Systemic lupus erythematosus: diagnosis and treatment

Tells Evgeny Zhilyaev,

Professor, MD, Doctor of the highest category.

This is a classic autoimmune disease based on a hereditary defect of the immune system, presumably related to innate immunity (non-specific protection). The disease is characterized by the appearance of a variety of autoantibodies directed against the body's own proteins and cells. The disease affects various organs and systems: the skin, musculoskeletal system, internal organs, and changes in blood are very common. A common complication of systemic lupus erythematosus is antiphospholipid syndrome, which is manifested by the formation of blood clots. The disease is characterized by a very high sensitivity to various kinds of infections.

Initially, systemic lupus erythematosus was mistakenly considered a skin disease. The generally accepted international name of the disease is Lupus (translated from Latin. - wolf), the name is due to the fact that the manifestations on the skin are similar to the effects of a wolf bite. However, the symptoms of systemic lupus erythematosus are similar to those of many other diseases, which causes difficulties in making a diagnosis. For example, skin tuberculosis and sarcoidosis have similar symptoms.

It has been proven that replenishing vitamin D deficiency in some cases reduces the risk of developing lupus in patients with hereditary problems and identified characteristic autoantibodies.

Symptoms of systemic lupus erythematosus

Due to the fact that the disease affects all organs and systems, its manifestations can be very diverse. The most characteristic rashes on the face are in the shape of a butterfly. If such changes occur, it is recommended to consult a doctor immediately.

Other possible symptoms of systemic lupus erythematosus:

• prolonged fever,
• intolerance to sunlight, marked weakness or fever after exposure to the sun,
• muscle pain,
• enlarged lymph nodes - lymphadenopathy.

Lupus can cause joint pain and develop arthritis. There may be changes in the cellular composition of the blood. Patients are often referred to a rheumatologist by a hematologist after anemia, pancytopenia, or thrombocytopenia is detected.

Some of the most serious manifestations of systemic lupus erythematosus are nephritis, kidney damage, and changes in urine tests. Even chest pains can be a manifestation of lupus. Epileptic seizures can also be one of the first manifestations of systemic lupus.

Diagnosis of systemic lupus erythematosus

The main methods are clinical examination and laboratory diagnostics. Additionally, instrumental methods are used: computed tomography, in particular, allows you to confirm the presence of pleurisy, echocardiography – pericarditis or endocarditis, magnetic resonance imaging is often used to clarify the nature of damage to the brain and spinal cord in patients with lupus.

Laboratory diagnostics are indispensable in the detection of systemic lupus erythematosus. To confirm the diagnosis, a number of autoantibody tests are performed. Their implementation is critically important. The activity of lupus is also largely measured by laboratory tests.

The following are usually evaluated in the laboratory: antinuclear factor, antibodies to double-stranded DNA, antibodies to SS-A antigens. There are also a number of other autoantibodies that are specific to lupus.

Treatment of systemic lupus erythematosus

Modern treatment protocols for systemic lupus erythematosus have undergone significant changes. Until now, it was believed that hormones were the basis for the treatment of lupus. To date, the basis of lupus treatment is vitamin D and hydroxychloroquine. Anti-inflammatory (glucocorticoid) hormones have to be used in most cases of active lupus, but they are not required by all patients and in many cases can be discontinued when a stable remission is achieved.

When the kidneys and central nervous system are affected, immunosuppressants (drugs that depress the immune system) and cytostatic drugs (drugs that disrupt the growth, development and division of all body cells, thereby causing their death) are used. For lupus nephritis, the drug azathioprine (an immunosuppressant) is often used. In cases where the disease occurs with increased thrombosis, anticoagulants (drugs that prevent the formation of blood clots) are used.

In some cases, genetically engineered drugs are used to treat systemic lupus erythematosus.

Thanks to modern technologies, it has become possible to achieve long-term remission, and the effectiveness of lupus treatment has increased significantly.

Advantages of the European Medical Center in the treatment of systemic lupus erythematosus

• Multidisciplinary approach to patient management: doctors of various specialties (rheumatologists, nephrologists, internists, radiologists, etc.) participate in the treatment.
• All EMC rheumatologists have significant experience in the diagnosis and treatment of patients with lupus and use protocols that have been proven effective by numerous studies. The EMC rheumatology team includes Professor Evgeny Valeryevich Zhilyaev.
• Round-the-clock emergency and emergency care, a full range of necessary diagnostic examinations.
• The research results are available to patients as soon as possible.

Evgeny Zhilyaev