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Systemic lupus erythematosus: symptoms, treatment, prognosis for life

Systemic lupus erythematosus (SLE) is a very severe progressive pathological condition, manifested by many syndromes and mainly affects young women.

The first signs appear at the age of 15-25 years old - the genetically imperfect immune system of the body does not recognize some of its own cells and activates antibodies against them, causing damage and chronic inflammation of organs.

Content

Systemic lupus erythematosus - a prognosis for life

prognosis for life In the past, most patients died 2–5 years after the first symptoms of the disease. With the possibilities of modern medicine, the prognosis for survival is quite high.

Duration and quality of life is associated with the severity of chronic organ damage, as with this form of the disease, drug therapy has a good effect on all types of symptoms. The correct treatment regimen for systemic lupus erythematosus improves the prognosis for a person’s life. Doctors claim that modern medicines make it possible to live for more than 20 years after an accurate diagnosis has been made.

Symptoms and signs of systemic lupus erythematosus occur depending on the form and rate of the disease. Most of the people who have SLE, lead a full life and continue to work.

In severe acute forms, a person often cannot work due to intense joint pain, severe weakness, and neuropsychiatric disorders.

Symptoms of systemic lupus erythematosus, photo

Symptoms of systemic lupus erythematosus

photos of characteristic manifestations of systemic lupus erythematosus

So, as with SLE, one can expect damage to any organ, the symptoms are rather eroded, and signs are characteristic of many diseases:

  • temperature increase of unknown origin;
  • muscle pain (myalgia), fatigue during physical and mental stress;
  • muscle pain, headaches, weakness;
  • frequent diarrhea;
  • nervousness, irritability, sleep disturbance;
  • depression.

Specific features

In addition to common symptoms, lupus erythematosus has many specific symptoms, grouped according to the affected organ or system.

Skin manifestations:

  • The classic symptom of the disease, which gave it its name - the characteristic erythema - redness of the skin in the form of "butterfly", which occurs when the capillaries are expanded, and the appearance of a rash in the zone of the nose and cheekbones. It is noted in every second or third patient. Erythema is also observed on the body, limbs in the form of individual or confluent swollen red spots of various shapes.
  • Small hemorrhagic rash (due to small vessels bursting) on ​​the skin of the palms and finger tips.
  • On the mucous membrane of the genital organs, nose, throat, lips, ulcers, aphthas appear.
  • Trophic ulcers occur in severe disease.
  • Nails become brittle, hair is dry, focal hair loss is observed.

Joint problems:

The connective tissue present in the area of ​​the joints is subjected to severe lesions in lupus, so most patients note:

  • Pain in the small joints of the wrists, hands, knees;
  • The manifestation of polyarthritis inflammation, which passes without destroying the bone tissue (in comparison with rheumatoid arthritis), but with frequent deformities of damaged joints (every fifth);
  • Inflammation and pain in the coccyx and sacrum (mainly in men).
signs of systemic lupus erythematosus, photo

signs of systemic lupus erythematosus, photo

The reaction of the hematopoietic system:

  • Detection of lupus LE cells in the blood is a characteristic sign of SLE.
  • These cells are altered leukocytes, inside of which are found the nuclei of other blood cells. This phenomenon suggests that the immune system is mistaken, perceiving its own cells as foreign and dangerous, giving a signal to the white blood cells to absorb them.
  • Anemia, leukopenia, thrombocytopenia (in every second patient), arising due to illness, and because of the medications taken.

Cardiac activity and vascular system

Many patients are found:

  • Pericarditis, endocarditis and myocarditis (without revealing signs of an infection that provokes such inflammatory diseases).
  • Damage of heart valves with further development of the disease.
  • The development of atherosclerosis.

Nephrology for SLE:

  1. The development of Lupus nephritis (lupus nephritis) is a pronounced renal inflammation with impaired glomerular activity and decreased renal function (more likely in the acute form of the disease).
  2. Hematuria (abundance of blood in the urine) or proteinuria ( large amounts of protein ), proceeding without painful manifestations.

With timely diagnosis and initiation of therapy, acute renal pathology occurs only in 1 out of 20 patients.

Neurological and mental disorders

Without effective treatment, the probability of occurrence is high:

  • Encephalopathy (damage to brain cells).
  • Convulsive seizures.
  • Cerebrovascular disease (inflammation of cerebral vessels).
  • Decreased sensitivity.
  • Visual hallucinations.
  • Confusion of perception, violation of the adequacy of thinking.

These abnormalities in the neuropsychiatric sphere are difficult to correct.

Respiratory system

Symptoms of lupus erythematosus are manifested in the lung system in the form of shortness of breath, painful sensations in the chest during breathing (often with the development of pleurisy).

Forms of the disease

Forms

There are three forms of the disease.

The acute form is characterized by:

  • a sharp start when the patient can name a certain day;
  • high fever, chills;
  • polyarthritis;
  • a rash and the appearance of a "lupus butterfly" on the face;
  • cyanosis (bluish skin color) on the nose and cheeks.

During half a year, signs of acute serositis (inflammation of the serous membranes of the pericardium, pleura, peritoneum), pneumonitis (pneumonia with lesions of the alveolar walls), neurological and mental disorders, seizures similar to epileptic develop.

The course of the disease in acute form is severe. Life expectancy without active therapy is no more than a year or two.

Subacute form begins with manifestations such as:

  • common symptoms of lupus erythematosus;
  • soreness and swelling of small joints;
  • arthritis with relapses;
  • skin lesions in the form of discoid lupus (ulceration on the skin, scaly, covered with scales);
  • photodermatosis appearing in the neck, chest, forehead, lips, ears.

The wave-like flow of the subacute form appears quite clearly. For a period of 2–3 years, a complete clinical picture is formed.

Marked by:

  1. Persistent paroxysmal headaches, high degree of fatigue.
  2. Severe heart disease in the form of endocarditis Liebman-Sachs and valve inflammation - mitral, aortic, tricuspid.
  3. Myalgia (muscle pain, even at rest).
  4. Inflammations of muscles and muscles of the skeleton with their atrophy - myositis.
  5. Raynaud's syndrome (blue or whitening of the skin of the tips of the fingers or toes during cold, stress), often leading to necrosis of the tips of the fingers.
  6. Lymphadenopathy is a pathological increase in lymph nodes.
  7. Lupus pneumonitis (inflammation of the lungs with SLE, developing in the form of vasculitis or atypical pneumonia).
  8. Inflammation of the kidneys, which does not acquire such severity as in acute form;
  9. Anemia, leukopenia (a strong reduction in the number of leukocytes), thrombocytopenia or Velgoff syndrome (a sharp decrease in blood platelets, which is accompanied by bruises, hematomas on the skin, mucous membranes, bleeding and difficulty in stopping bleeding, even after minor injuries).
  10. Increased concentration of immunoglobulins in the blood.

Chronic form

The disease of lupus erythematosus, occurring in a chronic form, for a long time is expressed in frequent polyarthritis, manifestations of discoid lupus, lesions of small arteries, Velgof's syndrome.

During 6 - 9 years of the disease, the addition of other organic pathologies (nephritis, pneumonitis) occurs.

Diagnosis of lupus

Diagnosis of lupus

The diagnosis is made on the basis of a complex of symptoms (joint and muscle pain, fever), systemic lupus erythematosus Raynaud and Velgof's syndromes and research results.

To make a reliable diagnosis, certain criteria are taken into account, which manifested themselves during the patient’s illness.

These include:

  • Lupus "butterfly".
  • Photosensitization - increased sensitivity of exposed skin to sunlight.
  • Discoid lupus in the form of a swollen, flaky rash the size of a coin, after which there are scarring changes.
  • Ulcers on the mucous membranes.
  • Arthritis with soreness and swelling of the joints (often symmetrically).
  • Serozity or inflammation of the membranes surrounding the heart, lungs, peritoneum, causing difficulty in breathing and pain when changing the position of the body.
  • Kidney inflammation develops in almost all patients with SLE in mild or severe form. First, it is detected only by urine tests, detecting blood and protein in it, and swelling of the eyes, legs and feet.
  • Neurological manifestations expressed in depressive states, acute headaches, memory impairment, concentration, psychosis (severe mental pathology with behavioral and perceptual disorders).
  • Pathological changes in blood cells: the destruction of red blood cells that carry oxygen (causes anemia), a decrease in the number of leukocytes (leukopenia), platelets with the occurrence of bleeding from the nose, urinary tract, brain, digestive organs and uterus.
  • Immunological disorders: the formation of autoantibodies (antibodies to native DNA), which indicates the development of SLE. The increase in their number indicates the active development of the disease.
  • The appearance of SM-antibodies, which are detected only in a disease of systemic lupus erythematosus This confirms the diagnosis.
  • Antiphospholipid antibodies (ANA) in the blood, aimed against cell nuclei, are also found in almost every patient.
  • The level of complement in the blood (proteins that destroy bacteria and are responsible for the regulation of inflammatory and immune responses of the body). Low indicates progression of the disease,

Laboratory tests and tests are necessary for:

  • clarification of the diagnosis;
  • identifying the organs involved in the disease process;
  • control the progression and severity of SLE;
  • determine the effectiveness of drug therapy.

There are many tests that reveal the effects of lupus on different organs:

  • removal of radiographs of the lungs, heart;
  • electrocardiogram, echocardiography of the heart;
  • determination of the respiratory function of the lungs;
  • for examining the brain - electroencephalography EEG, MRI.

Treatment of systemic lupus erythematosus

Treatment of systemic lupus erythematosus

The main objectives of complex treatment:

  • removal of inflammation and regulation of immune pathology;
  • prevention of exacerbations and complications;
  • treatment of complications provoked by immunosuppressants, hormonal and antitumor agents;
  • active treatment of individual syndromes;
  • purification of blood from antibodies and toxins.

Basic methods:

Pulse therapy, which include the use of:

  • corticosteroids, which are prescribed in the initial stages of the disease. All patients are in the dispensary, so that with the most initial manifestations of the worsening of SLE, the use of hormones was started in a timely manner.
  • the use of high doses of cytostatics (drugs that suppress the growth and development of cancer cells), which allows you to quickly get rid of the severe symptoms of the disease. The course is short.

The method of hemosorption is the removal of toxins from the blood, pathological cells of immune complexes and blood cells, regulation of blood formation with the help of a special apparatus through which blood is passed through a filter with an absorbent.

  • If it is impossible to use steroids, prescribe agents that suppress some of the pathological manifestations of the central nervous system.
  • Immunosuppressants (drugs that suppress abnormal immune responses).
  • Drugs that block the action of enzymes that trigger inflammatory processes, and allowing to relieve symptoms.
  • Non-steroidal agents against inflammatory processes.
  • Mandatory treatment of diseases that lupus causes - nephritis, arthritis, pulmonary diseases. It is especially important to monitor the condition of the kidneys, as lupus nephritis is the most common cause of death of patients with SLE.
  • All drugs and methods are used for strict medical reasons, in compliance with the dosing regimen and precautions.
  • During periods of remission, steroids are reduced to maintenance therapy.

Complications of SLE

The main complications that provokes SLE:

1. Renal pathologies (nephritis, nephrosis) develop in 25% of patients with SLE. The first symptoms are swelling in the legs, the presence of protein and blood in the urine. Kidney failure is extremely dangerous for life to work normally. Treatment includes the use of strong drugs for SLE, dialysis, kidney transplants.

2. Heart disease:

  • pericarditis - inflammation of the heart bag;
  • hardening of the coronary arteries that feed the heart due to the accumulation of thrombotic clots (atherosclerosis);
  • endocarditis (infection of damaged heart valves) due to the sealing of heart valves, accumulation of blood clots. Often carry out valve transplantation;
  • myocarditis (inflammation of the heart muscle), causing severe arrhythmias, diseases of the heart muscle.

3. Lung diseases (30%), pleurisy, inflammation of the muscles of the chest, joints, ligaments. The development of acute tuberculous lupus (inflammation of the lung tissue). Pulmonary embolism - blockage of arteries with emboli (blood clots) due to increased blood viscosity.

4. Blood diseases, life-threatening.

  • reduction of red blood cells (supplying cells with oxygen), leukocytes (suppressing infections and inflammation), platelets (promote blood clotting);
  • hemolytic anemia caused by a deficiency of red blood cells or platelets;
  • pathological changes of the blood-forming organs.

Systemic lupus erythematosus and pregnancy

Systemic lupus erythematosus and pregnancy

Although pregnancy with lupus suggests a high likelihood of exacerbations, for most women, the gestation period and childbirth go well.

But, when compared with 15% of miscarriages in healthy future mothers, then in pregnant patients with SLE the number increases to 25%.

Very important - six months before conception there should be no signs of lupus. And in these 6 months, all medications that can cause the medicinal form of lupus are canceled.

What is important is the choice of therapy during pregnancy. Some drugs for the treatment of SLE cancel, so as not to cause miscarriage and not cause harm to the fetus.

Symptoms of SLE during pregnancy:

  • mild to moderate exacerbations;
  • when using corticosteroids there is a big risk of increased blood pressure, diabetes, kidney complications.

One in four babies from lupus pregnancy is born prematurely, but they have no defects. In the future, children also do not show any mental or physical retardation.

Very rarely, children born to women with special antibodies in the blood show some signs of lupus in the form of a rash or low red blood cell count. But these symptoms are coming, and most children do not need treatment at all.

Pregnancy that has arisen unplanned - at the time of exacerbation of the disease - has a negative effect on the fetus and mother, increasing all manifestations of SLE, and creating difficulties with gestation.

The safest method of contraception is the use of diaphragms, caps with contraceptive gels and uterine spirals. It is not recommended to use oral contraceptive drugs, the use of drugs with a high content of estrogens is especially dangerous.

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