SLE, Systemic lupus erythematosus

Raynaud Syndrome

Clinic

• SLE is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body.
• Symptoms vary between people and may be mild to severe.
• Common symptoms are Painful and swollen joints, Fever, Chest pain, Hair loss, Mouth ulcers, Swollen lymph nodes, Feeling tired and Red rash which is most commonly on the face.

Types

Skin type

• 70% of people with lupus have some skin symptoms. The three main categories of lesions are  
  • Chronic cutaneous (discoid) lupus exhibit thick, red scaly patches.
  • Subacute cutaneous lupus manifests as red, scaly patches of skin but with distinct edges.
  • Acute cutaneous lupus: Rash, classically malar rash or butterfly rash (30- 60%)
  • Hair loss
  • Mouth and nasal ulcers

Muscles and bones type

• Most commonly small joints of the hand and wrist usually affected
• More than 90 % have myalgia
• Unlike RA, lupus arthritis is less disabling and usually does not cause severe destruction of the joints. Fewer than 10% of people with lupus arthritis will develop deformities of the hands and feet.
• Osteoarticular tuberculosis
• A possible association between rheumatoid arthritis and SLE has been suggested
• SLE may be associated with an increased risk of bone fractures 

Blood type

• Anemia is common in children lupus (50%)
• Low platelet count
• Low white blood cell count 
• SLE may have an association with antiphospholipid antibody syndrome (a thrombotic disorder) which includes
  • A paradoxical prolonged partial thromboplastin time
  • A positive test for antiphospholipid antibodies; the combination of such findings have earned the term "lupus anticoagulant-positive".
• Another autoantibody finding in SLE is the anti-cardiolipin antibody

Heart type

• Pericarditis
• Myocarditis
• Endocarditis: Libman–Sacks endocarditis which involves either the mitral valve or the tricuspid valve
• Atherosclerosis also occurs more often and advances more rapidly than in the general population.

Lungs type

• SLE can cause Pleuritic pain / Pleurisy
• Other associated lung conditions include
  • Pneumonitis
  • Chronic diffuse interstitial lung disease
  • Pulmonary hypertension
  • Pulmonary emboli
  • Pulmonary hemorrhage

Kidney type

• Painless Hematuria / Proteinuria  
• Lupus nephritis, leading to acute or end-stage kidney failure. Because of early recognition and management of SLE, end-stage renal failure occurs in less than 5% of cases; except in the black population, where the risk is many times higher.
• The histological hallmark of SLE is membranous glomerulonephritis with "wire loop" abnormalities.

Neuropsychiatric type

• It can be the result of CNS or peripheral nervous system involvement.
• Neuropsychiatric syndromes concurrent with SLE= NPSLE
• Common sign / Symptoms are
  • Headache
  • Cognitive dysfunction
  • Mood disorder
  • Cerebrovascular disease
  • Seizures
  • Polyneuropathy
  • Anxiety disorder
  • Psychosis
  • Depression
  • Personality disorders

More rare manifestations are

• Acute confusional state
• Guillain–Barré syndrome
• Aseptic meningitis
• Autonomic disorder
• Demyelinating syndrome
• Mononeuropathy (Mononeuritis multiplex)
• Movement disorder (more specifically, chorea)
• Myasthenia gravi
• Myelopathy
• Cranial neuropathy
• Plexopathy

Eye SLE

• 33% of SLE patients
• Most commonly, Dry eye syndrome and secondary Sjögren's syndrome
• Others
• Episcleritis / Scleritis
• Retinopathy (often affecting both eyes than one)
• Ischemic optic neuropathy
• Retinal detachment
• Secondary angle-closure glaucoma may occur.

Reproductive SLE

• Increased rate of fetal death in utero and spontaneous abortion (miscarriage). (72%)

Neonatal lupus

• Discoid lupus erythematosus
• Heart block
• Liver and spleen enlargement

Systemic SLE

• Fatigue/ Anemia
• Hypothyroidism
• Pain
• Depression
• Poor sleep quality