Pathology: Systemic lupus erythematosus (SLE) is a chronic, inflammatory, multisystem disease that follows a relapsing and remitting course, and is characterized by an autoantibody response to nuclear and cytoplasmic antigens.
Aetiology: The exact cause of SLE is unknown, but it tends to peak in Afro-Caribbean women aged 25-35 years and has been associated with conditions such as epilepsy, digital infarcts, alopecia, and pleurisy.
Symptoms: Common symptoms of SLE include arthralgia, fever, and malaise.
Signs: SLE may appear with certain signs, such as a malar 'butterfly' rash, a discoid rash, episcleritis, optic neuritis, Raynaud's phenomenon, Sjögren's syndrome, mucosal ulceration, and symmetrical arthritis.
Investigations: Bloods: A full blood count (FBC) may reveal pancytopenia, an elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and reduced levels of C3 and C4.
Auto-Antibodies: Tests may also be carried out to check for the presence of autoantibodies such as antinuclear antibody (ANA), anti-double-stranded DNA (anti-dsDNA), anti-Smith (anti-Sm, which is the most specific antibody for SLE) and anti-cardiolipin, anti-Ro/La, and anti-histone.
Renal Biopsy: A renal biopsy may be necessary to confirm lupus nephritis.
Treatment: Medical: The main treatments for SLE include nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritis, corticosteroids, and immunosuppressant drugs.
Complications: Cardiovascular: Complications of SLE may include pericarditis, myocarditis, endocarditis (Libman-Sacks), stroke, fits, psychosis, lupus nephritis in 50% of cases, and acute respiratory distress syndrome (ARDS) and pleural effusions.
Prognosis: Patients with SLE have a good prognosis despite the serious nature of the condition, with 80% survival at 15 years. However, there is an increased long-term risk of cardiovascular disease and osteoporosis.
