Systemic lupus erythematosus - Causes, Symptoms and Treatment .MF .
Systemic lupus erythematosus (SLE) - is a disease in which due to the disruption of the immune system develop inflammatory responses in various organs and tissues.
disease occurs with periods of exacerbation and remission, the occurrence of which is difficult to predict.At the end of systemic lupus erythematosus disease leads to the formation of an organ, or multiple organs.
Women suffer from systemic lupus erythematosus 10 times more often than men.The disease is most common between the ages of 15-25 years.Most often, the disease manifests during puberty, during pregnancy and the postpartum period.
Causes of systemic lupus erythematosus
The cause of lupus is not known.We discuss the indirect influence of factors external and internal environment, such as heredity, viral and bacterial infections, hormonal changes, environmental factors.
• for the occurrence of the disease plays a role genetic predisposition.It is proved that if one of the twins revealed lupus, the risk that the second one can be i
• in favor of viral and bacterial theory says frequent finding in patients with systemic lupus erythematosus Epstein-Barr virus.In addition, it is proved that the DNA of certain bacteria capable of stimulating the synthesis of antinuclear autoantibodies.
• in women with SLE in the blood is often determined by the increase in hormones such as estrogen and prolactin.Often the disease manifests during pregnancy or after childbirth.All this speaks in favor of the hormonal development of the disease theory.
• know that ultraviolet rays have a number of susceptible individuals are able to start the production of skin cells autoantibodies that may cause or aggravate an existing disease.
Unfortunately, none of the theories were not significantly explain the cause of the disease.Therefore, at the present time it is considered to be systemic lupus erythematosus disease of poly etiology.
symptoms of systemic lupus erythematosus
Under the influence of one or more of the above factors in a malfunction of the immune system is "exposure" of the DNA of different cells.Such cells are perceived as foreign by the body (antigens) and to protect against specific proteins produced antibodies specific to these cells.The interaction of antibodies and immune complexes produced antigens, which are fixed in different organs.These systems lead to the development of immune inflammation and cell damage.Most often affects the connective tissue cells.Given the wide distribution of the connective tissue in the body, in systemic lupus erythematosus in the pathological process involved almost all the organs and tissues of the body.Immune complexes, fixing on the wall of blood vessels, can provoke thrombosis.Circulating antibodies due to their toxic effect lead to the development of anemia and thrombocytopenia.
Systemic lupus erythematosus refers to chronic diseases occurring with periods of exacerbation and remission.Depending on the initial manifestations are the following variants of the disease:
• keen for SLE - manifested by fever, weakness, fatigue, pain in the joints.Very often patients indicate the first day of the disease.Within 1-2 months, formed a full-blown injury to vital organs.When rapidly progressive course of 1-2 years, patients usually die.
• subacute SLE - the first symptoms of the disease is not as pronounced.From demonstrations to organ damage passes on average 1-1.5 years.
• chronic SLE - for many years, there is one or more symptoms.In chronic course rare periods of exacerbation, without disruption to the vital organs.Often, for the treatment of the disease requires minimal doses.
Typically, the initial manifestations of nonspecific diseases, when taking anti-inflammatory drugs, or spontaneously they leave without a trace.Often the first sign of the disease is the appearance of redness on the face in the form of a butterfly's wings, which also disappears with time.Remission depending on the type of flow can be quite long.Then, under the influence of some predisposing factors (sun exposure, pregnancy) there is an exacerbation of the disease, which was also later replaced by the remission phase.Over time, non-specific manifestations of joining organ damage symptoms.For the developed clinical picture is characterized by damage to the following organs.
1. skin, nails and hair .Skin lesions - one of the most common symptoms of the disease.Often the symptoms appear or are worse after prolonged exposure to the sun, cold, with psycho-emotional shock.A characteristic feature of SLE is the appearance of the cheeks and nose, reddening of the skin in the form of a butterfly's wings.
Erythema type butterfly
So, as a rule, on exposed skin (face, upper extremities, the region of "cleavage") found different shapes and sizes of skin redness, prone to peripheral growth centrifugal erythema Biett.Discoid lupus erythematosus is characterized by the appearance of redness on the skin, which is then followed by an inflammatory swelling, then the skin in this area is sealed, and the final sections are formed atrophy with scarring.
discoid lupus erythematosus
Pockets of discoid lupus can occur in various areas, in this case we speak about the process of dissemination.Another clear manifestation of skin lesions is a capillary-redness and swelling and numerous melkotochechnye hemorrhage on the balls of the fingers, palms, soles.Hair defeat in systemic lupus erythematosus manifested alopecia.Changes in the structure of nails, up to atrophy okolonogtevogo roller occurs during the exacerbation of the disease.
2. Mucous membranes.Usually it affects the mucous membrane of the mouth and nose.The pathological process characterized by the appearance of redness, formation of mucosal erosions (enanthema), as well as small ulcers of the mouth (thrush).
If cracks, erosions and ulcers of the red border of the lips are diagnosed lupus cheilitis.
3. Musculoskeletal .The defeat of the joints occurs in 90% of patients with SLE.
Arthritis joint II finger in SLE
in the pathological process involved the small joints, usually the fingers.Defeat is symmetrical, patients worried about the pain and stiffness.The deformation of the joints is rare.Aseptic (without inflammatory component) necrosis of bone are common.It affects the femoral head and the knee joint.The clinic is dominated by symptoms of functional insufficiency of the lower limbs.With involvement in the pathological process of ligament apparatus develop non-permanent contracture, in severe cases, dislocations and subluxations.
4. respiratory system.The most common lung disease.Pleurisy (accumulation of fluid in the pleural cavity) is usually bilateral, accompanied by chest pain and shortness of breath.Acute lupus pneumonitis and pulmonary hemorrhage related to life-threatening conditions and without treatment lead to the development of respiratory distress syndrome.
5. Cardiovascular system.The most common is endocarditis Libman-Sacks with frequent lesion of the mitral valve.At the same time resulting in inflammation occurs fusion of the valve leaflets and the formation of heart disease on the type of stenosis.When pericarditis pericardial leaflets thicken, as the liquid can occur between them.Myocarditis is manifested by pain in the chest, increased heart.In SLE commonly affects the blood vessels of small and medium caliber, including the coronary arteries and the arteries of the brain.Therefore, stroke, coronary heart disease is a major cause of mortality in patients with SLE.
6. Kidney .In patients with SLE lupus nephritis is formed at a high activity of the process.
7. nervous system.Depending on the affected area, in SLE patients revealed a wide range of neurological symptoms, ranging from headaches, migraine type and ending with transient ischemic attacks and strokes.In a period of high activity of the process there may be seizures, chorea, cerebral ataxia.Peripheral neuropathy occurs in 20% of cases.The most dramatic manifestation of it is considered to optic neuritis with loss of vision.
diagnosis of systemic lupus erythematosus
diagnosis of SLE is considered to be established if 4 or more of the 11 criteria (American Associations for Rheumatology, 1982.).
|Erythema type butterfly||Fixed erythema (flat or elevated) on the cheeks, with a tendency to spread to the nasolabial folds.|
|Discoid rash||towering erythematous lesions with a tightly fitting scales over time atrophy of the skin and scarring.|
|Photosensitivity||occurrence or increased severity of the rash after sun exposure.|
|ulcers of the mouth and / or nose and throat||usually painless.|
|Arthritis||appearance of swelling and soreness at least two joints without distortion.|
|Serozem||pleurisy or pericarditis.|
|Kidney damage||One of the following manifestations: periodic increase of protein in the urine and 0.5 g / day or the definition of the cylinders in the urine.|
|CNS||One of the following manifestations: seizures or psychosis is not related to other causes.|
|hematologic abnormalities||One of the following manifestations: hemolytic anemia, lymphopenia, thrombocytopenia, or not related to other causes.|
|Immune disorders||Identification of LE-cells, or antibodies to dsDNA in serum, or antibodies to Smith-antigen, or false-positive Wassermann reaction, continuing for 6 months without detection of Treponema pallidum.|
|Antinuclear antibodies||Increased titer of antinuclear antibodies is not associated with other causes.|
Immunological tests play an important role in the diagnosis of SLE.The absence of serum antinuclear factor makes the diagnosis of SLE questioned.On the basis of laboratory data is determined by the degree of disease activity.
With the increase in the level of activity increases the risk of new organs and systems, as well as aggravation of existing diseases.
classification of SLE according to the degree of activity.
treatment of systemic lupus erythematosus
Treatment should be most suitable for a particular patient.Hospitalization is required in the following cases:
• under persistently elevated temperature for no apparent reason;
• in the event of life-threatening conditions: rapidly progressive renal failure, acute pneumonitis or pulmonary hemorrhage.
• the appearance of neurological complications.
• with a significant decrease in the number of platelets, red blood cells or blood cells.
• when the exacerbation of SLE can not be cured in an outpatient setting.
For the treatment of systemic lupus erythematosus in acute widely used hormonal drugs (prednisone) and cytotoxic drugs (cyclophosphamide) in a specific pattern.nonsteroidal anti-inflammatory drugs (diclofenac) is prescribed for the affected organs of the musculoskeletal system, as well as the temperature rises.
for adequate treatment of the disease of an organ requires expert advice in this area.
prognosis for life in SLE with timely and proper treatment is favorable.The five-year survival rate of these patients is approximately 90%.But nevertheless the mortality of patients with SLE in the general population than three times.Poor prognosis factors considered early onset of the disease, male gender, the development of lupus nephritis, high activity of the process, the accession of infection.
therapists Sirotkin EV