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Diff: Systemic Lupus Erythematosus

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	'''Systemic lupus erythematosus''' ('''SLE'''), usually called '''lupus''', is a chronic autoimmune disease that can cause inflammation in many parts of the body. It may affect the skin, joints, kidneys, blood, brain, heart, lungs and other tissues.

Systemic Lupus Erythematosus (SLE), commonly known as lupus, is a chronic autoimmune disease that can affect multiple organs and systems in the body. It is characterized by a dysregulated immune response, leading to inflammation and damage to various tissues. Lupus predominantly affects women of childbearing age, although it can occur in individuals of any age or gender.
	Lupus varies widely. Some people have mainly skin and joint symptoms, while others develop serious organ involvement. The condition often follows a pattern of flares and quieter periods.

	== Who Is Affected ==
	Lupus can affect anyone, but it is much more common in women, especially during the childbearing years. NHS inform notes that around 90 percent of SLE cases occur in women and that the condition is more common in people of African, Caribbean or Asian origin than in people of white European origin.

== Symptoms ==	== Symptoms ==
The symptoms of systemic lupus erythematosus can vary widely among individuals and may come and go. Common signs and symptoms include:
	Common symptoms include fatigue, joint pain, swelling, skin rashes, mouth ulcers, fever, hair loss, chest pain caused by inflammation around the lungs or heart, and sensitivity to sunlight.

* Fatigue: Persistent and overwhelming exhaustion.
* Joint Pain and Swelling: Pain, stiffness, and swelling in the joints, often involving the hands, wrists, and knees.
* Skin Rashes: Butterfly-shaped rash across the cheeks and nose (malar rash), as well as other skin rashes triggered by sun exposure.
* Photosensitivity: Increased sensitivity to sunlight, resulting in rashes or flare-ups.
* Fever: Low-grade or recurrent fevers without an apparent cause.
* Mouth and Nasal Ulcers: Sores inside the mouth or nasal passages.
* Chest Pain: Chest discomfort or pain due to inflammation of the lining around the heart (pericarditis) or lungs (pleurisy).
* Kidney Problems: Lupus nephritis, an inflammation of the kidneys that can lead to impaired kidney function.
* Neurological Symptoms: Headaches, seizures, cognitive difficulties, or changes in mood or behavior.
* Raynaud's Phenomenon: Cold fingers or toes that turn white or blue in response to cold or stress.
	The well-known butterfly-shaped rash across the cheeks and nose can occur, but not everyone with lupus has it. Raynaud's phenomenon may cause fingers or toes to change colour in response to cold or stress.

It's important to note that these symptoms can also occur in other conditions, making an accurate diagnosis crucial.
	More serious disease can involve the kidneys, nervous system, blood counts, lungs or heart. Lupus nephritis is kidney inflammation caused by lupus and can require close monitoring and stronger treatment.

== Causes and Risk Factors ==
The exact cause of systemic lupus erythematosus remains unknown, but it is believed to result from a combination of genetic, hormonal, and environmental factors. Potential risk factors include:
	== Causes and Triggers ==
	The cause is not fully understood. Lupus appears to involve genetic susceptibility, immune-system dysfunction, hormones and environmental triggers.

* Genetics: A family history of lupus or other autoimmune diseases may increase the risk.
* Hormonal Factors: Lupus predominantly affects women, suggesting a role for hormonal factors such as estrogen.
* Environmental Triggers: Exposure to certain environmental factors, such as sunlight, infections, certain medications, or chemicals, may contribute to disease development in susceptible individuals.
	Possible triggers include ultraviolet light, infections, some medicines and major physical or emotional stress. A trigger does not act the same way in every person, and many flares have no single obvious cause.

== Diagnosis ==	== Diagnosis ==
Diagnosing systemic lupus erythematosus can be challenging as it shares symptoms with other conditions. Healthcare professionals consider the following when making a diagnosis:
	Diagnosis is based on the pattern of symptoms, examination findings and test results. There is no single test that proves lupus in every case.

* Medical History and Symptoms: A thorough evaluation of the patient's medical history, family history, and symptom presentation.
* Physical Examination: Examination of the skin, joints, and other organs to identify signs of inflammation or damage.
* Laboratory Tests: Blood tests to assess autoantibodies commonly seen in lupus, such as antinuclear antibodies (ANA), anti-double-stranded DNA (anti-dsDNA) antibodies, and others.
* Other Tests: Additional tests, such as imaging studies or tissue biopsies, may be necessary to evaluate specific organ involvement or rule out other conditions.
	Blood tests may include antinuclear antibody testing, anti-double-stranded DNA antibodies, complement levels, full blood count, kidney tests and inflammatory markers. Urine tests are important because kidney inflammation can be present before obvious symptoms develop.

== Treatment ==	== Treatment ==
The management of systemic lupus erythematosus aims to control symptoms, prevent disease flares, and minimize organ damage. Treatment options depend on the severity of symptoms and organ involvement:
	Treatment depends on severity and which organs are affected. There is currently no cure, but treatment can reduce symptoms, control inflammation and lower the risk of organ damage.

* Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, antimalarial drugs, immunosuppressants, and biologics may be prescribed to manage symptoms and suppress the immune response.
* Lifestyle Modifications: Patients are advised to protect themselves from sun exposure, maintain a healthy lifestyle, manage stress, and engage in regular exercise.
* Multidisciplinary Care: Collaboration with various healthcare professionals, including rheumatologists, nephrologists, dermatologists, and others, to address specific organ involvement and provide comprehensive care.
	Common treatments include:

== Prognosis ==
The prognosis of systemic lupus erythematosus varies among individuals. With appropriate management and adherence to treatment, many individuals with lupus can lead fulfilling lives. However, lupus is a chronic condition, and some patients may experience periods of disease activity (flares) interspersed with periods of remission. Regular follow-up care and monitoring are essential to prevent organ damage and manage symptoms effectively.
	* anti-inflammatory medicines for pain or fever
	* hydroxychloroquine for fatigue, rashes, joint pain and flare prevention
	* corticosteroids for stronger anti-inflammatory treatment
	* immunosuppressants for more active or organ-threatening disease
	* biologic medicines for selected patients

	People with lupus may also be advised to protect their skin from strong sunlight, manage cardiovascular risk, keep vaccinations up to date where appropriate, and have regular monitoring.

	== Outlook ==
	The outlook for lupus has improved greatly because of earlier diagnosis, monitoring and better treatment. Many people with lupus have a normal or near-normal life expectancy, but some remain at risk of serious complications, especially when kidneys, heart, lungs or the nervous system are involved.

	Long-term care usually needs coordination between rheumatology, primary care and any organ-specific specialists involved.

== See Also ==	== See Also ==
	* [[Hydroxychloroquine]]
	* [[Autoimmune_Disorders]]
	* [[Rheumatoid_Arthritis]]

* [[Rheumatoid Arthritis]] - Explore an autoimmune disorder characterized by chronic joint inflammation.
* [[Sjögren's Syndrome]] - Learn about an autoimmune condition that primarily affects the salivary and tear glands.
	== References ==
	* [https://www.nhsinform.scot/illnesses-and-conditions/immune-system/lupus/ NHS inform: Lupus]
	* [https://www.niams.nih.gov/health-topics/lupus/diagnosis-treatment-and-steps-to-take NIAMS: Lupus diagnosis, treatment and steps to take]
	* [https://www.uhbristol.nhs.uk/patients-and-visitors/your-hospitals/bristol-royal-infirmary/what-we-do/rheumatology/conditions-we-treat/lupus/ University Hospitals Bristol NHS Foundation Trust: Lupus]

	[[Category:Medicine]]
	[[Category:Autoimmune Disorders]]