SLE

This page describes how SLE is diagnosed.  It shall be updated regularly and focuses specifically on Systemic lupus Erythematosus.  It does not refer to any of the other forms of Lupus described hereunder for clarity’s sake.

These are the several kinds of Lupus according to the NIH:

  • Systemic lupus erythematosus (SLE) is the form of the disease that most people are referring to when they say “lupus.” The word “systemic” means the disease can affect many parts of the body. The symptoms of SLE may be mild or serious. Although SLE usually first affects people between the ages of 15 and 45 years, it can occur in childhood or later in life as well. This publication focuses on SLE.
  • Discoid lupus erythematosus is a chronic skin disorder in which a red, raised rash appears on the face, scalp, or elsewhere. The raised areas may become thick and scaly and may cause scarring. The rash may last for days or years and may recur. A small percentage of people with discoid lupus have or develop SLE later.
  • Subacute cutaneous lupus erythematosus refers to skin lesions that appear on parts of the body exposed to sun. The lesions do not cause scarring.
  • Drug-induced lupus is a form of lupus caused by medications. Many different drugs can cause drug-induced lupus. They include some antiseizure, high blood pressure, and thyroid medications; antibiotics and antifungals; and oral contraceptive pills. Symptoms are similar to those of SLE (arthritis, rash, fever, and chest pain), and they typically go away completely when the drug is stopped. The kidneys and brain are rarely involved.
  • Neonatal lupus is a rare disease that can occur in newborn babies of women with SLE, Sjögren’s syndrome, or no disease at all. Scientists suspect that neonatal lupus is caused in part by autoantibodies in the mother’s blood called anti-Ro (SSA) and anti-La (SSB). Autoantibodies (“auto” means self) are blood proteins that act against the body’s own tissues. At birth, the babies have a skin rash, liver problems, and low blood counts. These symptoms gradually go away over several months. In rare instances, babies with neonatal lupus may have congenital heart block, a serious heart problem in which the formation of fibrous tissue in the baby’s heart interferes with the electrical impulses that affect heart rhythm. Neonatal lupus is rare, and most infants of mothers with SLE are entirely healthy. All women who are pregnant and known to have anti-Ro (SSA) or anti-La (SSB) antibodies should be monitored by echocardiograms (a test that monitors the heart and surrounding blood vessels) periodically during pregnancy. It is important for women with SLE or other related autoimmune disorders to be under a doctor’s care during pregnancy. Doctors can now identify mothers at highest risk for complications, allowing for prompt treatment of the infant at or before birth. SLE can also flare during pregnancy, and prompt treatment can keep the mother healthier longer.”

Definition of SLE – Systemic Lupus Erythematosus

SLE is one disorder of the immune system, an autoimmune disease whereby the defense system of the body, the immune system, turns against parts of the body it should be protecting.  This leads to inflammation and damage to various body tissues.  It can affect various body parts including but not limited to the joints, skin, kidneys, heart, lungs, blood vessels, and brain.

People with the disease may experience many different symptoms.  The commonest are extreme fatigue, painful or swollen joints (arthritis), fever, skin rashes, and kidney problems (Lupus Nephritis).

At present, there is no cure for Lupus but it can be effectively treated.  Most sufferers can lead active, healthy lives.  SLE is characterized by periods of illness (flares) and periods of  remission when the disease is quiet.  Preventing flares and treating them when they occur helps people with lupus socially active.

Research is underway to answer the two most puzzling questions about SLE.  Who gets it?  and Why? One we have answers to these questions we can work on finding a cure.  We know that 90% of SLE patients are women and that it is two to three times more common in African American women than in Caucasian women.  African American and Hispanic women are also more likely to have active disease and serious organ system involvement. SLE can run in families but the risk that a child or a sibling of a patient will also have SLE is quite low.

Basic facts about SLE

  • It is an autoimmune disorder where the body’s defense systems attack its organs.  You can read here for more detail.
  • It is not considered hereditary.
  • It is not contagious.
  • It is not cancer, nor AIDS, nor anything else.

To start with it is important to make this clear.  Diagnosing SLE is everything but an easy task, so please don’t bear a grudge against anyone who missed a diagnosis, or otherwise diagnosed you after a decade or two of suffering.

There is no single test that determines if anyone is affected by SLE or not.

To complicate matters, many symptoms of lupus are similar to those of other diseases, so much so that it is one of the group of diseases called the great imitators.  Symptoms might come and go over weeks and months and this is why it can often take years for a diagnosis to be made, if ever.

Making a diagnosis

To diagnose SLE it often takes a rheumatologist.  The evidence needed is a collection of physical signs and symptoms and laboratory results, such as swelling of joints, protein in the urine, fluid around the lungs or heart, or a skin biopsy (test of a sample) that shows evidence of the disease.  Special tests are also made to rule out other diseases.

The “Eleven Criteria of Lupus” by the American College of Rheumatology help make a diagnosis of SLE.  Typically, four or more of the following criteria must be present to make a diagnosis.

The “Eleven Criteria”

  1. Malar rash: butterfly-shaped rash across cheeks and nose
  2. Discoid (skin) rash: raised red patches
  3. Photosensitivity: skin rash as result of unusual reaction to sunlight
  4. Mouth or nose ulcers: usually painless
  5. Arthritis (nonerosive) in two or more joints, along with tenderness, swelling, or effusion. With nonerosive arthritis, the bones around joints don’t get destroyed.
  6. Cardio-pulmonary involvement: inflammation of the lining around the heart (pericarditis) and/or lungs (pleuritis)
  7. Neurologic disorder: seizures and/or psychosis
  8. Renal (kidney) disorder: excessive protein in the urine, or cellular casts in the urine
  9. Hematologic (blood) disorder: hemolytic anemia, low white blood cell count, or low platelet count
  10. Immunologic disorder: antibodies to double stranded DNA, antibodies to Sm, or antibodies to cardiolipin
  11. Antinuclear antibodies (ANA): a positive test in the absence of drugs known to induce it.

The “Eleven Criteria” – one by one.

1.  Malar rash: butterfly-shaped rash across cheeks and nose

Malar Rash

Malar Rash – a.k.a – Butterfly rash

The term Lupus is attributed to Rogerius, a thirteenth century physician who used it to describe the facial lesions.  He thought that they resembled a wolf’s bite.  They are today known as discoid lupus skin lesions (diagnosed in the mid 1800’s as a separate condition).  SLE was diagnosed in the late 1800’s when the lesions were associated also with fatigue, inflammation, and other symptoms.

2.  Discoid Skin Rash: Press on the link here to read a comprehensive description.

3.  Photosensitivity:

People with SLE might be photosensitive.  This means that they might have unusually strong reactions to sunlight.  More than half of those with SLE are light sensitive.  Even worse, 40% to 70% of those with SLE experience an increase in symptoms after exposure to ultraviolet (UV) rays.  The source?  Either the Sun or artificial light.

Photosensitivity may develop int a butterfly rash or in other rashes that look like hives.  Sunlight may also cause a Lupus flare: fever, joint pain, or even organ inflammation.

Each person might have different levels of photosensitivity, just like in the general population.  Eventually, this blog will have a section with instructions on how to deal with these rays.

4.  Mouth or nose ulcers

Oral ulcers and sores are a common symptom in SLE patients.  They are often not painful but sometimes exceptionally uncomfortable.  They are a  direct manifestation of lupus affecting the mouth.  These ulcers and plaques may mimic numerous other conditions such as lichen planus (which itself might be a manifestation of an autoimmune disorder) or recurrent aphthous ulcers (canker sores).  The ulcers attributable to lupus are crudely estimated to affect about 5% – 40% of lupus patients. SLE does not appear to directly affect the teeth although two other factors may complicate the oral health of the lupus patient.  These are secondary Sjögren’s syndrome and adverse effects of many of the medications prescribed to manage lupus.  See list below:

  • Steroids suppress the immune system and increase the risk of an oral fungal infection and poor wound healing.
  • Hydroxychloroquine (Plaquenil) and Methotrexate may themselves cause oral sores or ulcerations.

 

There are other causes which one should also consider, like:

  • Stress and anxiety
  • Oral trauma – could be caused by hard food or excessive teeth brushing
  • Hormonal changes
  • Other medical conditions like: Vitamin B12 deficiency, Iron deficiency, Coeliac disease (Gluten Intolerance), Crohn’s disease, Reactive arthritis, Immunodeficiency (perhaps caused by lupus medication)
  • Occasionally mouth ulcers can be a side effect of medications like:  Non-steroidal anti-inflammatory drugs (NSAIDs) or Beta-blockers

10. and 11.  Immunologic disorder and the ANA:  See page on Blood tests

There is no single laboratory test that can determine if a person has lupus.

To complicate matters, many symptoms of lupus are similar to those of other diseases, and can come and go over weeks and months. It can often take years for a diagnosis to be made.

To diagnose lupus, a doctor should be able to find physical or laboratory evidence of the condition, such as swelling of joints, protein in the urine, fluid around the lungs or heart, or a skin biopsy (test of a sample) that shows evidence of the disease. The doctor also will look at a person’s medical history and special tests to rule out other diseases.

Doctors use the American College of Rheumatology’s “Eleven Criteria of Lupus” to help make—or exclude—a diagnosis of lupus.

Typically, four or more of the following criteria must be present to make a diagnosis of systemic lupus.

The “Eleven Criteria”

  1. Malar rash: butterfly-shaped rash across cheeks and nose
  2. Discoid (skin) rash: raised red patches
  3. Photosensitivity: skin rash as result of unusual reaction to sunlight
  4. Mouth or nose ulcers: usually painless
  5. Arthritis (nonerosive) in two or more joints, along with tenderness, swelling, or effusion. With nonerosive arthritis, the bones around joints don’t get destroyed.
  6. Cardio-pulmonary involvement: inflammation of the lining around the heart (pericarditis) and/or lungs (pleuritis)
  7. Neurologic disorder: seizures and/or psychosis
  8. Renal (kidney) disorder: excessive protein in the urine, or cellular casts in the urine
  9. Hematologic (blood) disorder: hemolytic anemia, low white blood cell count, or low platelet count
  10. Immunologic disorder: antibodies to double stranded DNA, antibodies to Sm, or antibodies to cardiolipin
  11. Antinuclear antibodies (ANA): a positive test in the absence of drugs known to induce it. A special note on the ANA test

– See more at: http://www.lupusresearchinstitute.org/lupus-facts/lupus-diagnosis#sthash.eTH2ceyi.dpuf

There is no single laboratory test that can determine if a person has lupus.

To complicate matters, many symptoms of lupus are similar to those of other diseases, and can come and go over weeks and months. It can often take years for a diagnosis to be made.

To diagnose lupus, a doctor should be able to find physical or laboratory evidence of the condition, such as swelling of joints, protein in the urine, fluid around the lungs or heart, or a skin biopsy (test of a sample) that shows evidence of the disease. The doctor also will look at a person’s medical history and special tests to rule out other diseases.

Doctors use the American College of Rheumatology’s “Eleven Criteria of Lupus” to help make—or exclude—a diagnosis of lupus.

Typically, four or more of the following criteria must be present to make a diagnosis of systemic lupus.

The “Eleven Criteria”

  1. Malar rash: butterfly-shaped rash across cheeks and nose
  2. Discoid (skin) rash: raised red patches
  3. Photosensitivity: skin rash as result of unusual reaction to sunlight
  4. Mouth or nose ulcers: usually painless
  5. Arthritis (nonerosive) in two or more joints, along with tenderness, swelling, or effusion. With nonerosive arthritis, the bones around joints don’t get destroyed.
  6. Cardio-pulmonary involvement: inflammation of the lining around the heart (pericarditis) and/or lungs (pleuritis)
  7. Neurologic disorder: seizures and/or psychosis
  8. Renal (kidney) disorder: excessive protein in the urine, or cellular casts in the urine
  9. Hematologic (blood) disorder: hemolytic anemia, low white blood cell count, or low platelet count
  10. Immunologic disorder: antibodies to double stranded DNA, antibodies to Sm, or antibodies to cardiolipin
  11. Antinuclear antibodies (ANA): a positive test in the absence of drugs known to induce it. A special note on the ANA test

– See more at: http://www.lupusresearchinstitute.org/lupus-facts/lupus-diagnosis#sthash.eTH2ceyi.dpuf

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s