctors, together with the patient. After all, exacerbation of SLE requires long-term use drugs, some of which are absolutely contraindicated during pregnancy.
- It is recommended to become pregnant no earlier than 6 months after discontinuation of cytotoxic drugs (Methotrexate and others).
- For lupus damage to the kidneys and heart There can be no talk of pregnancy; this can lead to the woman’s death from renal and/or heart failure, because it is precisely these organs are coming a huge burden when carrying a baby.
1. Necessary throughout pregnancy be observed by a rheumatologist and obstetrician-gynecologist , the approach to each patient is individual.
2. It is necessary to adhere to the following regime: don’t overwork, don’t be nervous, eat normally.
3. Be attentive to any changes in your health.
4. Delivery outside the maternity hospital is unacceptable , since there is a risk of developing severe complications during and after childbirth.
7. Even at the very beginning of pregnancy, the rheumatologist prescribes or adjusts therapy. Prednisolone is the main drug for the treatment of SLE and is not contraindicated during pregnancy. The dose of the drug is selected individually.
8. Also recommended for pregnant women with SLE taking vitamins, potassium supplements, aspirin (up to the 35th week of pregnancy) and other symptomatic and anti-inflammatory drugs.
9. Mandatory treatment of late toxicosis and other pathological conditions of pregnancy in a maternity hospital.
10. After childbirth the rheumatologist increases the dose of hormones; in some cases, it is recommended to stop breastfeeding, as well as prescribe cytostatics and other drugs for the treatment of SLE - pulse therapy, since it is postpartum period dangerous for the development of severe exacerbations of the disease.Previously, all women with systemic lupus erythematosus were not recommended to become pregnant, and if they conceived, everyone was recommended to have an induced termination of pregnancy (medical abortion). Now doctors have changed their opinion on this matter; a woman cannot be deprived of motherhood, especially since there is a considerable chance of giving birth to a normal, healthy baby. But everything must be done to minimize the risk for mother and baby.
Is lupus erythematosus contagious?
Of course, any person who sees strange rashes on their face thinks: “Could it be contagious?” Moreover, people with these rashes walk for so long, feel unwell and constantly take some kind of medication. Moreover, doctors previously assumed that systemic lupus erythematosus was transmitted sexually, by contact, or even by airborne droplets. But having studied the mechanism of the disease in more detail, scientists have completely dispelled these myths, because this is an autoimmune process.The exact cause of the development of systemic lupus erythematosus has not yet been established; there are only theories and assumptions. It all boils down to one thing: the main cause is the presence of certain genes. But still, not all carriers of these genes suffer from systemic autoimmune diseases.
The trigger for the development of systemic lupus erythematosus can be:
- various viral infections;
- bacterial infections (especially beta-hemolytic streptococcus);
- stress factors;
- hormonal changes (pregnancy, adolescence);
- environmental factors (for example, ultraviolet irradiation).
Only tuberculous lupus can be contagious (facial skin tuberculosis), since a large number of tuberculosis bacilli are detected on the skin, and contact path pathogen transmission.
Lupus erythematosus, what diet is recommended and are there any methods of treatment with folk remedies?
As with any disease, nutrition plays an important role in lupus erythematosus. Moreover, with this disease there is almost always a deficiency, or against the background of hormonal therapy - excess body weight, lack of vitamins, microelements and biological active substances.The main characteristic of a diet for SLE is a balanced and proper diet.
1. foods containing unsaturated fatty acids (Omega-3):
- sea fish;
- many nuts and seeds;
- vegetable oil in small quantities;
3. juices, fruit drinks;
4. lean poultry meat: chicken, turkey fillet;
5. low-fat dairy , especially fermented milk products (low-fat cheese, cottage cheese, yogurt);
6. cereals and vegetable fiber (grain bread, buckwheat, oatmeal, wheat germ and many others).1. Products with saturated fatty acids have a bad effect on blood vessels, which can aggravate the course of SLE:
- animal fats;
- fried food;
- fatty meats (red meat);
- high fat dairy products and so on.
Photo: alfalfa grass.
3. Garlic – powerfully stimulates the immune system.
4. Salty, spicy, smoked dishes that retain fluid in the body.If diseases of the gastrointestinal tract occur against the background of SLE or taking medications, the patient is recommended to undergo frequent fractional meals according to therapeutic diet– table No. 1. All anti-inflammatory drugs are best taken with or immediately after meals.
Treatment of systemic lupus erythematosus at home possible only after selection individual scheme therapy in a hospital setting and correction of conditions that threaten the patient’s life. Heavy drugs used in the treatment of SLE cannot be prescribed on their own; self-medication will not lead to anything good. Hormones, cytostatics, non-steroidal anti-inflammatory drugs and other drugs have their own characteristics and a bunch of adverse reactions, and the dose of these drugs is very individual. The therapy selected by doctors is taken at home, strictly adhering to the recommendations. Omissions and irregularity in taking medications are unacceptable.
Concerning traditional medicine recipes, then systemic lupus erythematosus does not tolerate experiments. None of these remedies will prevent the autoimmune process; you may simply waste valuable time. Folk remedies can be effective if they are used in combination with traditional methods treatment, but only after consultation with a rheumatologist.
Some traditional medicines for the treatment of systemic lupus erythematosus:
Precautionary measures! All folk remedies containing poisonous herbs or substances should be kept out of the reach of children. You have to be careful with such drugs; any poison is a medicine as long as it is used in small doses.Photos of what the symptoms of lupus erythematosus look like?
Photo: Butterfly-shaped changes on the facial skin in SLE.
Photo: skin lesions on the palms with systemic lupus erythematosus. Except skin changes, this patient shows thickening of the joints of the phalanges of the fingers - signs of arthritis.
Dystrophic changes nails with systemic lupus erythematosus: fragility, discoloration, longitudinal striations of the nail plate.
Lupus lesions of the oral mucosa . By clinical picture very similar to infectious stomatitis, which does not heal for a long time.
And this is what they might look like first symptoms of discoid or cutaneous lupus erythematosus.
And this is what it might look like neonatal lupus erythematosus, These changes, fortunately, are reversible and in the future the baby will be absolutely healthy.
Skin changes in systemic lupus erythematosus, characteristic of childhood. The rash is hemorrhagic in nature, resembles measles rashes, and leaves pigment spots that do not go away for a long time.
– serious disease, during which the human immune system perceives the cells of its own body as foreign. This disease is terrible for its complications. Almost all organs are affected by the disease, but most severely are the musculoskeletal system and the kidneys (lupus arthritis and nephritis).
Causes of systemic lupus erythematosus
The history of the name of this disease goes back to the times when wolf attacks on people were not uncommon, especially on cabbies and coachmen. At the same time, the predator tried to bite an unprotected part of the body, most often the face - nose, cheeks. As you know, one of the most striking symptoms of the disease is the so-called lupus butterfly– bright pink spots that affect the skin of the face.
Experts have come to the conclusion that women are more predisposed to this autoimmune disease: 85 - 90% of cases of the disease occur in the fair sex. Most often, lupus makes itself felt in the age range from 14 to 25 years.
Why does it occur systemic lupus erythematosus, it is still not completely clear. But scientists still managed to discover some patterns.
- It has been established that people who, for various reasons, are forced to spend a lot of time in unfavorable temperature conditions (cold, heat) get sick more often.
- Heredity is not the cause of the disease, but scientists suggest that relatives of the sick person are at risk.
- Some studies show that systemic lupus erythematosus– this is the immune response to numerous irritations (infections, microorganisms, viruses). Thus, disruptions in the functioning of the immune system do not occur accidentally, but with constant negative impact on the body. As a result, the body's own cells and tissues begin to suffer.
- There is an assumption that certain chemical compounds can cause the disease.
There are factors that can provoke an exacerbation of an existing disease:
- Alcohol and smoking have a detrimental effect on the entire body in general and on the cardiovascular system in particular, and it already suffers from lupus.
- Taking medications containing large doses of sex hormones can cause an exacerbation of the disease in women.
Systemic lupus erythematosus - the mechanism of disease development
The mechanism of development of the disease is still not fully understood. It's hard to believe that the immune system, which is supposed to protect our body, begins to attack it. According to scientists, the disease occurs when the body's regulatory function fails, as a result of which certain types of lymphocytes become overactive and contribute to the formation immune complexes(large protein molecules).
Immune complexes begin to spread throughout the body, penetrating various organs and small vessels, which is why the disease is called systemic.
These molecules attach to tissues and then begin to be released from them. aggressive enzymes. Being normal, these substances are enclosed in microcapsules and are not dangerous. But free, unencapsulated enzymes begin to destroy healthy body tissue. This process is associated with the appearance of numerous symptoms.
Main symptoms of systemic lupus erythematosus
Harmful immune complexes spread throughout the body through the bloodstream, so any organ can be affected. However, a person does not associate the first symptoms that appear with this serious illness, How systemic lupus erythematosus, since they are characteristic of many diseases. So, the following signs appear first:
- causeless increase in temperature;
- chills and muscle pain, fatigue;
- weakness, frequent headaches.
Later, other symptoms associated with damage to one or another organ or system appear.
- One of the obvious symptoms of lupus is the so-called lupus butterfly - appearance of rash and hyperemia(overflow of blood vessels) in the area of the cheekbones and nose. In fact, this sign of the disease appears only in 45-50% of patients;
- the rash may appear on other parts of the body: arms, stomach;
- Another symptom may be partial hair loss;
- ulcerative lesions of the mucous membranes;
- the appearance of trophic ulcers.
Lesions of the musculoskeletal system
It suffers much more often than other tissues in this disorder. Most patients complain of the following symptoms.
- Painful sensations in the joints. Note that most often the disease affects the smallest ones. There are lesions of paired symmetrical joints.
- Lupus arthritis, despite the similarity with it, differs from it in that it does not cause destruction bone tissue.
- About 1 in 5 patients develop deformity in the affected joint. This pathology is irreversible and can only be treated surgically.
- In men with systemic lupus, inflammation most often occurs in the sacroiliac joint Pain syndrome occurs in the area of the coccyx and sacrum. The pain can be either permanent or temporary (after physical activity).
Damages of the cardiovascular system
In about half of the sick, a blood test reveals anemia, as well as leukopenia and thrombocytopenia. Sometimes this leads to drug treatment diseases.
- During the examination, the patient may be found to have pericarditis, endocarditis or myocarditis that has arisen for no apparent reason. No concomitant infections that could lead to damage to heart tissue are detected.
- If the disease is not diagnosed in time, then in most cases the mitral and tricuspid valves of the heart are damaged.
- Besides, systemic lupus erythematosus is a risk factor for the development of atherosclerosis, like other systemic diseases.
- The appearance of lupus cells (LE cells) in the blood. These are modified leukocytes exposed to immunoglobulin. This phenomenon clearly illustrates the thesis that cells of the immune system destroy other tissues of the body, mistaking them for foreign.
Kidney damage
- In acute and subacute cases lupus arises inflammatory disease kidney disease, which is called lupus nephritis, or lupus nephritis. At the same time, fibrin deposition and the formation of hyaline blood clots begin in the kidney tissues. At untimely treatment is happening a sharp decline kidney function.
- Another manifestation of the disease is hematuria(presence of blood in the urine), not accompanied by pain and not disturbing the patient.
If the disease is detected and treated on time, then acute renal failure develops in approximately 5% of cases.
Nervous system lesions
- If treatment is not started in a timely manner, it can cause severe disorders of the nervous system in the form of seizures, sensory disturbances, encephalopathy and cerebrovasculitis. Such changes are persistent and difficult to treat.
- Symptoms manifested by the hematopoietic system. The appearance of lupus cells (LE cells) in the blood. LE cells are white blood cells that contain the nuclei of other cells. This phenomenon clearly illustrates how cells of the immune system destroy other tissues of the body, mistaking them for foreign.
Diagnosis of systemic lupus erythematosus
If a person is diagnosed at the same time 4 signs of illness, he is diagnosed: systemic lupus erythematosus. Here is a list of the main symptoms that are analyzed during diagnosis.
- The appearance of lupus butterfly and rash in the cheekbones;
- increased skin sensitivity to sun exposure (redness, rash);
- ulcers on the mucous membranes of the nose and mouth;
- inflammation of two or more joints (arthritis) without bone damage;
- inflamed serous membranes(pleurisy, pericarditis);
- protein in urine (more than 0.5 g);
- dysfunction of the central nervous system (convulsions, psychosis, etc.);
- found in a blood test low content leukocytes and platelets;
- Antibodies to one's own DNA are detected.
Treatment of systemic lupus erythematosus
It should be understood that this disease cannot be cured in any specific period of time or with the help of surgery. This diagnosis is made for life, however systemic lupus erythematosus- not a sentence. Timely diagnosis and correctly prescribed treatment will help avoid exacerbations and allow you to lead a full life. At the same time there is important condition– You can’t be in the open sun.
Various drugs are used in the treatment of systemic lupus erythematosus.
- Glucocorticoids. First, a large dose of the drug is prescribed to relieve the exacerbation, and later the doctor reduces the dosage. This is done to reduce strong side effect, which has a detrimental effect on a number of organs.
- Cytostatics – quickly remove the symptoms of the disease (short courses);
- Extracorporeal detoxification – subtle purification of blood from immune complexes through transfusion;
- Non-steroidal anti-inflammatory drugs. These products are not suitable for long-term use because they are harmful to of cardio-vascular system and reduce testosterone production.
Significant assistance in the complex treatment of the disease will be provided by a drug that includes natural component- drone. The biocomplex helps strengthen protective forces body and cope with this complex disease. Particularly effective in cases where the skin is affected.
Natural Remedies for Complications of Lupus
Treatment of concomitant diseases and complications is necessary - for example, lupus nephritis. It is necessary to constantly monitor the condition of the kidneys, since this disease ranks first in cases of mortality in systemic lupus erythematosus.
Equally important is the timely treatment of lupus arthritis and heart disease. In that invaluable help drugs such as Dandelion P And Plus.
Dandelion P is a natural chondroprotector that protects joints from destruction, restores cartilage tissue, and also helps lower blood cholesterol levels. The drug also helps remove toxins from the body.
Dihydroquercetin Plus– improves blood microcirculation, removes harmful cholesterol, strengthens the walls of blood vessels, making them more elastic.
is a serious autoimmune disease that is dangerous due to its complications. Do not despair, because such a diagnosis is not a death sentence. Timely diagnosis and proper treatment will help you avoid exacerbations. Be healthy!
USEFUL TO KNOW:
ABOUT JOINT DISEASES
No one thinks about how to avoid pain in the joints - the thunder hasn’t struck, why install a lightning rod. Meanwhile, arthralgia - the name of this type of pain - affects half of people over forty and 90% of those over seventy. So preventing joint pain is something worth considering, even if you...
Laboratory research
General blood analysis. An increase in ESR is often observed in SLE, but this sign does not correlate well with disease activity. An unexplained increase in ESR indicates the presence of an intercurrent infection.
. Leukopenia (usually lymphopenia) is associated with disease activity.
. Hypochromic anemia is associated with chronic inflammation, hidden gastric bleeding, taking certain drugs. Mild or moderate anemia is often detected. Severe Coombs-positive autoimmune hemolytic anemia is observed in less than 10% of patients.
Thrombocytopenia is usually detected in patients with APS. Very rarely, autoimmune thrombocytopenia develops associated with the synthesis of AT to platelets.
. An increase in CRP is unusual; noted in most cases in the presence of concomitant infection. Moderate increase in CRP concentration (<10 мг/мл) ассоциируется с атеросклеротическим поражением сосудов.
General urine analysis
Proteinuria, hematuria, leukocyturia are detected, the severity of which depends on the clinical and morphological variant of lupus nephritis.
Biochemical studies
Changes in biochemical parameters are nonspecific and depend on the predominant damage to internal organs during different periods of the disease. Immunological studies
. Antinuclear factor (ANF) is a heterogeneous population of autoantibodies that react with various components of the cell nucleus. ANF is detected in 95% of patients with SLE (usually in high titer); its absence in the vast majority of cases argues against the diagnosis of SLE.
Antinuclear AT. ATs to double-stranded (native) DNA (anti-DNA) are relatively specific for SLE; detected in 50-90% of patients ♦ AT to histones, more typical for drug-induced lupus. AT to 5m antigen (anti-Sm) are highly specific for SLE, but they are detected only in 10-30% of patients; AT to small nuclear ribonucleoproteins is more often detected in patients with manifestations of mixed connective tissue disease ♦ AT to Ro/SS-A antigen (anti-Ro/SSA) is associated with lymphopenia, thrombocytopenia, photodermatitis, pulmonary fibrosis, Sjögren's syndrome. AT to La/SS-B antigen (anti-La/SSB) is often found together with anti-Ro.
APL, false-positive Wasserman reaction, lupus anticoagulant and AT to cardiolipin are laboratory markers of APS.
Other laboratory abnormalities
In many patients, so-called lupus cells are detected - LE (ot lupus erythematosus) cells (leukocytes that have phagocytosed nuclear material), circulating immune complexes, RF, but the clinical significance of these laboratory abnormalities is small. In patients with lupus nephritis, a decrease in the total hemolytic activity of complement (CH50) and its individual components (C3 and C4), which correlates with the activity of nephritis (especially the C3 component), is observed.
Diagnostics
To diagnose SLE, the presence of one symptom of the disease or one identified laboratory change is not enough - the diagnosis is established on the basis of the clinical manifestations of the disease, data from laboratory and instrumental research methods and the classification criteria of the disease of the American Association of Rheumatology.American Rheumatology Association Criteria
1. Rash on the cheekbones: fixed erythema on the cheekbones, tending to spread to the nasolabial area.2. Discoid rash: erythematous raised plaques with adherent skin scales and follicular plugs; Old lesions may have atrophic scars.
3. Photosensitivity: A skin rash that occurs as a result of an unusual reaction to sunlight.
4. Oral ulcers: ulceration of the oral cavity or nasopharynx; usually painless.
5. Arthritis: non-erosive arthritis affecting 2 or more peripheral joints, manifested by tenderness, swelling and effusion.
6. Serositis: pleurisy (pleural pain, or pleural friction rub, or the presence of pleural effusion) or pericarditis (confirmed by echocardiography or auscultation of a pericardial friction rub).
7. Kidney damage: persistent proteinuria >0.5 g/day or cylinder (erythrocyte, hemoglobin, granular or mixed).
8. Damage to the central nervous system: convulsions or psychosis (in the absence of taking drugs or metabolic disorders).
9. Hematological disorders: hemolytic anemia with reticulocytosis, or leukopenia<4,0х109/л (зарегистрированная 2 и более раза), или тромбоцитопения <100х109/л (в отсутствие приёма ЛС).
10. Immunological disorders ♦ anti-DNA or ♦ anti-Sm or ♦ aPL: -increased level of IgG or IgM (AT to cardiolipin); - positive test for lupus anticoagulant using standard methods; - false-positive Wasserman reaction for at least 6 months with a confirmed absence of syphilis using the Treponema pallidum immobilization test and the fluorescent adsorption test of treponemal AT.
11. ANF: increase in ANF titers (in the absence of taking drugs that cause lupus-like syndrome). The diagnosis of SLE is made when 4 or more of the 11 criteria listed above are found.
Diagnostic criteria for APS
I. Clinical criteria1. Thrombosis (one or more episodes of arterial, venous or small vessel thrombosis in any organ).
2. Pathology of pregnancy (one or more cases of intrauterine death of a morphologically normal fetus after the 10th week of gestation or one or more cases of premature birth of a morphologically normal fetus before the 34th week of gestation or three or more consecutive cases of spontaneous abortions before the 10th week of gestation ).
II. Laboratory criteria
1. AT to cardiolipin (IgG and/or IgM) in the blood in medium or high titers in 2 or more studies with an interval of at least 6 weeks.
2. Plasma lupus anticoagulant in 2 or more studies at least 6 weeks apart, determined as follows:
. prolongation of plasma clotting time in phospholipid-dependent coagulation tests;
. lack of correction for prolongation of clotting time of screening tests in tests of mixing with donor plasma;
. shortening or correction of prolongation of the clotting time of screening tests when adding phospholipids;
. exclusion of other coagulopathies. A specific APS is diagnosed based on the presence of one clinical and one laboratory criterion.
If SLE is suspected, the following studies should be performed:
. general blood test with determination of ESR and counting the content of leukocytes (with leukocyte formula) and platelets. immunological blood test with determination of ANF. general urine analysis. chest x-ray
. ECG, echocardiography.
