SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

INTRODUCTION

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can be fatal; however, with recent medical advances, fatalities are becoming increasingly rare.

The immune system attacks the body’s cells and tissue, resulting in inflammation and tissue damage.

SLE can affect any part of the body, but most often harms the heart, joints, skin, lungs, blood vessels, liver, kidneys, and nervous system.

Lupus can occur at any age, and is most common in women, particularly of non-European descent.

EPIDEMIC

About 90% of SLE sufferers are women while about 10% are men and children.

About 90% of women with SLE are in their childbearing years, within the range of 15 to 50 years old.Ratio of SLE sufferers :In the West, among Afro-Carribeans 1 in 250-500 peopleUSA - 1 in 2,000 peopleChina - 1 in 1,000 people

In Malaysia, it is estimated that more than 10,000 people have been diagnosed with SLE over the past 30 years. However, this number may be only the tip of the iceberg. The Malaysian SLE Association believes that there are many more SLE sufferers in Malaysia who have not been diagnosed.

STATISTICS BY COUNTRY FOR

LUPUS

Country/Region Extrapolated Prevalence

Population Estimated Used

USA 1,511,461 293,655,4051

Czech Republic 6,414 1,0246,1782

United Kingdom 310,216 60,270,7082

Malaysia 121,071 23,522,4822

China 6,685,245 1,298,847,6242

About prevalence and incidence statistics in general for Lupus: The word 'prevalence' of Lupus usually means the estimated population of people who are managing Lupus at any given time

ETIOLOGY

The cause(s) of lupus is currently unknown, but there are environmental and genetic factors involved.

Some environmental factors which may trigger the disease include :

Infections

antibiotics (especially those in the sulfa and penicillin groups)

ultraviolet light

extreme stress

certain drugs

hormones.

SYMPTOMS

SYMPTOMS PERCENTAGE (%)

Achy joints / arthralgia 95

Fever of more than 100 degrees F / 38 degrees C 90

Arthritis / swollen joints 90

Prolonged or extreme fatigue 81

Skin Rashes 74

Anemia 71

Kidney Involvement 50

Pain in the chest on deep breathing / pleurisy 45

Butterfly-shaped rash across the cheeks and nose 42

Sun or light sensitivity / photosensitivity 30

Hair loss 27

Abnormal blood clotting problems 20

Fingers turning white and/or blue in the cold 17

Mouth or nose ulcers 12

SYSTEMIC LUPUS ERYTHEMATOSUS

butterfly rash

Finger turns blue

Skin rashes

DIAGNOSIS

Criterion Definition

Malar Rash Rash over the cheeks

Discoid Rash Red raised patches

Photosensitivity Reaction to sunlight, resulting in the development of or increase in skin rash

Oral Ulcers Ulcers in the nose or mouth, usually painless

Arthritis Nonerosive arthritis involving two or more peripheral joints (arthritis in which the bones around the joints do not become destroyed)

Serositis Pleuritis or pericarditis (inflammation of the lining of the lung or heart)

Renal Disorder Excessive protein in the urine (greater than 0.5 gm/day or 3+ on test sticks) and/or cellular casts (abnormal elements the urine, derived from red and/or white cells and/or kidney tubule cells)

DIAGNOSIS

Criterion Definition

Neurologic Disorder

Seizures (convulsions) and/or psychosis in the absence of drugs or metabolic disturbances which are known to cause such effects

Hematologic Disorder

Hemolytic anemia , leukopenia , lymphopenia or thrombocytopenia. The leukopenia and lymphopenia must be detected on two or more occasions. The thrombocytopenia must be detected in the absence of drugs known to induce it.

Antinuclear Antibody

Positive test for antinuclear antibodies (ANA) in the absence of drugs known to induce it.

Immunologic Disorder

Positive anti-double stranded anti-DNA test, positive anti-Sm test, positive antiphospholipid antibody such as anticardiolipin, or false positive syphilis test (VDRL).

Adapted from: Tan, E.M., et. al. The 1982 Revised Criteria for the Classification of SLE. Arth Rheum 25: 1271-1277.

BLOOD TESTS IN THE DIAGNOSIS OF SLE

The anti-nuclear antibody test (ANA) to determine if autoantibodies to cell nuclei are present in the blood.

The anti-DNA antibody test to determine if there are antibodies to the genetic material in the cell .

The anti-Sm antibody test to determine if there are antibodies to Sm, which is a ribonucleoprotein found in the cell nucleus .

Tests to examine the total level of serum (blood) complement (a group of proteins which can be consumed in immune reactions), and specific levels of complement proteins C3 and C4.

TREATMENTS Drug therapy

nonsteroidal anti-inflammatory drugs and antimalarials

Disease-modifying antirheumatic drugs (DMARDs)

Immunomodulating Drugs

Anticoagulants

Lifestyle changes

avoiding direct sunlight, covering up with sun-protective clothing, and using strong UVA/UVB sunblock lotion can also be effective in preventing photosensitivity problems.

Weight loss is also recommended in overweight and obese patients to alleviate some of the effects of the disease, especially where joint involvement is significant.

REFERENCES

http://www.lupus.org/webmodules/webarticlesnet/templates/new_aboutintroduction.aspx?articleid=75&zoneid=9

http://en.wikipedia.org/wiki/Systemic_lupus_erythematosus

http://www.lupusmalaysia.org/e/what-is-sle/

http://www.cureresearch.com/l/lupus/stats-country.htm