Systemic Chronic Lupus Erythematosus - Causes, Signs And Symptoms Of Lupus, Diagnosis, Pathogenesis And Etiology Of The Disease. Classification And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Lupus

Causes, signs and symptoms of systemic chronic lupus erythematosus

Systemic chronic lupus erythematosus is a disease that occurs as a result of a violation of autoimmune processes in the body with the involvement of all organs. The primary sign of the disease is a characteristic rash on the skin. It does not differ in prevalence and is quite rare, in 2-3 cases for every thousand of the population, more often among women of fertile age. The risk group, first of all, includes persons with a genetic predisposition and identical twins.

Reasons for the development of systemic lupus erythematosus

It is generally accepted that the occurrence of systemic chronic lupus erythematosus is facilitated by impaired immunoregulation, that is, the formation of abnormal antibodies (autoantibodies) in the body under the influence of genetic factors, which confirms the relationship of the disease with a hereditary deficiency of components of the immune system.

Although systemic chronic lupus erythematosus is diagnosed mostly in middle-aged women, the hormonal nature of the disease has not been confirmed. This factor rather contributes to the manifestation of the disease than serves as an impetus for its development. If a woman is diagnosed with systemic lupus erythematosus, she is not recommended to take pill contraceptives so as not to aggravate the manifestations of the disease.

There is also an opinion that external negative factors - toxic substances and uncontrolled intake of certain medications, as well as viruses, are predisposing for the onset of the disease.

As a result of past infections of viral etiology, exposure to excessive amounts of solar or ultraviolet radiation, psychological or physical stress, as a result of hormonal disruption in the body, the immune system is disrupted and antibodies to their own healthy tissues begin to form. The cells of the connective tissue are exposed to the immune attack, which leads to pronounced manifestations with allergic accompaniment. The process then goes to all internal organs.

Systemic chronic lupus erythematosus for a long time can be asymptomatic and manifest only as rashes on the skin and minor changes in the musculoskeletal system. But inside the body during this period, there is an accumulation of disorders of the immune system, which can provoke inflammation in almost any organ of the body.

Signs of developing lupus

With systemic lupus erythematosus, connective tissue is directly affected, which is present in all organs and systems of a person, therefore the clinical picture can manifest itself in many ways.

First of all, attention is paid to the appearance of specific rashes on the skin of the face in the form of a "butterfly" and "neckline" on the skin of the breast. The sensitivity of the skin to ultraviolet radiation is significantly increased, which manifests itself in the form of redness, the appearance of spots and rashes. Also a clear sign is the appearance on the surface of the body of disc-shaped elements with a bright red edging, a pale middle and bluish-red spots, similar to spiders on the lower extremities.

Lupus development symptoms

Most often, the earliest symptom of the disease is lupus arthritis and polyarthritis, polyarthralgia. First of all, the small joints of the bones of the hands, wrist, ankle and rarely knee are affected. There are sharp or aching pains, noticeable swelling and redness in the area of the joints involved in the pathological process. Even with the existing deformation, polyarthritis, as a rule, is not erosive in nature. Restriction of movement in the affected limbs ends with persistent deformity and subsequently complete immobilization of the bony joints.

As a result of damage to the external serous membranes of internal organs, lupus pneumonitis and pleurisy occurs. Patients complain of coughing and pain during breathing in the chest area. When listening, moist rales are clearly audible in both lower lobes of the lungs.

Pericarditis and myocarditis are common signs of damage to the cardiovascular system in lupus erythematosus, leading to disruption of the heart. Nagging pains appear, the rhythm of heart contractions changes. A complication such as endocarditis usually has no clinical manifestations and is detected only in laboratory and clinical studies.

Pathological changes in the blood vessels are accompanied by the appearance of cyanosis and weakness of the feet and hands, the limbs become cold, the patient feels a feeling of chilliness.

One of the most severe complications of systemic chronic lupus erythematosus is glomerulonephritis, accompanied by urinary, nephritic or nephrotic syndromes. Severe dense edema, increased blood pressure, erythrocytosis and protein in the urine - in a malignant course, all these symptoms quickly lead to the development of renal failure.

At all stages of the disease, patients have a violation of the neuropsychic state: asthenovegetative syndrome at the onset of the disease and further damage to all parts of the central and peripheral nervous system is observed - encephalitis, myelitis, polyneuritis. Seizures of epilepsy, visual and auditory hallucinations, and delusional states can very rarely be noted.

Abdominal syndrome is accompanied by pain in the abdomen, dyspeptic disorders and anorexia. Hepatitis with systemic lupus erythematosus develops quite rarely.

Diagnostics of the systemic lupus erythematosus

An important role in the diagnosis is played by a comprehensive examination, which includes clinical, laboratory, immunological and histological data. The initial examination performed by the doctor allows you to determine the nature of skin rashes and changes in the oral mucosa, sensitivity to ultraviolet radiation.

Immunological diagnostic methods are used to clarify the systemic nature of the disease - examination of affected and healthy skin areas, changes in the blood formula inherent in lupus erythematosus, detection of antinuclear antibodies. With a Wasserman reaction (blood for syphilis), a false positive result may be noted.

Such mandatory research methods as general urine analysis, general and biochemical blood tests, electrocardiography, X-ray of the joints, chest, ultrasound - examination of the abdominal cavity and kidneys, as well as neurological examination can reveal the spread of the disease to internal organs.

It is necessary to carry out a careful differentiation of the diagnosis with various skin diseases that have similar clinical manifestations in the form of edematous erythema and plaques, mainly on the skin of the face.

Pathogenesis and etiology of the disease

Systemic chronic lupus erythematosus is a genetic disease, as evidenced by the presence in the blood and tissues of a sick person of autoantibodies, lupus erythematosus cells, as well as circulating and located directly in the tissues of immune complexes. Various factors can serve as predisposing factors, or the impetus for the development of the pathological process: exogenous (viruses, drugs, trauma, stress, and others) or endogenous, which include hormonal disorders, abortion, childbirth.

Classification of systemic lupus erythematosus

According to the clinical and laboratory characteristics, the disease has three stages of activity - high, moderate and minimal.

The disease, proceeding in an acute form, is characterized by an increase in temperature, a significant sharp decrease in body weight, severe pain in the joints, skin symptoms and is accompanied by severe lesions of the internal organs and the nervous system. In the future, the course of the disease becomes recurrent with a characteristic polysyndromism. The subacute course of the disease is characterized by a gradual development of the process - the body temperature can be normal or rise to low numbers, the skin manifestations are not as pronounced as in the acute variant, the changes in blood are insignificant. This form is dangerous in that as the pathological process develops, all internal organs and systems of the body are affected, as a rule, with a blurred clinical picture.

Chronic lupus usually presents with one or more symptoms. Against the background of good health, patients have only skin manifestations and arthritis. The process develops slowly and gradually captures new organs and systems. Relapses of polyarthritis and discoid lupus syndrome have been observed for a long time, only 5-10 years after the onset of the disease appears its characteristic polysyndromism.

Treatment of systemic chronic lupus erythematosus

The earlier the treatment of the disease is started, the more chances are to avoid irreversible pathological changes in the organs and systems of the body. Therapy necessarily includes anti-inflammatory drugs, agents that suppress the activity of the immune system and corticosteroid hormones. Unfortunately, this method of treatment is not effective for about half of the patients. In these cases, stem cell therapy is performed. In most cases, autoimmune aggression is not observed after this. This method is recommended even in advanced cases.

Author of the article: Kaplan Alexander Sergeevich | Orthopedist

Education: diploma in the specialty "General Medicine" received in 2009 at the Medical Academy. I. M. Sechenov. In 2012 completed postgraduate studies in Traumatology and Orthopedics at the City Clinical Hospital named after Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.