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Autoimmune disease，AID

Systemic lupus erythematosus

SLE

SLE is an autoimmune disease in which the body’s immune system mistakenly attacks healthy tissue in many parts of the body. Common symptoms include joint pain and swelling, fever, chest pain, hair loss, mouth sores, swollen lymph nodes, feeling tired and, most commonly, a red rash. The disease is divided into flares and remission according to the severity of the disease.
The cause of SLE is unknown. It is thought to be related to hormones, environmental factors, and genetics. Other possible potential risk factors include estrogen, sunlight, smoking, vitamin D deficiency, and other infectious factors. The antibodies that cause the disease are usually antinuclear antibodies and cause inflammation. About 50-70% of patients with lupus erythematosus will have lung lesions, including pulmonary fibrosis that can cause permanent lung damage, and about 3~9% have interstitial lung disease (pulmonary fibrosis).
There is no cure for SLE. Drugs for symptomatic treatment include nonsteroidal anti-inflammatory drugs, corticosteroids, immunosuppressants, hydroxychloroquine, and methotrexate. Current treatments give 80-90% of patients a survival rate of 10 years or more.
The global incidence of systemic lupus erythematosus is approximately 20-70 cases per 100,000 people. Among women, the rate is highest between the ages of 45 and 64. Women of childbearing age are about nine times more frequent than men. It most commonly begins between the ages of 15 and 45, but affects a wide range of ages.

Signs and symptoms

The main complaints include: fever, discomfort, joint pain, muscle pain and fatigue. It’s suggestive when co-occurring with other signs and symptoms.

  • Frequent fatigue
  • Loss of appetite
  • Mild cold
  • The photosensitive response becomes intense and acute
  • Facial rash (butterfly rash), which occurs in 30-60% of patients with SLE.
  • Ulcers in the mouth or nose
  • Joint or muscle pain, > 90% of patients have had similar experiences
  • Pericarditis, myocarditis, endocarditis, pleurisy
  • Blood circulates in the hands and toes
  • Lupus nephritis is an important complication that can lead to acute or end-stage renal failure.
  • Neuropsychiatric SLE (NPSLE). Common symptoms are headache, cognitive impairment, mood disorders, cerebrovascular diseases, etc. Neurological disorders account for a large proportion of morbidity and mortality in patients with SLE.
  • About one-third of people have visible eye involvement. The most common disorders are dry eye and secondary Sjogren syndrome, but episcleritis, scleritis, retinopathy (more commonly affecting both eyes), ischaemic optic neuropathy, retinal detachment, and secondary angle-closure glaucoma may occur.

Diagnostic criteria

According to the criteria revised by the American Rheumatism Association in 1997, lupus erythematosus can be diagnosed if any four or more of the following eleven criteria are present.

  1. Red spots on the cheeks – a butterfly rash on the face (Malar rash)
  2. Discoid lupus
  3. Sunlight allergy (photosensitivity)
  4. Oral ulcer
  5. Non-erosive arthritis
  6. Serositis includes costitis or pericarditis
  7. Renal dysfunction, presence of proteinuria or cylinders in the urine
  8. Neurological disorders such as convulsions or psychosis
  9. Blood disorders are mainly hemolytic anemia, reticulocytosis, plus one of the following: oligocyte (< 4000/mm3), too few lymphocytes (< 1500/mm3), too few platelets (< 100000/mm3).
  10. Immune system disorders have one of the right columns: LE (lupus) cell positive reaction, DNA antibody, nucleic acid nucleoprotein antibody (AntiSm), syphilis serum false positive reaction for more than half a year
  11. Positive reaction to antinuclear antibodies (ANAs).

Treat

Treatment of systemic lupus erythematosus includes prevention of acute attacks and reduction of the severity and duration of attacks. Individualized therapy with glucocorticoids plus immunosuppressants.  In 1955, the U.S. Food and Drug Administration approved hydroxychlorquinine, and in October 2010, belimumab was approved for the treatment of the onset and pain of systemic lupus erythematosus. Early detection of pulmonary fibrosis lesions and appropriate treatment can maximize the preservation of lung function and improve survival rate and quality of life. The 10-year survival rate for patients has exceeded 90%, and many people are relatively asymptomatic. 80-90% of people can expect a normal life expectancy.

Antirheumatic drugs that improve disease

Antirheumatic drugs (DMARDs) are used prophylactically to reduce the incidence of flare-ups, and  commonly used DMARD is hydroxychloroquine

Immunosuppressive drugs

Corticosteroid therapy prevents disease progression and flare-up

In more severe cases, drugs that modulate the immune system, immunosuppressants, such as methotrexate  and azathioprine, are used to control the disease and prevent recurrence of symptoms.

Analgesics

If NSAIDs are not effective in relieving pain, stronger prescription analgesics (painkillers) may be used. Pain is usually treated with opioids, and the potency varies depending on the severity of symptoms. When opioids are used chronically, drug tolerance, chemical dependence, and addiction may occur.

Intravenous immunoglobulin (IVIG)

Intravenous immunoglobulin can be used to control organ involvement in SLE or vasculitis.