Systemic Lupus Erythematosus Treatment

OVERVIEW:

SLE is an ideal disease with a prevalence that ranges from about 0.3 people in Americans and 0.2 people in Africans. 90% of affected patients are females with a peak age of 30 years. It is associated with an increased risk of morbidity. It is an autoimmune connective tissue disorder and has many clinical features and is characterized by the deregulation of immune responses. Systemic lupus erythematosus treatment is long term but earlier treatment prevents complications.

Factors Require For Systemic Lupus Erythematosus Treatment?

There is higher Concordance in twins and the disease is strongly associated with polymorphic variants in HLA compatible individuals. Mutations in C1, C2, and C4 in immunosuppressive individuals is a major risk factor. There is a hypothesis that SLE occurs due to defects in apoptosis or in the clearance of apoptotic cells which causes inappropriate exposure of antigens of cell surfaces. Various environmental factors have been associated with it which causes acute flares of SLE. Ultraviolet radiations and infections increase the susceptibility of acquiring the disease and systemic lupus erythematosus treatment is required. Whatever is the underlying cause for SLE, the autoantibodies production and immune complex formation inside the body is the main factor for tissue damage in active flares of SLE. This leads to inflammation of vessels and organ damage.

Clinical Features Associated With Sle:

Symptoms such as weight loss and fever and lymphadenopathy may occur during flares of disease. Arthritis may be constant and may occur from time to time. Arthralgia is a common symptom in most people. The joints are painful, swollen and stiffness is associated with arthralgia. Raynaud’s phenomenon is common and may occur for months or years. If Raynaud’s phenomenon is severe it may even cause ulceration of digits. Skin disease is one of the most common symptoms of lupus and is precipitated by exposure to ultraviolet rays. The skin involvement requires systemic lupus erythematosus treatment. Renal involvement is one of the main indicators of prognosis for Systemic lupus erythematosus treatment.

How It Is Diagnosed?

The disease is diagnosed on the basis of history and clinical findings and laboratory findings.

  • Anti dsDNA antibodies are positive in most of cases of SLE.
  • ELISA and other laboratory tests have low specificity while anti dsDNA is more specific for the disease.
  • X-ray hands give a clue of disease affecting joints in various ways. It tells about the joint spaces and bone erosion inside the joint cavity.
  • Anti Ro antibodies
  • Anti La antibodies

Systemic Lupus Erythematosus Treatment

Therapy of SLE is done for the education of the patient for the seriousness of the illness, to control acute flares of disease and to prevent organ damage. It helps maintain the person’s normal physiology. There is no cure for systemic lupus erythematosus and the systemic lupus erythematosus treatment controls the symptoms only. The treatment is long term and patient compliance is required for the complete remission of the disease.

Treatments For Mild to Moderate Disease:

Patients with mild to moderate disease have their disease restricted to the joints and skin only. They suffer arthritis, malar rash, and Discoid rash due to exposure to the sun. The systemic lupus erythematosus treatment is

  • Glucocorticoids
  • Nonsteroidal anti inflammatory drugs like ibuprofen and paracetamol
  • Painkillers or Analgesics
  • Prednisolone(5-20mg/day)
  • Immunosuppressive therapy such as methotrexate, Azathioprine and mycophenolate mofetil (MMF)
  • Monoclonal antibody belimumab which targets growth factors is effective in patients with active disease and for those who don’t respond to the other therapies.

Doses of Glucocorticoids may be increased for the active disease of when the disease involves lungs and heart.

Steroids are to be used for short term only as they may have the worst side effects if given for long term usage. They cause osteoporosis, hyperglycemia, hypertension, and many other side effects.

Treatment of Severe Disease

The severe disease involves the kidney, heart, CNS, and lungs of the person. A high dose of Glucocorticoids and Immunosuppressive agents are required for its treatment. The most commonly used regimen includes cyclophosphamide and methylprednisolone in a cyclic way and this is done as six cycles. Cyclophosphamide causes hemorrhagic cystitis and also affects fertility in males so it is given with precaution in males. Sperm in males and oocyte collection in females is required before the treatment with cyclophosphamide.

Mycophenolate mofetil MMF is used with high dose steroids for kidneys involvement and has fewer side effects. Belimumab decreases disease incidents in patients with active SLE and is well tolerated by patients.  Rituximab is another drug that is effected in selected individuals.

Maintenance Therapy for Systemic Lupus Erythematosus

High dose oral Prednisolone is used and its dose is tapered off gradually. Azathioprine and methotrexate or MMF can also be used for Systemic lupus erythematosus treatment.

Conservative Systemic Lupus Erythematosus Treatment

  • Sun exposure should be prevented
  • Use of sunblocks
  • Maintenance of blood pressure and hypertension
  • Patients with previous episodes of thrombosis should be on regular therapy of Warfarin
  • Risk of osteoporosis can be prevented by using vitamin D and the patients should be scanned and screened for Biochemical changes accordingly

The exact cause of SLE is incompletely understood but genetic factors play an important role. There is higher Concordance in twins and the disease is strongly associated with polymorphic variants in HLA compatible individuals. Various environmental factors have been associated with it which causes acute flares of SLE. Ultraviolet radiations and infections increase the susceptibility of acquiring the disease and systemic lupus erythematosus treatment is required.

When to Consult with Doctor?

SLE is a chronic or long term disease that is progressive and affects multiple systems of the body. If the disease causes significant restriction of mobility the doctor should be consulted. Systemic lupus erythematosus treatment is long term and this treatment decreases flares of active disease and stops the progression of the disease. Steroids used to cause a high risk of complications like osteoporosis, decreased bone mass, and Immunosuppression. It also causes increased blood sugar levels and increased the risk of diabetes. Diabetic patients are advised to increase the dose of insulin during the systemic lupus erythematosus treatment with steroids. It should be used with caution in the patient having osteoporosis with regular bone scans and immunity tests.