Home Prevention What kind of disease is lupus in women? Systemic lupus erythematosus: a disease with a thousand faces

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What kind of disease is lupus in women? Systemic lupus erythematosus: a disease with a thousand faces

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Lupus (systemic lupus erythematosus, SLE) is an autoimmune disease in which the human immune system attacks the host's connective tissue cells as foreign.

Connective tissue is found almost everywhere, and most importantly, in the ubiquitous vessels.

Inflammation caused by lupus can affect the most different organs and systems including skin, kidneys, blood, brain, heart and lungs.

Lupus is not spread from person to person.

Science does not know the exact cause of lupus, like many other autoimmune diseases.

These diseases are most likely caused by genetic disorders in the immune system that make it possible for it to produce antibodies against its own host.

Lupus is difficult to diagnose because its symptoms are varied and it can masquerade as other diseases. The most distinctive sign of lupus is erythema on the face that resembles butterfly wings spread across both cheeks of the patient (butterfly erythema). But this symptom does not occur in all cases of lupus.

There is no definitive treatment for lupus, but its symptoms can be controlled with medications.

Causes and Risk Factors of Lupus

Combination external factors may trigger an autoimmune process. Moreover, some factors affect one person, but do not affect another.

Why this happens remains a mystery.

There are many possible causes of lupus:

Exposure to ultraviolet rays (sunlight) may cause lupus to develop or worsen its symptoms.
Female sex hormones do not cause lupus, but they do influence its course. Among them may be high-dose preparations of female sex hormones for the treatment gynecological diseases. But this does not apply to taking low-dose oral contraceptives (OCs).
Smoking is considered a risk factor for lupus, which can cause the disease and worsen its course (especially vascular damage).
Some medications can aggravate the course of lupus (in each case, you should read the instructions for the drug).
Infections such as cytomegalovirus (CMV), parvovirus ( erythema infectiosum) and hepatitis C can also cause lupus. Epstein-Barr virus is associated with lupus in children.
Chemicals can cause lupus. Among these substances, the first place is trichlorethylene (a narcotic substance used in the chemical industry). Hair dyes and fixatives, previously thought to be a cause of lupus, are now completely justified.

The following groups of people are more likely to develop lupus:

Women get lupus more often than men.
People of African descent get lupus more often than whites.
People between the ages of 15 and 45 get sick most often.
Heavy smokers (according to some studies).
People with a family history.
People regularly taking medications associated with a risk of lupus (sulfonamides, some antibiotics, hydralazine).

Medicines that cause lupus

One of the common causes of lupus is the use of medicines and other chemicals. In the United States, one of the main drugs associated with drug-induced SLE is hydralazine (about 20% of cases), as well as procainamide (up to 20%), quinidine, minocycline, and isoniazid.

Drugs most commonly associated with lupus include calcium channel blockers, ACE inhibitors, TNF-alpha antagonists, thiazide diuretics, and terbinafine ( antifungal drug).

The following groups of drugs are commonly associated with drug-induced SLE:

Antibiotics: minocycline and isoniazid.
Antipsychotic drugs: chloropromazine.
Biological agents: interleukins, interferons.
Antihypertensive drugs: methyldopa, hydralazine, captopril.
Hormonal drugs: leuprolide.
Inhaled drugs for COPD: tiotropium bromide.
Antiarrhythmic drugs: procainamide and quinidine.
Anti-inflammatory: sulfasalazine and penicillamine.
Antifungal: terbinafine, griseofulvin and voriconazole.
Hypocholesterolemic: lovastatin, simvastatin, atorvastatin, gemfibrozil.
Anticonvulsants: valproic acid, ethosuximide, carbamazepine, hydantoin.
Other drugs: eye drops with timolol, TNF-alpha inhibitors, sulfonamide drugs, high-dose drugs of female sex hormones.

Additional list medications that cause lupus:

Amiodarone.
Atenolol.
Acebutolol.
Bupropion.
Hydroxychloroquine.
Hydrochlorothiazide.
Glyburide.
Diltiazem.
Doxycycline.
Doxorubicin.
Docetaxel.
Gold and its salts.
Imiquimod.
Lamotrigine.
Lansoprazole.
Lithium and its salts.
Mephenytoin.
Nitrofurantoin.
Olanzapine.
Omeprazole.
Practolol.
Propylthiouracil.
Reserpine.
Rifampicin.
Sertalin.
Tetracycline.
Ticlopidine.
Trimethadione.
Phenylbutazone.
Phenytoin.
Fluorouracil.
Cefepime.
Cimetidine.
Esomeprazole.

Sometimes systemic lupus erythematosus is caused by chemicals that enter the body from the environment. This only happens to some people, for a reason that is not yet clear.

These chemicals include:

Some insecticides.
Some metal compounds.
Eosin (fluorescent liquid in lipsticks).
Para-aminobenzoic acid (PABA).

Lupus symptoms

Symptoms of lupus vary widely because the disease can affect different organs. Whole volumes have been written about the symptoms of this complex disease. medical guidelines. We can look at them briefly.

No two cases of lupus are exactly alike. Symptoms of lupus can appear suddenly or develop gradually; they can be temporary or bother the patient for life. In most patients, lupus is relatively mild, with periodic exacerbations when the symptoms of the disease become worse and then subside or disappear altogether.

Symptoms of lupus may include:

Fatigue and weakness.
Temperature increase.
Pain, swelling and stiffness of the joints.
Erythema on the face in the form of a butterfly.
Skin lesions worsened by sun.
Raynaud's phenomenon (decreased blood flow in the fingers).
Breathing problems.
Chest pain .
Dry eyes.
Memory loss.
Impaired consciousness.
Headache.

It is almost impossible to suspect that you have lupus before visiting a doctor. Seek advice if you have an unusual rash, fever, joint pain, or fatigue.

Diagnosis of lupus

Diagnosing lupus can be very difficult due to the variety of manifestations of the disease. Symptoms of lupus can change over time and resemble other diseases. Diagnosing lupus may require a range of tests:

1. General blood test.

This analysis determines the content of red blood cells, white blood cells, platelets, and hemoglobin. Anemia may be present in lupus. Low white blood cell and platelet counts may also indicate lupus.

2. Determination of ESR indicator.

The erythrocyte sedimentation rate is determined by how quickly the red blood cells from your blood settle in a prepared blood sample to the bottom of the tube. ESR is measured in millimeters per hour (mm/h). Fast speed Erythrocyte sedimentation may indicate inflammation, including autoimmune inflammation, as with lupus. But ESR also increases in cancer, other inflammatory diseases, even with a common cold.

3. Assessment of liver and kidney functions.

Blood tests can show how well your kidneys and liver are working. This is determined by the level of liver enzymes in the blood and the level of toxic substances that the kidneys must cope with. Lupus can affect both the liver and kidneys.

4. Urine tests.

Your urine sample may show elevated levels of protein or red blood cells. This indicates kidney damage, which can occur with lupus.

5. Analysis for ANA.

Antinuclear antibodies (ANAs) are special proteins that are produced by the immune system. A positive ANA test may indicate lupus, although it can also occur in other diseases. If your ANA test is positive, your doctor may order other tests.

6. Chest X-ray.

Taking an image of the chest can help detect inflammation or fluid in the lungs. This may be a sign of lupus or other diseases that affect the lungs.

7. Echocardiography.

Echocardiography (EchoCG) is a method that uses sound waves to get a real-time image of the beating heart. An echocardiogram can reveal problems with the heart valves and more.

8. Biopsy.

A biopsy, the removal of a sample of an organ for testing, is widely used in the diagnosis of various diseases. Lupus often affects the kidneys, so your doctor may order a biopsy of your kidneys. This procedure is carried out using a long needle after preliminary anesthesia, so there is nothing to worry about. The resulting piece of tissue will help identify the cause of your illness.

Lupus treatment

Treatment for lupus is very complex and lengthy. Treatment depends on the severity of the disease's symptoms and requires a serious discussion with your doctor about the risks and benefits of any given therapy. Your doctor should monitor your treatment regularly. If the symptoms of the disease subside, he may change the drug or reduce the dose. If an exacerbation occurs, it’s the other way around.

Modern drugs for the treatment of lupus:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs).

Over-the-counter NSAIDs such as naproxen (Anaprox, Nalgesin, Floginas) and ibuprofen (Nurofen, Ibuprom) can be used to treat inflammation, swelling, and pain caused by lupus. Stronger NSAIDs, such as diclofenac (Olfen), are available as prescribed by your doctor. Side effects of NSAIDs include abdominal pain, stomach bleeding, kidney problems and an increased risk of cardiovascular complications. The latter is especially true for celecoxib and rofecoxib, which are not recommended for older people.

2. Antimalarial drugs.

Medicines commonly prescribed to treat malaria, such as hydroxychloroquine (Plaquenil), help control lupus symptoms. Side effects: stomach discomfort and retinal damage (very rare).

3. Corticosteroid hormones.

Corticosteroid hormones are powerful drugs that fight inflammation in lupus. Among them are methylprednisolone, prednisolone, dexamethasone. These drugs are prescribed only by a doctor. They have long-term side effects: weight gain, osteoporosis, high blood pressure, risk of diabetes and susceptibility to infections. The higher the dose you use and the longer the course of treatment, the higher the risk of side effects.

4. Immunosuppressants.

Drugs that suppress the immune system can be very helpful for lupus and other autoimmune diseases. Among them are cyclophosphamide (Cytoxan), azathioprine (Imuran), mycophenolate, leflunomide, methotrexate and others. Possible side effects: susceptibility to infections, liver damage, decreased fertility, risk of many types of cancer. More new drug, belimumab (Benlysta), also reduces inflammation in lupus. Its side effects include fever, nausea and diarrhea. If you have lupus, there are several steps you can take to help yourself. Simple measures can make flare-ups less frequent and improve your quality of life.

Try this:

1. Adequate rest.

People with lupus experience constant fatigue, which is different from the fatigue of healthy people and does not go away after rest. For this reason, you may have a hard time judging when to stop and rest. Develop a gentle daily routine for yourself and follow it.

2. Beware of the sun.

Ultraviolet rays can trigger lupus flare-ups, so you should wear covered clothing and avoid walking in hot rays. Choose yours Sunglasses darker, and a cream with SPF of at least 55 (for particularly sensitive skin).

3. Eat a healthy diet.

A healthy diet should include fruits, vegetables, and whole grains. Sometimes you will have to endure dietary restrictions, especially if you have high blood pressure, kidney problems or gastrointestinal problems. Take this seriously.

4. Exercise regularly.

Exercising as approved by your doctor will help you get in better shape and recover faster from flare-ups. In the long term, fitness reduces the risk of heart attack, obesity and diabetes.

5. Stop smoking.

Among other things, smoking can worsen the damage to the heart and blood vessels caused by lupus.

Alternative medicine and lupus

Sometimes Alternative medicine may help those with lupus. But we should not forget that it is unconventional precisely because its effectiveness and safety have not been proven. Be sure to discuss any alternative treatments you want to try with your doctor.

Unconventional methods of treating lupus known in the West:

1. Dehydroepiandrosterone (DHEA).

Dietary supplements steroids containing this hormone can reduce the dose of steroids that the patient receives. DHEA relieves symptoms of the disease in some patients.

2. Flax seed.

Flaxseed contains a fatty acid called alpha-linolenic acid, which may reduce inflammation. Some studies have shown the ability of flax seeds to improve kidney function in lupus patients. Side effects include bloating and abdominal pain.

3. Fish oil.

Dietary fish oil supplements contain omega-3 fatty acid, which may be helpful in lupus. Preliminary studies have shown promising results. Side effects fish oil: nausea, vomiting, belching and fishy taste in the mouth.

4. Vitamin D

There is some evidence that this vitamin improves symptoms in people with lupus. True, scientific data on this issue is very limited.

Complications of lupus

Inflammation caused by lupus can affect different organs.

This leads to numerous complications:

1. Kidneys.

Kidney failure is one of the leading causes of death in people with lupus. Signs of kidney problems include itching all over the body, pain, nausea, vomiting, and swelling.

2. Brain.

If the brain is affected by lupus, the patient may experience headaches, dizziness, behavioral changes, and hallucinations. Sometimes seizures and even strokes occur. Many people with lupus have problems with memory and expression.

3. Blood.

Lupus can cause blood disorders such as anemia and thrombocytopenia. The latter is manifested by a tendency to bleeding.

4. Blood vessels.

With lupus they can become inflamed blood vessels various organs. This is called vasculitis. The risk of vascular inflammation increases if the patient smokes.

5. Lungs.

Lupus increases the likelihood of inflammation of the pleura, called pleurisy, which can make breathing painful and difficult.

6. Heart.

Antibodies can attack the heart muscle (myocarditis), the sac around the heart (pericarditis), and large arteries. This leads to an increased risk of heart attack and other severe complications.

7. Infections.

People with lupus become vulnerable to infection, especially as a result of treatment with steroids and immunosuppressants. Most common infections genitourinary system, respiratory infections. Common pathogens: yeast, salmonella, herpes virus.

8. Avascular necrosis of bones.

This condition is also known as aseptic or non-infectious necrosis. Occurs when the blood supply to the bones is reduced, leading to fragility and easy destruction bone tissue. Problems often arise with the hip joint, which experiences heavy loads.

9. Complications of pregnancy.

Women with lupus have high risk miscarriage. Lupus increases the likelihood of preeclampsia and premature birth. To reduce your risk, your doctor may advise you not to conceive until at least 6 months have passed since your last outbreak.

10. Cancer.

Lupus is associated with increased risk many types of cancer. In fact, some lupus drugs (immunosuppressants) themselves increase this risk.

Systemic lupus erythematosus is a disease in which the body's cells and tissues are affected by its own antibodies. The immune system begins to consider its cells foreign and tries to fight them. Red systemic lupus It is more common in women (approximately 90% of cases) under the age of 30 years. Moreover, according to statistics, women of the Negroid race, as well as those of Asian, Spanish or Indian origin, are more often affected. This disease has been known for a long time; external skin symptoms were described back in the first half of the 19th century. Lupus comes in several forms and this makes diagnosis somewhat difficult.

Causes of the disease

The causes of systemic lupus erythematosus in women have not yet been fully studied. A combination of a congenital immune defect and a viral infection is thought to play a major role. However, the disease often appears after excessive sunbathing, childbirth and other stress on the body. Scientists have identified a pattern between the appearance of lupus and allergies to foods and medications. Also significant role genetic predisposition plays a role - if someone in the family suffers from this pathology, then you are at risk. The occurrence of the disease can be influenced by hormonal imbalances and an unfavorable external environment.

Symptoms of the disease

Symptoms of lupus erythematosus in women appear gradually. Weakness, joint aches, fever and weight loss appear, and hair begins to fall out. In rare cases, the disease may begin sharp increase temperature and acute inflammation in some parts of the body. The further course of the disease occurs in waves with periods of remission and exacerbation. Moreover, with each subsequent exacerbation, the number of affected organs and tissues increases.

Signs of lupus that appear on the skin in women include:

redness of the nose and cheeks - this manifestation resembles a butterfly in shape;
the rash is shaped like rings, and the color inside is paler, and closer to the edges it is richer;
redness of the skin color in the décolleté area, increasing after prolonged exposure to the sun, exposure to cold air or during nervous shocks,
reddish rash on the extremities.

Then, as the disease spreads, the mucous membranes are affected oral cavity, pain in the muscles and symmetrical joints is added to the symptoms. On late stages the membranes of the internal organs become inflamed, the kidneys and sometimes others are almost always affected internal organs. More than half of affected women develop diffuse glomerulonephritis and other kidney diseases. When systemic lupus erythematosus affects the cardiovascular system, pericarditis may develop, which develops into myocarditis. If lupus affects the lung tissue, then lupus pneumonia is diagnosed, accompanied by cough, shortness of breath and moist rales.

To make it easier to monitor patients, lupus activity is divided into three stages:

minimum,
moderate,
expressed.

Diagnosis of the disease

If a woman exhibits signs of lupus, she should consult a rheumatologist. First of all, he will definitely appoint clinical tests blood and urine, blood test for lupus erythematosus, fluoroscopy of internal organs and immunity study. After all, it is important for a doctor not only to make a correct diagnosis, but also to determine how badly the disease has affected the body.

Treatment of the disease

When suffering from systemic lupus erythematosus, long-term and continuous complex treatment. Naturally, the sooner signs of lupus erythematosus in women are detected and an appropriate diagnosis is made, the better for the patient. Moreover, the course of treatment is individual for each patient, taking into account the characteristics of her body and the stage of the disease.

Hormonal anti-inflammatory drugs (glucocorticoids) are used for therapy, often in combination with immunosuppressants. These may be Ibuprofen, Prednisolone, salicylates. If they are taken simultaneously, there is a risk of adverse reactions, dangerous to the body, so the entire course of treatment must be carried out under the supervision of a doctor. If the disease develops very quickly, the patient may be prescribed plasmapheresis - the separation of blood into plasma and components, followed by purification of the plasma and return of the components back to the body. This method of treatment is very effective. The activity of pathological cells sharply decreases, and the functioning of all affected body systems is normalized. May be recommended spa treatment to enhance the entire therapeutic course.

If a woman has symptoms of systemic lupus erythematosus, then she should avoid overheating or hypothermia, prolonged exposure to sun rays, operations and the introduction of various vaccines and serums into the body.

Discoid lupus erythematosus in women

Systemic lupus erythematosus should be distinguished from discoid lupus. The latter is a cutaneous form of the disease and manifests itself in the form of flaky reddish plaques on the skin. With this form of the disease, there is no damage to internal organs, but with untimely or improper treatment, discoid lupus erythematosus can develop into. The skin form is treated with ointments and creams containing corticosteroid components and sunscreens. At the same time, nicotinic acid or B vitamins may be prescribed intramuscularly.

Complications during pregnancy

The greatest danger is the appearance of signs of lupus erythematosus in women carrying a child. In such situations, the doctor cannot predict how the disease will progress and whether it will affect the fetus. After all, systemic lupus erythematosus can affect any internal organ, including the placenta. This will reduce blood flow to the fetus, which can even lead to fatal outcome. Autoantibodies can also cross the placenta and cause lupus in the newborn. At the same time, it is very difficult to treat the disease during pregnancy, because hormonal and steroid medications can have Negative influence on fetal development. Therefore, the woman is under medical supervision throughout her pregnancy and specialists decide on the method of delivery.

And although this disease is chronic and incurable, with the right course of treatment you can live a long and fulfilling life. The patient can prevent the exacerbation of the pathology or reduce the intensity of the attack. Therefore, it is necessary at least general outline imagine what kind of disease lupus is and what symptoms appear in women who have it. Such knowledge helps to detect as early as possible dangerous pathology and start treatment in a timely manner, while the consequences of the disease are not so strong.

Doctors recommend daily morning exercise, walks in the fresh air and a balanced diet that excludes alcohol to increase periods of remission. The body also needs proper rest and a convenient schedule for planned activities. This helps cope with chronic fatigue syndrome.

In fact, it is more correct to call it systemic lupus erythematosus or Libman-Sachs disease, but this is scientific, medical, and people use one word - lupus, but everyone understands what kind of disease we are talking about. It refers to collagenosis or diffuse diseases connective tissue (DBST), and it occurs with damage to all organs where this tissue is present, in addition, the walls of blood vessels also become inflamed (), so we can say that the whole body suffers.

SLE (systemic lupus erythematosus) has many epithets, unfortunately, disappointing ones, so this disease cannot be called benign.

It has been proven that lupus has a hereditary predisposition, which arises under the influence of initiating or provoking factors. However, first things first.

Viruses, stress, immune response... Lupus

It’s somehow impossible to say unambiguously what causes lupus, since it has no specific causes. However, the prerequisites contributing to the formation of the pathological process are known reliably.

Lupus is autoimmune disease , that is, it is accompanied by the production of specific proteins (immunoglobulins of various classes, called antibodies) to one’s own tissues and cell components (autoantibodies). This type of immune response in relation to one’s own body is called autoimmunization and underlies the development of autoimmune processes. Similar type of functioning immune system is caused by certain genetic abnormalities, that is, SLE has a hereditary predisposition, as indicated by family cases of the disease.

Infection plays a significant role in the origin of the disease., and its type is completely unimportant, since the main point is the tension of the immune system and the production of antibodies. And since in acute viral infections destructive changes occur at the site of pathogen penetration (for example, mucous membrane respiratory tract with influenza), a pronounced immune response is formed, then conditions are created for the formation of immunoglobulins, including autoantibodies.

Other provoking factors include:

Insolation (stay in the sun);
Fluctuations in hormone levels (therefore the disease is more common in the female sex);
Abortion and childbirth also affect women;
Psycho-emotional stress, stress;
Taking certain medications (salicylates).

The combination of these reasons aggravates the situation and contributes to the development of such a bad disease as lupus, which, however, can occur in different ways and exist for several various forms and, accordingly, give a variety of clinical manifestations.

Depending on the predominant lesion of a particular organ and the causes of its occurrence, several types of lupus lesions are distinguished.

Is it just the skin a separate form of lupus?

Discoid shape or discoid lupus erythematosus(DLE) is considered the province of dermatologists, characterized by the appearance of erythematous rashes, which can affect the face, cheekbones, nose and spread to the cheeks, forming a “butterfly” (the so-called rash because its outlines closely resemble this insect).

The degree of severity of the “butterfly” and the persistence of inflammatory manifestations are very significant in establishing the diagnosis and determine DKV options:

Variable redness with cyanosis of the midface, which pulsates and intensifies under the influence of weather conditions (low ambient temperature, ultraviolet exposure, strong wind) or psycho-emotional state(excitement);
The appearance of persistent erythematous spots with swelling, accompanied by thickening of the epidermis at the site of their formation (hyperkeratosis);
Severely swollen eyelids, swelling of the entire face, the presence of bright pink spots, dense and swollen;
A distinct cicatricial atrophy is noted in the discoid elements.

In other cases, the rash may spread to other parts of the body: earlobes, forehead, neck, torso, scalp heads, limbs or manifest nonspecifically - purpura, nodules (erythema multiforme).

Rash on the mucous membrane is typical for lupus

For the diagnosis of DLE, a special role is given to the presence of a rash on the oral mucosa, as well as the presence of lupus cheilitis, manifested by swelling and a red border of the lips, covered with gray dryish scales or crusts and erosions, which subsequently undergo cicatricial atrophy.

The equivalent of a “butterfly” is capillaritis (vasculitis), which is characterized by the formation of small, slightly swollen spots, with lung development atrophy is another option. In this case, the fingers of the upper and lower limbs, surface of the palms and soles, trophic changes are observed skin(fragility of nails and their deformation, formation of ulcers and bedsores, increased hair loss).

It should be noted that DKV is not excluded with generalized lupus erythematosus, but there she is occurs as a symptom, and not as a separate form of the disease.

Other isolated forms of lupus

As for other variants of lupus, although they look like the classic form (“butterfly”, erythematous rashes, etc.), they have other causes and require specific treatment and differ in prognosis (tuberculosis and drug).

Tuberculous lupus, otherwise called cutaneous tuberculosis or lupus vulgaris, which originates from the Koch bacillus, which is the causative agent of tuberculosis (Tbc) of any type and location. The disease is called lupus because its symptoms closely resemble those of DLE.

Treatment of tuberculous (vulgar) lupus is aimed at eliminating the underlying disease (Tbc) and the consequences of lupus (ulcers, bumps, nodules). However, to cure tuberculosis is to get rid of lupus.

Cannot be considered as separate symptom SLE and drug-induced lupus, which occurs as a result of taking certain medications (oral contraceptives, salicylates, sulfonamides, etc.), since it is reversible and disappears after discontinuation of the medications.

Classification according to the nature of the flow

Having considered isolated variants of lupus erythematosus, in the future there will be a description of SLE - generalized form diseases with a variety of symptoms and manifestations. The working classification of pathology considers clinical variants of the course, taking into account:

Degree of severity of the initial period;
Symptoms of the onset of the disease;
The nature of the flow;
Activity of the pathological process;
Rates of progression;
The effect of using hormones;
Duration of the period.
Morphological features of damage to the body.

Due to this It is customary to distinguish three types of flow:

Spicy option, characterized by a sudden onset, so sudden that the patient can even indicate an hour when his illness overtook him, a rapid increase in body temperature, the appearance of a “butterfly”, the development of polyarthritis and serositis. Multiple organ damage and rapid involvement of the excretory (kidney) and nervous systems in the process leads to a sharp deterioration of the condition, which can last up to 2 years. However, treatment with glucocorticosteroids can lengthen the initial period to 5 years and even achieve stable remission;
Subacute undulating course, which is characterized by a gradual development of the disease, where the joints and skin are usually the first to suffer, and the remaining organs (more and more new) join the process with each relapse. The disease develops slowly (5-6 years), after which it has a multi-syndromic clinical picture;
A gradual onset, imperceptible even for the patient, the presence of only one syndrome, the rest join only after many years, characterizes chronic course of SLE.

Clinical picture of SLE – symptoms, syndromes, variants

In most cases The following signs indicate the onset of SLE:

Joint damage is recurrent polyarthritis, which is very similar to rheumatic arthritis;
Increased body temperature;
Skin rash;
Weakness, feeling tired, loss of interest in life;
Losing weight.

Start with acute manifestations The disease is less common and is characterized by symptoms:

Fever;
Polyarthritis;
Severe skin lesions;
Jade;
Polyserosita.

Clinic chronic course , as a rule, is limited to one syndrome for a long time, for example:

Recurrent arthritis;
Polyserositis;
or Werlhof, epileptiform syndrome or discoid lupus.

Manifestations and complications of systemic lupus. Based individual course Disease localization of lesions can vary greatly. (More on this later).

However, sooner or later, perhaps after 10 years, as a result of the uncontrollable progression of the pathological process, other organs are still affected. Polymorphic symptoms of the disease can lead to development of functional failure of any organ, which ends in the death of the patient.

SCV. Lesions of the skin, joints, heart, blood vessels

Symptoms skin lesions for SLE were discussed above (description of DLE), which in the form of a skin syndrome are present in a generalized pathological process and are characterized by analogy with the symptoms of discoid lupus.

At articular syndrome almost all patients report migrating pain, limited mobility in joints, often small ones (lupus arthritis). In some cases, these symptoms are added to:

Fusiform deformation of the fingers;
Atrophic changes in muscles;
Tormenting myalgia (muscle pain);
Myositis (muscle inflammation);
Ossalgia (bone pain).

Pericarditis is one of the forms of lupus affecting the heart.

Serositis (inflammatory lesions of the serous membranes)– a rather serious component of SLE, including the diagnostic triad:

, bilateral pleurisy, sometimes peritonitis;
Dermatitis;
Arthritis.

Serositis have a tendency to relapse, forming adhesions in the pericardial cavity and pleura. The symptoms of serositis are quite common: the patient feels pain, the doctor hears friction noise of the pleura, pericardium, and peritoneum.

For systemic lupus erythematosus damage to the cardiovascular system is not limited to pericarditis. The endocardium, valvular apparatus (mitral and tricuspid valves - primarily), myocardium and large vessels suffer, and thus, in the condition of the heart and blood vessels in SLE, pathology may be present in the form of:

Atypical warty Libman-Sachs;
Raynaud's syndrome, the likelihood of developing which increases several times in SLE;

Myocarditis in lupus has a fairly pronounced clinical picture:

Persistent increase in rhythm (tachycardia);
Heart pain, which the patient finds difficult to describe, because “it is somehow vague”;
Shortness of breath, especially with exertion;
Muffled tones, the appearance of noise on pulmonary artery or at the apex of the heart (auscultation);
In the case of a diffuse process: cyanosis of the skin, low blood pressure, gallop rhythm;
Characteristic changes on the ECG.

It can be noted that almost all pathological processes in any organ do not leave the vessels indifferent. Small and large, arterial and venous trunks are affected with the development and For example, Raynaud's syndrome can noticeably advance the clinical picture of the disease and form long before the appearance of other manifestations.

Lupus and body functions: breathing, digestion, neuropsychiatric activity and protection

The inflammatory process in lupus finds connective tissue in the respiratory system , spreading around the bronchi, pulmonary vessels, between the lobes of the lungs, and sometimes even affecting the alveolar septa. These changes lead to the formation lupus pneumonitis with the development of foci of inflammatory infiltration in the lungs, the main clinical sign of which is shortness of breath that slowly increases over time.

However, the inflammatory process in the lungs with lupus may behave differently and give acute course, in which the following are observed:

Shortness of breath, quite severe;
Painful cough, attacks of suffocation;
Hemoptysis;
Bluish color of the skin of the face, hands and feet;
Formation (possibly).

Damage to the gastrointestinal tract (gastrointestinal tract) characterized by the brightness of the clinical picture and many symptoms:

Complete lack of appetite (anorexia);
Dyspeptic disorders;
Almost constant, but unspecified, abdominal pain;
Frequent diarrhea.

The most common culprit is lupus lesions of the gastrointestinal tract:

Vasomotor mesenteric disorders;
Hemorrhagic edema of the mesentery and intestinal wall;
Segmental ileitis (recurrent obstruction of the small intestine);

In some cases, the lupus inflammatory process in the gastrointestinal tract can lead to ulcerative-necrotic changes and give aphthous stomatitis, esophagitis, gastroenterocolitis, which can be complicated by perforation of the ulcer and the development of peritonitis or pancreatitis.

The most common and dangerous complications of systemic lupus erythematosus

Approximately in half of patients with SLE kidneys are affected with the development of pyelonephritis, lupus nephritis (lupus nephritis), nephrotic syndrome and impaired renal excretory function. Rarely, lupus may begin with a pathology resembling pregnancy nephropathy or acute nephrotic syndrome.

Violation by nervous system and mental activity is also observed in approximately 50% of cases at all stages of systemic lupus erythematosus. The initial phase is characterized by:

General weakness;
Fast fatiguability;
Adynamia;
Irritability and short temper;
Depressed mood;
Decreased general emotional background, apathy;
Sleep disturbance;
Hyperhidrosis (excessive sweating);
Heaviness in the head, headache.

Due to the involvement of the brain and spinal cord, meninges, nerve roots and peripheral nerves At the very height of the disease, certain neurological symptoms appear, which develop into syndromes:

Cerebral (meningoencephalitis);
Cerebrospinal (encephalomyelitis);
Diffuse (meningoencephalomyelopolyradiculoneuritis).

Shifts in emotional sphere at this stage not only do not go away, but also get worse:

Unstable mood (depression alternates with euphoria);
Insomnia;
Intellectual-mnestic disorders (memory and intelligence suffer);
Sometimes delusions and hallucinations (visual and auditory);
Convulsive seizures;
Reduced criticism, inadequate judgment, inability to correctly assess one’s own capabilities.

In addition, it should be borne in mind that such disturbances in neuropsychic activity are sometimes caused by treatment with hormones (steroid psychoses).

Reticuloendothelial system(macrophage system) responds to SLE with an increase in all groups of lymph nodes, which indicates early generalization of the disease. In addition, there is an enlargement of the spleen and liver. Symptoms of liver damage (hepatitis accompanied by jaundice, fatty hepatosis) often occur against the background of heart failure caused by diffuse myocarditis or pulmonary hypertension, and resemble acute viral hepatitis.

Lupus in children and pregnant women

A General Description of Lupus for Everyone age groups, gender and conditions may not satisfy certain categories of patients who are interested in the following questions:

Does SLE occur in children?
How does pregnancy proceed in a woman with lupus, what are her chances of happy motherhood?
Is SLE contagious, and is it not transmitted in household conditions?

Question one. Unfortunately, the lupus process does not spare children's body. Schoolchildren are more susceptible to the disease junior classes and teenagers, and even at this age, lupus prefers girls; they get sick 3 times more often than boys.

Causes, development of the disease, nature of the course, clinical picture and therapeutic measures, in general, are no different from those in adults, so it’s hardly worth repeating.

Second question: systemic lupus erythematosus during pregnancy. Of course, given that SLE is predominantly a disease of women, this issue cannot but concern us, especially since pregnancy can trigger the onset of the disease or its exacerbation. However, it is possible that as pregnancy progresses as a result of a decrease in the activity of the immune system, the woman’s condition, on the contrary, may improve and the risk of complications decrease. Thanks to modern medicine, such women are no longer immediately offered abortion. Vice versa, expectant mother surrounded by attention and care by gynecologists and rheumatologists, who have close contact with each other and coordinate their actions on the tactics of managing the patient.

Special accounting in antenatal clinic, enhanced control over the course of pregnancy and the necessary treatment help half of sick women safely reach childbirth and become a mother. Although a quarter of pregnant women with lupus still have complications in the form of bleeding, thrombosis and fetal death.

Finally, third question: Is lupus contagious? The answer is ambiguous, because if we are talking about skin tuberculosis, then, of course, this disease is contagious, like other forms of Tbc. In this regard, all preventive measures should be directed not against lupus, but against tuberculosis, the danger of which is undeniable. It is a fairly serious infection that is difficult to treat. Probably, people can also be reassured by the fact that tuberculosis lupus does not just “walk the streets”, since patients are subject to treatment in specialized hospitals and can be discharged only when they no longer pose any danger to others.

Other variants of lupus erythematosus are not contagious and are not transmitted even through close contact, so you don’t have to be afraid or shy away from sick people at home, in a group, and under other circumstances.

Diagnosis of SLE

Systemic lupus erythematosus with pronounced clinical manifestations can be suspected already during the initial examination of the patient and a preliminary diagnosis can be made if:

"Butterflies";
Discoid rash;
Dermatitis, aggravated by ultraviolet radiation;
Ulcers in the mouth or nasopharynx;
Nonerosive arthritis;
Pericarditis or pleurisy (serositis);
Convulsions and psychoses (damage to the central nervous system).

Additional diagnosis of SLE involves laboratory clinical-biochemical (traditional blood and urine tests) and immunomorphological ( immunological test, histological analysis of biopsy material of kidneys and skin) studies. Lupus is indirectly indicated by the appearance of:

Protein in urine above 0.5 g/day or cylindruria ( renal pathology);
, or (hematological disorders).
The final diagnosis can be established by identifying immunological disorders, which are indicated by:
- AvailabilityL.E.–cells with absorbed nuclear material from destroyed tissues;
- Presence of antibodies to nuclear components and antinuclear antibodies;
- False-positive Wasserman reaction (test for syphilis).

However, the diagnosis of systemic lupus erythematosus is not as simple as it might seem at first glance, since there are atypical variants of the disease (combined or borderline forms with other connective tissue pathologies), which is especially typical for the early stages of SLE. For example, the same LE cells are sometimes found in small concentrations in other pathologies.

The treatment process for systemic lupus erythematosus

The greatest success can be achieved if treatment is started at an early stage in the development of the pathological process. Both the onset of the disease and its exacerbation require a stay within the hospital walls, so during such periods a hospital stay cannot be avoided.

Initial subacute and chronic, predominantly articular forms are treated with non-steroidal anti-inflammatory drugs (NSAIDs): voltaren or brufen.

If at chronic course Since the disease is more affected by the skin, preference is given to quinoline medications: delagil, chloroquine, etc., which, however, can have side effects in the form of dyspeptic disorders, dermatitis, tinnitus, and headaches.

Diffuse lupus nephritis is treated with Plaquenil (hydroxychloroquine).

The main drugs for the treatment of SLE are glucocorticoids, which are used depending on the form, nature of the course, activity of the process and clinical picture of the disease. But if hormones do not have the desired effect, they resort to prescribing cytotoxic immunosuppressants.

In addition to the use of specific drugs, with SLE the patient needs a special diet and symptomatic treatment (antiulcer and antibacterial drugs, vitamins, etc.).

Exercise therapy and massage can be recommended only after subsidence inflammatory process in parenchymal organs and always under the control of their condition. Physiotherapy and Spa treatment It is not indicated for lupus at all. Insolation, radon baths, ultraviolet irradiation of joints very well provoke an exacerbation of the disease, which should not be forgotten.

Prognosis and prevention of SLE

The prognosis depends directly on the form and course of SLE.

An absolutely favorable prognosis is only for drug-induced lupus.
The discoid variant has a chance of being cured in approximately 40% of cases.
As for the generalized form, then when early diagnosis and adequate therapy, remission occurs in 90% of cases, which significantly lengthens life and improves its quality. The remaining 10%, unfortunately, can hardly count on a successful outcome, and with the early formation of lupus nephritis, the prognosis becomes even more unfavorable.

Lupus is a serious disease and in order to prolong life, more attention needs to be paid to preventing exacerbations and preventing the progression of the process.

The preventive complex includes:

Timely, rational complex treatment (hormone therapy);
Strict adherence to drug dosages;
Regular visits to the doctor;
Dispensary examination;
Establishment optimal mode sleep (quiet hour in the daytime - 1-2 hours) and wakefulness;
Following a diet (limiting the amount of carbohydrates and table salt, enriching the diet with protein and vitamin products);
If the skin is affected, use sunscreen (ointment, cream, powder with salol, photoprotective film) before going outside;
Strict bed rest, antibacterial and desensitizing treatment for various infectious diseases(ARVI, etc.).

Patients should remember that lupus does not “like” surgical interventions, vaccinations (unless they are simply vital), hypothermia, and does not accept a “chocolate” tan. Treatment with ultraviolet light and gold preparations is contraindicated for patients with SLE. The desire to spend a summer holiday in southern latitudes will also be inappropriate.

One of the presenters will answer your question.

IN this moment answers the questions: A. Olesya Valerievna, candidate of medical sciences, teacher at a medical university

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Systemic lupus erythematosus– a chronic systemic disease, with the most pronounced manifestations on the skin; The etiology of lupus erythematosus is unknown, but its pathogenesis is associated with a violation of autoimmune processes, as a result of which antibodies are produced to healthy cells of the body. Middle-aged women are more susceptible to the disease. The incidence of lupus erythematosus is not high - 2-3 cases per thousand people. Treatment and diagnosis of systemic lupus erythematosus is carried out jointly by a rheumatologist and a dermatologist. The diagnosis of SLE is made based on typical clinical signs, laboratory test results.

General information

Development and suspected causes of systemic lupus erythematosus

The exact etiology of lupus erythematosus has not been established, but most patients have antibodies to the Epstein-Barr virus, which confirms the possible viral nature of the disease. Features of the body that result in the production of autoantibodies are also observed in almost all patients.

The hormonal nature of lupus erythematosus has not been confirmed, but hormonal disorders worsen the course of the disease, although they cannot provoke its occurrence. Women diagnosed with lupus erythematosus are not recommended to take oral contraceptives. In people who have genetic predisposition and identical twins have a higher incidence of lupus erythematosus than other groups.

The pathogenesis of systemic lupus erythematosus is based on a violation of immunoregulation, when protein components of the cell, primarily DNA, act as autoantigens and, as a result of adhesion, even those cells that were initially free from immune complexes become targets.

Clinical picture of systemic lupus erythematosus

Lupus erythematosus affects connective tissue, skin and epithelium. Important diagnostic sign is a symmetrical lesion of large joints, and if joint deformation occurs, it is due to the involvement of ligaments and tendons, and not due to lesions of an erosive nature. Myalgia, pleurisy, pneumonitis are observed.

But most clear symptoms lupus erythematosus is noted on the skin and it is based on these manifestations that the diagnosis is made in the first place.

In the initial stages of the disease, lupus erythematosus is characterized by continuous flow with periodic remissions, but almost always becomes systemic. Erythematous dermatitis of the butterfly type is most often observed on the face - erythema on the cheeks, cheekbones and always on the dorsum of the nose. Hypersensitivity to solar radiation appears - photodermatoses are usually round in shape and multiple in nature. In lupus erythematosus, a feature of photodermatoses is the presence of a hyperemic corolla, an area of atrophy in the center and depigmentation of the affected area. The pityriasis scales that cover the surface of the erythema are tightly fused to the skin and attempts to separate them are very painful. At the stage of atrophy of the affected skin, the formation of a smooth, delicate alabaster-white surface is observed, which gradually replaces the erythematous areas, starting from the middle and moving to the periphery.

In some patients with lupus, the lesions spread to the scalp, causing complete or partial alopecia. If the lesions affect the red border of the lips and the mucous membrane of the mouth, then the lesions are bluish-red dense plaques, sometimes with pityriasis-like scales on top, their contours have clear boundaries, the plaques are prone to ulceration and cause pain while eating.

Lupus erythematosus has a seasonal course, and in the autumn-summer periods the skin condition worsens sharply due to more intense exposure to solar radiation.

In the subacute course of lupus erythematosus, psoriasis-like lesions are observed throughout the body, telangiectasia is pronounced, and livedio reticularis (a tree-like pattern) appears on the skin of the lower extremities. Generalized or focal alopecia, urticaria and itchy skin observed in all patients with systemic lupus erythematosus.

In all organs where there is connective tissue, over time they begin pathological changes. With lupus erythematosus, all the membranes of the heart, renal pelvis, gastrointestinal tract and central nervous system are affected.

If, in addition to skin manifestations, patients suffer from periodic headaches, joint pains unrelated to injuries and weather conditions, and disturbances in the functioning of the heart and kidneys are observed, then based on the survey, we can assume deeper and systemic disorders and examine the patient for the presence of lupus erythematosus. A sharp change in mood from a euphoric state to a state of aggression is also a characteristic manifestation of lupus erythematosus.

In elderly patients with lupus erythematosus, skin manifestations, renal and arthralgic syndromes are less pronounced, but Sjogren's syndrome is more often observed - this is an autoimmune lesion of connective tissue, manifested by hyposecretion salivary glands, dryness and pain in the eyes, photophobia.

Children with the neonatal form of lupus erythematosus, born from sick mothers, have an erythematous rash and anemia already in infancy, so they should be differential diagnosis with atopic dermatitis.

Diagnosis of systemic lupus erythematosus

If systemic lupus erythematosus is suspected, the patient is referred for consultation with a rheumatologist and dermatologist. Lupus erythematosus is diagnosed by the presence of manifestations in each symptomatic group. Criteria for diagnosis from the skin: butterfly erythema, photodermatitis, discoid rash; from the joints: symmetrical damage to the joints, arthralgia, “pearl bracelet” syndrome on the wrists due to deformation of the ligamentous apparatus; from the internal organs: various localizations serositis, persistent proteinuria and cylindruria in urine analysis; from the central nervous system: convulsions, chorea, psychosis and mood swings; In terms of hematopoietic function, lupus erythematosus is manifested by leukopenia, thrombocytopenia, and lymphopenia.

The Wasserman reaction can be false-positive, like other serological tests, which sometimes leads to the prescription of inadequate treatment. If pneumonia develops, an X-ray of the lungs is performed; if pleurisy is suspected,

Patients with lupus erythematosus should avoid direct sunlight, wear clothing that covers the entire body, and apply creams with a high UV filter to exposed areas. Corticosteroid ointments are applied to the affected areas of the skin, since the use of non-hormonal drugs has no effect. Treatment must be carried out intermittently so that hormone-related dermatitis does not develop.

In uncomplicated forms of lupus erythematosus to eliminate pain in muscles and joints, non-steroidal anti-inflammatory drugs are prescribed, but aspirin should be taken with caution, as it slows down the blood clotting process. It is mandatory to take glucocorticosteroids, and the doses of the drugs are selected in such a way as to protect the internal organs from damage while minimizing side effects.

The method, when stem cells are taken from the patient, and then immunosuppressive therapy is administered, after which stem cells are reintroduced to restore the immune system, is effective even in severe and hopeless forms of lupus erythematosus. With this therapy, autoimmune aggression in most cases stops, and the condition of the patient with lupus erythematosus improves.

Healthy lifestyle, giving up alcohol and smoking, adequate exercise stress, balanced diet and psychological comfort allow patients with lupus erythematosus to control their condition and prevent disability.