What's wrong with lupus

Lupus erythematosus

The most common forms are cutaneous lupus erythematosus with its subtypes and systemic lupus erythematosus. There are also special forms of drug-induced systemic lupus erythematosus and neonatal lupus erythematosus.

Cutaneous Lupus Erythematosus (CLE)

Usually only the skin is affected. However, SLE can also develop over time. In Europe, almost 50 per 100,000 inhabitants are affected, most of them women. A distinction is made between several sub-forms in which different-shaped changes can occur in different skin regions. Some heal without scars, others leave deep scars.

Diagnosis is based on medical history and physical examination. In addition, histological examinations, immunofluorescence examinations and laboratory tests of blood may be necessary. Pimecrolimus is used as a local treatment.

Systemic lupus erythematosus (SLE)

The prevalence of SLE worldwide is 4 to 250 patients per 100,000. Over 90 percent of patients are female, and 50 percent of the cases are diagnosed before the age of 30. 15 percent become ill in childhood, mostly between the ages of 12 and 14. The symptoms vary greatly among those affected. The first symptoms can appear suddenly or slowly. The disease activity can be constant, but a relapsing course with symptom-free phases is also possible.

Organ systems or individual organs can be affected. At the same time, inflammatory processes can occur with different levels of activity and severity.

The following symptoms can occur, among others:

  • Swelling and pain in the joints;
  • Muscle pain,
  • General complaints (tiredness, exhaustion, poor performance, weight loss, etc.);
  • Skin changes (usually healing without scars: butterfly erythema, measles-like rash);
  • Kidney disease (lupus nephritis);
  • Central nervous system complaints (especially epileptic seizures, migraine-like headaches, coordination disorders, mental illness, uncontrolled tremors and / or convulsions);
  • Changes in the mucous membrane (inflammation and open wounds, especially in the mouth, nose or on the lips);
  • Gastrointestinal complaints (especially nausea, vomiting and abdominal pain);
  • Inflammation of the pleura (pleurisy), lungs, joints, muscles, heart muscle (myocarditis), inner lining of the heart (endocarditis), pancreas;
  • Venous thrombosis
  • Enlarged lymph nodes;

If SLE is suspected, the following laboratory tests should be carried out: erythrocyte sedimentation rate (ESR), CRP, blood count, antinuclear antibodies (ANA) and urine findings. The diagnosis is based on the characteristic symptoms, clinical findings and laboratory findings. With early diagnosis and adequate therapy, most of those affected have an almost normal life expectancy.

SLE and pregnancy

  • The risk of complications (abortion, premature birth, preeclampsia, low birth weight) is about 2–3 times higher than in healthy women.
  • The prognosis is good under the following conditions: no disease activity six months before birth, corticosteroid dose below 10 mg prednisone, stable blood pressure, good kidney function (eGFR> 60 ml / min, proteinuria <1 g / day), negative or low antiphospholipid antibodies.
  • If anti-SS-A / SS-B antibodies are increased, the risk of congenital atrioventricular block (AV block) is increased in about one percent of children during the first pregnancy.
  • Patients planning a pregnancy should contact specialists (rheumatology / gynecology).
  • The pregnancy should be monitored by specialists.
  • For repeated abortions and elevated antiphospholipid antibodies: aspirin (100 mg / day) as soon as pregnancy is desired, and low molecular weight heparin if there are indications of fetal life.

Neonatal lupus erythematosus

Neonatal lupus erythematosus in newborns is the result of a lupus erythematosus disease in the mother, although she does not have to have any symptoms. Maternal autoantibodies are transferred to the child via the placenta.

Skin changes occur in children, and rarely also myocardial fibrosis with atrioventricular block (AV block). This heart disease develops during pregnancy and usually has to be treated with a pacemaker. With the exception of the AV block on the heart, the disease has a good prognosis because the other symptoms disappear within two years when the autoantibodies passively transmitted by the mother are broken down.

Drug-induced systemic lupus erythematosus

Some drugs (e.g. hydrazine, hydantoine, procainamide, sulfasalazine) can trigger a clinical picture very similar to SLE (pseudo-lupus erythematosus syndrome). This usually subsides quickly after stopping the drug.