Treatment Of Systemic Lupus Erythematosus

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Lupus treatment

Systemic lupus erythematosus is a chronic disease that is caused by autoimmune processes in the body. Most often, women suffer from it, whose age varies from 15 to 45 years. The dry numbers of statistics indicate that systemic lupus is not a very common disease. So, out of 100 thousand of the population, only 50 people will develop this pathology.

Although lupus is a chronic disease, it must be treated. The therapy allows you to alleviate a person's condition during an exacerbation of the disease, as well as to maximize the period of remission.

Content:

• Causes and risk factors for the development of systemic lupus erythematosus
• How can systemic lupus erythematosus develop?
• Systemic lupus erythematosus symptoms
• Diagnostic criteria for systemic lupus erythematosus
• Differential diagnosis
• How to treat systemic lupus erythematosus
• Disease prevention
• Prognosis for life with systemic lupus erythematosus
• Power features
• Which doctor is treating?

Causes and risk factors for the development of systemic lupus erythematosus

Among the risk factors that can, to one degree or another, affect the occurrence of systemic lupus erythematosus, one can single out:

• Frequent stress.
• Excessive exposure to ultraviolet rays on the skin. In this regard, severe tanning and sunburn are very dangerous.
• Hypothermia of the body.
• Excessive mental and physical stress.
• Postponed viral diseases, or their chronic course. In this regard, measles, rubella, influenza, mumps, herpes, cytomegalovirus, Epstein-Barr virus can pose a danger.
• Human immunodeficiency virus, or stage AIDS.
• Immune system disorders. The development of the disease can be affected by the lack of the C2 component in the complement system, which is a complex complex of proteins that constantly circulate in the blood.
• The risks of developing the disease increase if a person has a burdened heredity. This means that systemic lupus is more likely to occur when close relatives have suffered from the disease.
• The circulation in the blood of such antigens as: B7, B35, HLA, All, DR2, DR3.

There are several risk factors that, according to scientists, are capable of provoking the development of the disease, but the exact cause of the disease is still unknown. Modern science believes that lupus is a polyetiological disease, that is, it is caused by a number of reasons.

How can systemic lupus erythematosus develop?

Lupus erythematosus can have a different origin. Sometimes the disease manifests itself acutely, and sometimes it develops gradually.

Depending on this, they distinguish:

• Acute onset of lupus, when symptoms of the disease occur unexpectedly, against the background of complete health.
• Subclinical onset of the disease. In this case, the symptoms increase gradually and are often disguised as other diseases of a rheumatic nature.

Depending on the course of the disease, it is customary to distinguish:

• The acute course of the disease. In this case, the person knows exactly when the symptoms of lupus were manifested. The disease is accompanied by an increase in body temperature, characteristic rashes appear on the face, and joints begin to hurt. If there is no adequate treatment for the acute course of the disease, then after six months the patient's nervous and urinary system will be seriously affected.
• Subacute course of the disease. It is according to this type that the disease most often occurs. Its onset is not very specific for systemic lupus. A person begins to experience painful sensations in the joints, general health suffers, sometimes a rash appears on the skin. As a rule, the disease is exacerbated by periods, and during each exacerbation, new organs and systems are involved in the pathological process.
• Chronic course of the disease. In this case, lupus for a long time is expressed exclusively by the symptoms with which it manifested. That is, during an exacerbation, a person's joints begin to ache, skin rashes appear and Raynaud's syndrome develops. Other systems and organs are not affected. The chronic course of the disease has the most favorable prognosis.

Systemic lupus erythematosus symptoms

Inflammation of the joints

Arthritis with systemic lupus erythematosus does not develop in only 10% of cases. At the same time, patients complain of pain and inflammation of the joints. Such a situation is rarely observed when a person has only one joint pain, most often they are massively affected.

The first to suffer are the joints of the phalanges of the fingers, the wrist joints. The ankle joints are inflamed somewhat less often. Very rarely, arthritis affects the large joints that move the knees and elbows. Joint inflammation in systemic lupus erythematosus is accompanied by severe pain in the muscles.

Dermatological manifestations

Most often, with lupus, red rashes appear on the person's face, which merge and resemble a butterfly in shape.

The skin is affected by the following type:

• Vascular eruptions or vascular butterfly. The focus of redness is not persistent, it tends to intensify after exposure to the skin of the face of sunlight, frost, wind. The rash can get stronger with excitement. The focus of inflammation is flat, or rises above the skin. When the inflammatory process subsides, scar tissue does not form.
• Rashes can be multiple, they occur on areas of the body that most often remain open - this is the face, neck, décolleté, arms and legs. Redness appears after exposure to sunlight. When the irritant is removed, the rash goes away.
• Subacute lupus is characterized by the appearance of erythema after exposure to the sun. The rashes rise somewhat above the skin, have a different shape. They can resemble a crescent moon or combine into rings. Such spots are prone to flaking. After the inflammation process subsides, a depigmentation area may remain in the place of the former spot.
• Discoid lupus erythematosus. In this case, small red plaques first appear on the skin, which eventually merge and form one large focus. In the center, the spot peels off, and after it passes, scars remain on the skin. A favorite place for such rashes is the face, scalp and the surface of the skin on the bends of the arms and legs.

Sometimes patients experience severe hair loss, which can be very intense and even go to baldness. Also, nails and gums are often involved in the pathological process.

Inflammation of the serous membranes

Almost all patients have pleurisy, pericarditis and peritonitis. Since with systemic lupus, the serous membranes suffer in 90% of cases, their defeat is a symptom pathognomonic for this disease.

Inflammation of the heart and blood vessels

Against the background of lupus, pathologies such as:

• Pericarditis.
• Myocarditis.
• Vasculitis.
• Endocarditis Liebman-Sachs.
• Myocardial infarction occurs against the background of damage to the coronary arteries.

Angiotrophoneurosis of small arteries (Raynaud's syndrome)

This syndrome is expressed in the fact that a person has capillary spasms, and in the future this leads to necrosis of the fingertips on the hands, to lesions of the retina and to the development of severe arterial hypertension.

Respiratory system disorders

Among the characteristic pathologies of the respiratory system that occur against the background of lupus are:

• Inflammation of the pleural lobes.
• Pulmonary hypertension.
• AFP (acute lupus pneumonitis) is observed in 1-4% of cases.
• The connective tissue of the lungs may suffer, against the background of which multiple foci of necrosis appear in them.
• TELA.
• Patients begin to suffer from frequent bronchitis and pneumonia.

Disorders of the urinary system

Against the background of systemic lupus erythematosus, pyelonephritis and glomerulonephritis, urinary, nephrotic and nephritic syndrome can develop.

CNS disorders

• Frequent complaints of patients are: sleep disturbance, headaches, irritability, deterioration of mood, increased weakness and fatigue. All these symptoms are characteristic of the asthenic-vegetative syndrome.
• After the acute stage of the disease is over, many patients indicate that their sensitivity is deteriorating, paresthesias often occur. The doctor at the reception often diagnoses the extinction of tendon reflexes.
• With a severe course of the disease, inflammation of the brain and its membranes can develop.
• Many patients note that during an exacerbation of the disease, they often experience mood swings.
• In general, mental and cognitive processes suffer, memory deteriorates, and intelligence decreases.
• Some patients have seizures and psychosis.

Diagnostic criteria for systemic lupus erythematosus

For a doctor to be able to diagnose lupus erythematosus, at least four of the eleven items listed below must be confirmed:

• The presence of skin lesions in the face. There is erythema (flat or raised) on the cheekbones, cheeks, and nose.
• The presence of discoid lesions on the skin. In this case, the spots are peeling, and in the center they are prone to hyperkeratosis. After the inflammation has passed, a scar forms in its place.
• Skin rashes appear or worsen after exposure to ultraviolet radiation.
• Areas of ulceration appear in the mouth.
• More than 2 small joints are affected by arthritis. They periodically become inflamed and sore.
• There is pleurisy, pericarditis, and / or peritonitis.
• The inflammatory process affects the kidneys. Blood and protein are found in the urine.
• There are disorders of the nervous system. A person is prone to psychoses, seizures, frequent mood swings.
• At least two blood tests performed reveal anemia, lymphopenia, leukopenia, and thrombocytopenia.
• According to the results of immunological studies, a high level of rheumatoid factor is found, sometimes an analysis for syphilis gives a positive result, which is false. With the le-test, LE cells or systemic lupus erythematosus cells can be detected in the blood.
• Anti-nuclear antibodies circulate in the blood. They are detected using the ELISA method.

Differential diagnosis

The main problem in diagnosing systemic lupus erythematosus is that the disease has many symptoms and signs in common with other diseases of a rheumatic nature, including:

• Rheumatic lesions of connective tissue (dermatomyositis, scleroderma).
• Rheumatism.
• Polyarthritis.
• Rheumatoid arthritis.
• Still's disease.
• Autoimmune inflammation of the kidneys caused by other diseases.
• Cytopenias caused by autoimmune reactions of the body.

How to treat systemic lupus erythematosus

It is known that the disease manifests itself against the background of autoimmune reactions in the body. Therefore, therapy should be based on their suppression. For this, immunosuppressive treatment is carried out using various groups of drugs.

Hormones

Drugs from the GCS group (glucocorticosteroids) are the first-line drugs in the treatment of lupus. Their action is aimed at suppressing the activity of the immune system, thereby reducing the inflammatory response. Until that time, until doctors began to use GCS in the treatment of such patients, their life expectancy did not exceed five years. It is thanks to hormones that people diagnosed with SLE now live much longer.

Glucocorticosteroid therapy can be considered successful when the following results are achieved:

• Exacerbations of the disease are rare;
• Remission is achieved by taking small doses of hormonal drugs;
• The inflammation process is not very intense;
• The patient's condition remains steadily stable.

Prednisolone is the drug of choice in the treatment of lupus. The maximum daily dose is 50 mg, with a gradual decrease to 15 mg.

Despite the high efficiency of treatment with glucocorticosteroids, sometimes they do not cope with the task.

The therapy does not work for various reasons, including:

• The patient does not follow the doctor's recommendations (misses the pills);
• The dosage was initially chosen incorrectly;
• The disease is severe;
• The therapy was started too late.

Many patients are wary of taking hormonal drugs because of the many side effects they cause. However, systemic lupus is not a disease that gives a person a choice. If the patient refuses therapy, then his life expectancy is reduced to 5 years, and its quality deteriorates significantly. While patients taking hormone therapy can live for more than a dozen years. Moreover, not every person develops side effects.

However, taking GCS is always associated with certain risks, including:

• Development of gastric ulcer and intestinal ulcer, the formation of steroid erosions.
• Against the background of a decrease in immunity, the risk of infection with other diseases increases.
• The development of arterial hypertension.
• Development of diabetes mellitus.

However, if the patient adheres to the dosage prescribed by the doctor and does not miss the drug, side effects are rare.

Cytostatic drugs

Cytostatics are prescribed for lupus erythematosus in the case when hormone therapy is ineffective. In this case, GCS drugs are not canceled.

Cytostatics enhance the suppression of immunity, indications for their appointment are:

• The acute course of the disease with its rapid progression.
• Lesions of the urinary system against the background of lupus.
• Lack of result from treatment with glucocorticosteroids.
• Reducing the dose of Prednisolone against the background of its poor tolerance by the patient, or due to the development of pronounced side effects.
• The presence of the need to reduce the maintenance dose of GCS.
• The patient develops dependence on treatment with glucocorticosteroids.

The cytostatic drugs of choice remain Azathioprine (Imuran) and Cyclophosphamide.

Treatment with cytostatics can be considered successful if the following results are observed:

• The severity of the symptoms of the disease decreases;
• Hormonal dependence disappears;
• The disease subsides;
• A long and stable period of remission develops.

Treatment with non-steroidal anti-inflammatory drugs

NSAIDs are used to reduce the severity of arthritis. Most often, Indomethacin and Diclofenac are prescribed for this purpose. The drugs are recommended to be taken orally. The duration of NSAID intake is determined by the disappearance of joint pain and the normalization of body temperature.

Additional therapy

Plasmapheresis is an effective adjunctive therapy for lupus erythematosus. The procedure is aimed at cleansing the patient's blood, during which immune complexes that cause the inflammatory process, as well as metabolic products, are removed from it.

Disease prevention

It is impossible to prevent the development of the disease with the help of preventive measures, but it is quite possible to increase the period of remission.

To do this, you need to adhere to the following recommendations:

• Visits to your doctor should be regular. Lupus erythematosus is treated by a rheumatologist.
• It is impossible to deviate from the treatment regimen prescribed by the doctor. The drugs should be taken on schedule.
• The patient should have adequate rest. You need to sleep at least 8 hours a day.
• You should adhere to a dietary diet with limited salt, but with a predominance of protein foods.
• It is important to lead a healthy lifestyle: to spend more time outdoors, to engage in physical culture.
• While in the sun, you must use special sunscreen.
• In the event of foci of inflammation on the skin, it is imperative to use ointments with GCS. Most often, doctors prescribe Advantan for lupus.

Prognosis for life with systemic lupus erythematosus

Having heard your diagnosis, you should not despair. Despite the fact that lupus is a dangerous disease, millions of people around the world live with it. At the same time, they lead an active lifestyle, observing some restrictions.

How to improve your quality of life:

• Since people with systemic lupus get tired faster and may suffer from increased fatigue, it makes sense to reconsider their regimen. It is much better to lie down to rest several times a day than to bring your body to exhaustion and provoke an exacerbation of the disease.
• It is important to pay attention to the reasons that lead to a relapse of the disease. Most often these are stresses, infectious diseases, a long time in the sun. If possible, these risk factors should be eliminated from your life.
• You should not give up physical activity, but it must be adequate. For people with systemic lupus erythematosus, yoga or Pilates is appropriate.
• It is imperative to give up smoking, especially since this bad habit increases the risks of developing bronchopulmonary diseases.
• You need to collect as much information as possible on your illness, but it must be obtained from competent sources.
• Be sure to enlist the support of loved ones.

Power features

Food is designed to help a person cope with an existing disease. Therefore, you need to compose your menu correctly. First of all, you should focus on those products that can protect the brain, heart and blood vessels, as well as the kidneys from rheumatic lesions.

What not to eat with systemic lupus erythematosus:

• It is necessary to limit the intake of fats. The danger is not only fast food, but also dishes with a high content of oils (olive, butter, vegetable). Such products increase blood cholesterol levels, provoking the early development of myocardial infarction.
• Drinks containing caffeine put an increased load on the stomach, heart, and central nervous system. Therefore, it is best to refuse coffee, or limit its use.
• Reducing the amount of salt consumed helps protect the kidneys from damage, and also makes it possible to lower blood pressure levels.
• Alcohol is categorically contraindicated in patients with systemic lupus erythematosus.

What can you eat with systemic lupus erythematosus:

• Be sure to include fruits and vegetables in the diet. They are valuable sources of vitamins, fiber and minerals. Moreover, preference should be given to those vegetables and fruits that ripen in a particular season.
• You need to eat foods rich in vitamin D. It allows you to prevent the development of osteoporosis, as a complication of hormone therapy. Sour milk products, cheese and milk should be selected with a low percentage of fat. Advice: if you drink the drugs with milk (in the absence of contraindications), then the gastric mucosa will suffer to a lesser extent.
• Be sure to include porridge and whole grain bread in your menu. These foods contain B vitamins and plenty of fiber.
• Protein must enter the body along with meat: you need to eat poultry, veal, turkey, rabbit meat. For cooking fish dishes, you should choose low-fat fish, for example, pollock, hake, cod, pink salmon, low-fat herring, squid. Seafood is rich in minerals and also saturates the body with Omega-3 unsaturated fatty acids.
• A prerequisite for proper nutrition with lupus erythematosus is the use of sufficient volumes of fluid. So, you need to drink at least eight glasses of water per day. This will normalize metabolism and start metabolic processes in the body.

Systemic lupus erythematosus is a dangerous disease and can significantly shorten life, but only if treatment is ignored. To prevent the victory of autoimmune reactions over your body, you must lead a healthy lifestyle and follow all medical recommendations exactly.

Which doctor is treating?

Since the disease manifests itself in a variety of symptoms, it is necessary to consult a therapist if the state of health worsens. After the doctor has done the necessary tests to suspect lupus, he or she will refer the patient to a rheumatologist. It is this doctor who treats this disease. However, in addition, you may need to consult a nephrologist, pulmonologist, dermatologist and other narrow specialists.

Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist

Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".