SYSTEMIC LUPUS ERYTHEMATOSUS

Author: Sandy

Posted On: December 20, 2013

To fight against S.L.E. Disease, firstly we need to know what Lupus Erythematosus is. During the middle ages the term ‘Lupus’ was first used. In Latin ‘Lupus’ stands for ‘wolf’. That time it was used to put in plain words erosive skin lesions that were suggestive of a wolf’s bite.

The major breach in the diagnosis of S.L.E. was when Hargraves, Richmond and Maryo discovered the LE cell at the Mayo Clinic in 1948. Its serologic discovery symbolizes the commencement of the modern era in S.L.E. disease.

S.L.E. is an autoimmune disease in which the healthy cells and tissues undergo damage by its own overactive misdirected immune system. A healthy immune system is supposed to protect the body from foreign body as germs, virus, and bacteria but in an autoimmune disorder it attacks the parent body cells and organs.

Many times questions arise regarding Lupus Erythematosus symptoms. Its complex as the disease varies among patient and so the symptoms.There is a table of criterion in diagnosing SLE according to SLICC (Systemic Lupus International Collaborating Clinics) Classification which is briefly stated below:

Clinical and Immunologic criteria, in the SLICC classification

  • Clinical criteria
  1. Acute cutaneous lupus
  2. Chronic cutaneous lupus
  3. Oral ulcers
  4. Nonscarring alopecia – (diffuse thinning or hair fragility with visible broken hairs)
  5. Synovitis involving 2 or more joints, characterized by swelling or effusion OR even tenderness in 2 or more joints and at least 30 minutes of morning stiffness
  6. Serositis
  7. Renal –
    • Test urine protein to-creatinine ratio (or 24-hour urine protein) representing 500 mg protein/24 hours.
    • OR red blood cell casts
  8. Neurologic
  9. Hemolytic anemia
  10. Leukopenia
  11. Thrombocytopenia
  • Immunologic criteria
  1. ANA level being above laboratory reference range
  2. Anti-dsDNA antibody level being above laboratory reference range (or >2-fold the reference range if tested by ELISA)
  3. Anti-Sm: presence of antibody to Sm nuclear antigen
  4. Antiphospholipid antibody positivity as determined by any of the following:
    • Positive test result for lupus anticoagulant
    • False-positive test result for rapid plasma reagin
    • Medium- or high-titer anticardiolipin antibody level (IgA, IgG, or IgM)
    • Positive test result for anti2-glycoprotein I (IgA, IgG, or IgM)
  5. Low complement-
    • Low C3
    • Low C4
    • Low CH50

6. Direct Coombs’ test in the absence of hemolytic anemia

Criteria are cumulative and need not be present concurrently.

  • SLICC = Systemic Lupus International Collaborating Clinics;
  • SLE = systemic lupus erythematosus;
  • ANA = antinuclear antibody;
  • anti-dsDNA = anti-double-stranded DNA;
  • ELISA = enzyme-linked immunosorbent assay

When to classify a patient as having S.L.E?

A: If the patient satisfies four of the criteria listed in Table-1 including at least one clinical criterion and one immunologic criterion; or
The patient has biopsy-proven nephritis compatible with SLE and with ANA or anti-dsDNA antibodies.

However, it ranges from mild to fatally severe. Extreme cases of lupus are responsible for thousands of deaths. The disease seems to be more widespread in urban than countryside areas. Of patients with SLE, 65% have disease commencement between ages 16 and 55, 20% present before age 16, and 15% present after the age of 55. Women are nine times more prone to the SLE Disease than men.

Despite intensive research work, the cause of SLE remains mysterious.

With continuous researches everyday science is coming up with treatments, and the fight is on…

Discussion

      • Hi, Thanks for dropping in. Back in 2001, SLE was pretty rare and we hardly had enough knowledge and awareness to deal properly with. Today, it’s different.. We are together. I am glad that you are giving it a good fight and staying positive. Whenever, you need some suggestions and want to share something, don’t hesitate to drop in again.
        Love,
        Sandy

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