The Lymphatic System
Systemic Lupus Erythematosus (SLE)
is a multisystem connective tissue
disease characterised by the presence of numerous autoantibodies,
circulating immune complexes, activation of complement and widespread
immunologically mediated tissue damage. SLE affects individuals throughout the
world but occurs more frequently in the United States (especially Blacks) and
the Far East. The onset is most commonly in the 2nd and 3rd decades, with a female
to male ratio of 9:1, the prevalence of SLE is around 1:2,500.
the cause of SLE remains obscure, several factors may be involved.
It appears that genetic factors
are important in the aetiology of the disease because of frequent occurrence
in identical twins, and higher than expected prevalence of SLE, other
autoimmune connective tissue diseases, antinuclear antibodies and immune
complexes in related family members.
Certain environmental factors
have been also implicated in pathogenesis of SLE because it has been reported
that exposure to sunlight can
exacerbate the disease (but probably not cause it), as well as several drugs (especially anti-epileptic diphenylhydantoin, anti-arrhythmic procainamide, vasodilator hydralazine
and anti-tuberculotic isoniazid). Exacerbations of SLE commonly occur in pregnancy
and after delivery, and become infrequent in menopause; also prevalence is
increased in women who have several children and those using oral
contraceptives, suggesting the possible role of oestrogens.
3. All available evidence suggests that SLE in an autoimmune condition, as many immunological abnormalities are detectable in the blood of patients with SLE:
and other autoantibodies such as anti-DNA; anti-RNA; anti-Sm, anti-Ro, anti-La
(against nucleolar ribonucleoprotein antigens); anti-MA (anti-mitochondrial
against erythrocytes, leukocytes and platelets
antibodies and other organ specific autoantibodies
immune complexes which are frequently deposited in many tissues initiating
Immunologically-mediated tissue damage results from at least two different mechanisms:
Direct Type II antibody-mediated cytotoxicity
with activation of complement may be responsible for brain damage and
miscarriage (cytotoxic effect of antibodies which cross-react with fetal
tissues and neurons) as well as haemolytic anaemia, leukopenia and
Immune complex mediated Type III hypersensitivity
also known as immune complex disease can explain the mechanism of renal and
vascular lesions, which appear to be a consequence of deposition of
circulating DNA-anti-DNA and other complexes in tissues with subsequent acute
inflammation; vasculitis is thought to underlie probably most of the
Clinical features: < BACK TO TOP >
arthralgia and fever
These are the commonest presenting features
and occur in more than 90% of
patients and the
joints commonly involved are the proximal interphalangeal,
metacarpophalangeal, wrist and knees (differential diagnosis with
rheumatoid arthritis is essential).
Symptoms may begin during pregnancy and there
may be a past history of
The arthritis can be transient and migratory
or a more persistent polyarthritis.
In contrast to rheumatoid arthritis lupus
polyarthritis is usually non-destructive and non-deforming (no actual damage
of the joint cartilage).
They are seen in more than two-thirds of
patients, usually in form of erythematous ‘butterfly?/i>
rash across the face
(involving the bridge of the nose and malar areas of the face) and
macular reddish-purple lesions on the palms, fingers, arms and trunk.
Other skin lesions such as widespread rash
due to minute skin bleeding (purpura),
secondary to thrombocytopenia or vasculitis (inflammation in the blood vessel
wall with subsequent vessel rupture).
(hair loss) is seen in more than 50% of patients during active phases of SLE
but it is generally reversible.
These include pericarditis with retrosternal
chest pain, myocarditis and endocarditis (may produce increased heart rate
and fatigue or heart murmurs), pleurisy with pleuritic pain, fibrosing
alveolitis with thickening and hardening of alveolar walls.
lung syndrome?/i> (restrictive lung disorder) due to pulmonary fibrosis
immunologically mediated inflammation in the lungs is responsible for
compliance and breathlessness, especially on exertion.
Lung function tests reveal impairment of
ventilation and gas diffusion in these and many patients without overt
clinical or radiological evidence of pulmonary involvement.
Renal lesions follow secondary
glomerulonephritis pattern due to deposition of immune complexes in the
glomeruli and secondary inflammation.
Renal involvement may be benign and
asymptomatic or serious and relentlessly progressive.
The most common manifestation is persistent
mild proteinuria, but in more severe cases there can be nephrotic syndrome
developing eventually into chronic renal failure.
nervous system involvement
It occurs in up to half the patients in form of migraine-like headaches, mild psychiatric disturbance (personality and mood disorders) or partial organic epilepsy.
In a few patients there may be severe
depression, dementia, organic psychosis,
lesions, hemiparesis (weakness on one side of the body), ataxia
(incoordination, clumsiness) or peripheral neuropathy (sensory and motor).
Abdominal pain is sometimes reported and it
can be due to peritonitis, pancreatitis or intraabdominal vasculitis.
Lymphadenopathy is found in half the patients and a moderately enlarged spleen in 20-30% of patients.
Diagnosis: < BACK TO TOP >
diagnosis is largely clinical and according to American Rheumatism Association
at least four of the following eight symptoms must occur, either serially or
at the same time before a diagnosis can be made:
1. abnormal finding in urine
3. butterfly rash on the cheeks
4. sun sensitivity
5. mouth sores
6. seizures or psychosis
7. low white blood cells count, low platelet count, or haemolytic
8. autoantibodies in blood
is usually raised in active disease (interestingly C reactive protein can be
very low), while haematological findings may include normocytic normochromic
anaemia of chronic disease, sometimes autoimmune haemolytic anaemia,
findings are essential for diagnosis and include
Antinuclear antibodies (ANA) can be detected
by indirect immuno-fluorescence in the serum of more than 90% of patients but
positive tests are found in many other autoimmune conditions.
Anti-DNA antibodies detected by ELISA
(enzyme-linked immunosorbent assay) technique have much greater specificity,
but are present in the serum in only half the patients. Other autoantibodies
mentioned earlier can also be identified in some but not all patients.
An evidence for circulating immune complexes
may be obtained by using special techniques.
Tissue evidence for immune complex deposition comes from detection of immunoglobulins by direct immunofluorescence in skin or organ biopsies.
Management < BACK TO TOP >
condition generally runs unpredictable exacerbation-remission course.
treatment is with corticosteroids (e.g., prednisolone [Delta-Cortef,
Panafcortelone, Solone]) which can be given initially in large doses.
remission of disease careful attempts are made to withdraw steroids or
maintain patients on very low doses.
may be used for symptomatic relief of articular symptoms.
drugs (e.g., azathioprine [Imuran, Thioprine] or cyclophosphamide [Cycloblastin,
Endoxan]) are reserved for patients with severe diffuse progressive
glomerulonephritis who are not responding adequately to corticosteroids.
exchange can be attempted when, using the equipment similar to haemodialysis
machine, patient’s plasma can be separated and replaced by fresh plasma
(patient’s plasma is then discarded together with autoantibodies and immune
In patients who develop chronic renal failure dialysis or kidney transplantation are necessary; kidney transplantation in SLE patients has proven remarkably successful.
early diagnosis and efficient treatment the prognosis has improved markedly,
and 10-year survival today is more than 95%.
Prognosis < BACK TO TOP >
Nutrition < BACK TO TOP >
Nutrition that alleviate or prevent Systemic Lupus Erythematosus (SLE) :-
Herbs < BACK TO TOP >
Herbs that alleviate or prevent Systemic Lupus Erythematosus (SLE) :-
It is advised that patients avoid unnecessary exposure to sun and wear sunscreens whenever going outside. Skin lesions are treated with topical corticosteroid creams, but avoiding their excessive use.
Dr Zoran Pletikosa)
15 May 2009
19 June 2005
International Day of Families
Happy Father's Day
Animation Source : Minibyte Solutions
speaker Mr NgThian Watt the Principal Trainer from
Napoleon Hill Associates MalaysiaDetails