Life 58 _ Systemic lupus erythematosus, SLE
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Lupus erythematosus is a collection of autoimmune diseases in which the human immune system becomes overactive and attacks healthy tissue. As a result, many different bodily systems are affected, including the joints, skin, kidneys, blood cells, heart, and lungs. The most common and severe form is systemic lupus erythematosus.

Overview of lupus erythematosus

There is a type of medical condition that you might not even hear about, its symptoms are very similar and easily confused with other illnesses such as fever, difficulty breathing, joint pain, muscle fatigue, fatigue, fatigue and temporary cognitive loss, etc. On the contrary, the disease also presents other symptoms that are very different and seem unpredictable and therefore difficult to diagnose with precision. As a result, many people suffer from this disease without proper treatment for many years and of course suffered serious consequences. It is a disease called systemic lupus erythematosus.

Although there are other types of lupus erythematosus, such as discoid lupus erythematosus, medicated lupus erythematosus, and neonatal lupus erythematosus. But in this talk, I will talk in more detail about systemic lupus erythematosus – the most common type today.

The incidence of systemic lupus erythematosus varies widely from country to country, ethnicity, gender, and varies over time. Currently, the rate is highest in African Caribbean communities, around 159 / 100,000 people, then in the United States – 53 / 100,000 people and, in Northern Europe – 40 / 100,000 people.

In general, women are more affected by autoimmune diseases than men, and systemic lupus erythematosus is no exception, with an incidence 9 times higher in women than in men and especially at the age of 15 to 50 years old.
It should also be added that the additional notification of new cases can also be attributed to the increased incidence of the disease and possibly better diagnosis of the disease every day.

What is systemic lupus erythematosus?

Systemic lupus erythematosus is an autoimmune disease of the connective tissue. As in other autoimmune diseases, the immune system attacks cells and tissues in the body, causing inflammation and tissue damage. The disease affects all parts of the body, from the skin to tendons and bones and internal organs, where systemic lupus erythematosus causes the most damage to the joints, skin, blood vessels, heart, liver, kidneys, lungs and nervous system. .
The development of the disease is very unpredictable and also difficult to follow as there are periods of illness interspersed with stages of healing.

Common symptoms of systemic lupus erythematosus

As mentioned above, systemic lupus erythematosus with many initial symptoms is easy to confuse with other illnesses such as fever, difficulty living, joint pain, muscle fatigue, fatigue and temporary loss of cognitive ability, etc. also many complex symptoms that are difficult to follow. However, some of the following symptoms may also suggest that your doctor consider this condition:

  • Rash (or butterfly rash), red, thick, disc-shaped psoriasis patches (also called discoid lupus), hair loss, ulcers in the mouth, nose, vagina, and other skin lesions.
  • Joint pain, especially the small joints of the hands and wrists. Unlike rheumatoid arthritis, lupus arthritis is less disabling because it causes less severe joint damage and therefore less strain in the hands and feet than in rheumatoid arthritis.
    However, patients with systemic lupus erythematosus are also at risk for osteoarthritis, and in young women systemic lupus erythematosus may also be associated with a risk of fractures.
  • Anemia and of course iron deficiency. The decrease in the number of platelets and white blood cells is caused by the side effects of medication for the disease. Thrombotic disorders (ie Antiphospholipid _ antiphospholipid syndrome), etc.
  • Inflammation of different parts of the heart such as pericarditis (also called pericarditis), myocarditis and endocarditis (also called endocarditis and possibly inflammation of the mitral valve or tricuspid valve). In addition, atherosclerosis also manifests more and progresses faster in patients with systemic lupus erythematosus.
  • Pleurisy, pleural effusion, lupus pneumonia, chronic diffuse interstitial lung disease, pulmonary hypertension, pulmonary embolism, pulmonary hemorrhage and pulmonary disease narrowing syndrome) etc …
  • There is blood or protein in the urine. Acute or chronic kidney damage can develop lupus nephritis, resulting in acute or end-stage kidney failure.
  • Effects on the central nervous system or the peripheral nervous system. The most common symptoms are cerebrovascular disease, headaches, dementia, mood disorders, epilepsy, polyneuropathy, anxiety disorders, psychosis etc. …
  • And finally, the atypical symptoms of systemic lupus erythematosus alone, such as: Fatigue with multiple causes and linked not only to complications of the disease or complications such as anemia or hypothyroidism, but also to pain. depression; not sleeping well; lack of physical balance.

Causes of systemic lupus erythematosus

Unfortunately, there is currently no known specific cause of systemic lupus erythematosus. However, studies have shown that systemic lupus erythematosus is genetically linked, so genes may be the main cause of disease. But no single gene has been identified as the culprit, and many genes can influence the risk of developing the disease, especially when environmental factors are activated, for example.

  • Medications (such as certain antidepressants and antibiotics), severe depression, hormones, and inflammation not only make the disease worse, but can also trigger disease formation.
  • In addition, sun exposure is also a trigger that causes systemic lupus erythematosus as many studies have shown that ultraviolet (UV) rays can also change the structure of DNA and lead to the formation of self-antibodies. immune. Then nervous stress, overwork, and pregnancy or childbirth are also suspected of causing lupus by an unknown mechanism.
  • Or, sex hormones like estrogen also play an important role in the development of this disease. Indeed, at the stage of reproductive age in men, the frequency of this disease in women is 10 times higher than in men.
  • Recently, several studies have linked the Epstein-Barr virus to the development of autoimmune diseases, including lupus. This virus is extremely popular because it infects 95% of the population and can cause lupus in some susceptible people.
  • Interestingly, some studies have shown that women with silicone breast implants produce antibodies against their own collagen, although there is a lack of data indicating a direct association between these antibodies and connective tissue diseases. such as systemic lupus erythematosus. On the contrary, the use of lipstick is increasingly evidence of a link with systemic lupus erythematosus, although conclusive conclusions have not yet been drawn on this subject.
  • And, finally, the drug response for those taking drugs for long-term medical conditions. Although the symptoms that appear in such cases of medication are similar to those of systemic lupus erythematosus, they go away after stopping the medication. Out of about 400 drugs that can cause this disease, some of the most common are procainamide, hydralazine, quinidine and phenytoin etc.

Treatment of systemic lupus erythematosus

Systemic lupus erythematosus can be fatal, but with current advances in medicine, the death rate is drastically decreasing. In the United States, Canada and Europe, the survival rate of patients with systemic lupus erythematosus for 5 years is about 95%, for 10 years it is 90%, and for 20 years it is 78 %.
Since systemic lupus erythematosus is a chronic disease without complete cure, the treatment of systemic lupus erythematosus is also systemic and by treating its symptoms. This basically means the prevention of epidemics, reducing both the severity of the disease and the duration of the disease.
Commonly used drugs are corticosteroids which are immunosuppressants such as methotrexate and azathioprine. In particular, for certain types of lupus glomerulonephritis such as diffuse proliferative glomerulonephritis, cytotoxic drugs such as cyclophosphamide and mycophenolate are required.
However, since the symptoms and affected systems are so different, each patient may be treated differently. In mild and progressive cases, treatment may not be necessary, but if necessary, nonsteroidal anti-inflammatory drugs and antimalarial drugs containing hydroxychloroquine such as Plaquenil® and chloroquine (i.e. Aralen ®) are sufficient.
However, I think there is a need to talk more clearly about some of the common pain relievers that anyone can buy at a drugstore without a prescription (ie nonsteroidal anti-inflammatory drugs). For example, acetaminophen (often in the forms of Tylenol®, Atosol®, which are popular among pain relievers and anti-fever medications in North America) and over-the-counter anti-inflammatories like ibuprofen, Advil®, or Motrin can be used to relieve joint pain, when the lupus is not too severe, not too painful. And, most people think that these common pain relievers are so healing that they can be used freely. However, doctors recommend that if you have more severe lupus, do not take such over-the-counter pain relievers on your own. Because these drugs can increase your risk of complications from lupus, especially kidney damage, causing kidney failure. It may take some time for your doctor to find the anti-inflammatory medication that is right for you.
The reverse is also noticeable, as there is a large proportion of systemic lupus erythematosus patients with chronic pain, so they are prescribed by their doctor in cases deemed necessary for pain relief. Moderate or severe pain cases require strong addictive drugs such as hydrocodone, oxycodone or methadone, skin patches such as fentanyl containing duragesic etc. which are addictive and dependent on the drug. However, this sad fact must be accepted as the symptoms of systemic lupus erythematosus are often not completely reversible and the use of the above drugs must last a lifetime despite taking into account a dosage adjustment.
And, for end-stage kidney disease – a complication of lupus glomerulonephritis, the common treatment is a kidney transplant when conditions permit. However, there are still up to 30% of cases of relapse of the disease.
So what can each of us do before relying on doctors, entrusting our life to the hospital?

Prevention of systemic lupus erythematosus:

Unfortunately, systemic lupus erythematosus is not well understood, so it cannot be prevented by specific and specific measures. However, when sick, the patient can try to minimize the damage, improve his quality of life by preventing epidemics.
To do this, the patient should be aware of the warning signs of an impending flare which may be: fatigue, pain, rash, fever, abdominal pain, headache and dizziness. If you recognize the warning signs early and contact your doctor regularly, the patient may be more active, less painful, and reduce the number of hospital visits.

On the other hand, as the lifespan of patients with systemic lupus erythematosus increases, the likelihood of complications is also greater. Therefore, patients not only have to deal with systemic lupus erythematosus, but also constantly struggle with other types of complications such as cardiovascular disease, inflammation, osteoporosis and cancer. Among them, cancers linked to the immune system must be very vigilant on the part of patients and doctors. Because the use of drugs and the side effects of drugs for other diseases can make systemic lupus erythematosus worse.
In addition to the aforementioned measures, positive lifestyle changes also significantly contribute to fending off this disease. In particular, the patient should be very careful to avoid direct sunlight, as sunlight worsens the disease. Be very careful when using any medicine to treat any other disease and make sure that the medicine does not induce the development of the disease. In addition, occupational exposure to silica, pesticides and mercury should be avoided to prevent further deterioration of the disease.
Eat a balanced diet, stop smoking. Some people find that a poor diet contributes to the development of flare-ups. Smoking cigarettes increases your risk of developing heart disease, such as a heart attack or stroke. Meanwhile, people with lupus are inherently particularly susceptible to cardiovascular disease.
Seek out social support. Social fabric can be of great help when it comes to replenishing stored energy and improving health
Plan your pregnancy well with a doctor’s consultation. Women with lupus should choose the timing of pregnancy carefully (ideally after a 6 month remission period) and have close medical supervision during this time. Lupus increases the risk of miscarriage and premature birth, and symptoms tend to recur in pregnant women.
Take your blood pressure every 3 months. Sometimes kidney problems are manifested by an increase in blood pressure. Regular blood and urine tests will also help make sure the kidneys are working well or catch kidney damage early.
Practice relaxation technique, reduce stress with yoga exercises, meditation. Strengthen and resilient tendons and joints with appropriate sports, such as swimming, yoga.
And make sure you get a good night’s sleep. The National Institutes of Health recommend at least 8 to 10 hours of sleep to help relieve pain from lupus. Indeed, the first weapon against joint pain is simply rest. There are a number of techniques that can help relax and promote sleep through breathing exercises, mental relaxation techniques, yoga, meditation, etc.


I wish you good health!

https://youtu.be/pqIMqUdC2ts

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Maître VIKUDO

Docteur en Physiopathologie
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