Systemic Lupus Erythematosus

Definition

systemic lupus erythematosus is an autoimmune disease that results in multisystem involvement by the production of antinuclear antibodies.




Pathophysiology

A person with a susceptibility gene gets sunburn and that results in the activation of apoptosis and destruction of the cell. From this destructive process, parts of the cell nucleus will get exposed to the immune system, and the B cells will produce antibodies against these nuclear parts (nuclear antigen). This antigen-antibody complex can get into the bloodstream and reach all parts of the body. This will cause an inflammatory reaction. It is a type 3 hypersensitivity reaction.


Diagnosis


Skin

  • Malar rash ( butterfly rash) Occurring across the cheeks and over the bridge of the nose

  • A discoid rash appears on the scalp, face, ear, chest or arm. when these lesions heal, they can leave a scar

  • Photosensitivity other rashes from sun exposure

Mucosa ( inner membrane )

  • Ulcers in the mouth or nose

Serosa

  • Serositis

  • Pericarditis

  • Pleuritis

  • Myocarditis

  • Endocarditis

Libman sacks endocarditis - where the vegetation form, which are clumps of fibrin, blood-clotting protein and immune cells around the mitral valve.

Joints

  • Arthritis or arthralgia

Kidney

  • Abnormal urine protein

  • Diffuse proliferative glomerulonephritis

Brain

  • Neurological disorders

- seizures

- psychosis


Blood

  • Hematologic disorders

- Anemia (if RBC are targeted)

- Thrombocytopenia (if platelets are targeted)

-Leukopenia (if WBC and immune cells are targeted)


Antibodies

  • Antinuclear antibodies

  1. Presence of a large portion of antinuclear antibodies are seen in lupus patient, but this test is not specific, because they are also seen in other autoimmune diseases.

Other autoantibodies

MORE SPECIFIC

  1. Anti smith (targets ribonucleoprotein)

  2. Anti dsDNA (targets double-stranded DNA)

LESS SPECIFIC

  1. Antiphospholipid


Treatment

There are several medications used to treat lupus depends on the symptoms.

  • Restrict to appear in the open sun.

  • Chloroquine

  • Topical corticosteroids

  • Prednisolone

  • Methotrexate

  • Azathioprine



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