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Nier en systematische lupus erthematodes: Wat moet men weten?

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that can affect various systems. Mainly the skin, joints, kidneys, hematopoietic and nervous system are involved. In addition, it is a condition that belongs to the category of autoimmune diseases, diseases created by the disorder in which our defense system - the immune system - is directed against the body itself and causes injuries to organs and tissues.

Is SLE a common disease?
The incidence of SLE ranges from 50-100 cases per 100,000 population. It is most common in people aged 20-30 and women tend to be 9 times more likely to suffer the syndrome than men.

What are the most common symptoms of SLE?
SLE is a multi-systemic disease, meaning it may involve many systems. The main symptoms are:

  • fever (or low fever), fatigue, weight loss that lasts for many days
  • pain in multiple joints of hands and feet at the same time lasting several weeks (arthritis)
  • blushing on the cheeks and nose (butterfly-shaped rash), intense redness in the skin in areas that are sun-exposed (light sensitivity)
  • wounds on the gums or nose lasting several weeks (pustules, ulcers)
  • pale or purple fingers or toes from cold accompanied by pain (Raynaud's phenomenon)
  • low white blood or platelets in the blood (leukopenia, thrombocytopenia)
  • intense hair loss (alopecia)
  • blood or albumin in urine (nephritis)
  • chest pain or difficulty in breathing or dyspnea (pleurisy, pericarditis)
  • recurrent miscarriageor thrombosis (antiphospholipid syndrome)
  • spasms, strokes or severe depression(neuropsychiatric lupus)

How is the diagnosis made?
The diagnosis of the disease is based on medical history, the thorough clinical examination and the basic laboratory testing. Specific immunological tests are required depending on the clinical suspicion that may be created by the clinical examination and the laboratory tests. To accurately determine the damage of the affected organ, it is sometimes necessary to perform an organ biopsy.

Is SLE diagnosed with immunological examinations?
No, it cannot be diagnosed, these tests are useful for detecting some autoantibodies in the patient's blood. For example, antinuclear antibody (ANA) test is often used to detect autoantibodies that react with the nucleus of cells. Most SLE patients have a positive ANA, but this may be due to other causes, such as infections and other autoimmune diseases. Positive ANA may even be present in healthy individuals. ANA simply gives the doctor another element that helps in the diagnosis. In addition, the doctor will advise the patient to take some additional special tests except ANA. These are ENA (anti-DNA, Sm, SS-A, SS-B) antiphospholipid antibodies, C3 and C4 supplements to help establish the diagnosis more correctly.

What treatments are available for SLE?
The treatment of each patient with SLE is specialized and depends on the severity of the disease, the penetration of SLE at organs, the age of the patient, and the coexistence of other diseases. The treatment regimen to be applied to SLE patients is designed or modified during the disease based on clinical manifestations. Most people have mild lupus that only affects the skin and joints and is treated with hydroxychloroquine alone or in other cases in combination with low doses of cortisone. When organs such as kidney or blood are infected, higher doses of corticosteroids and immunosuppressants (azathioprine, mycophenolate, cyclophosphamide) are used. The medicines used to treat SLE are:

non-steroidal anti-inflammatory drugs

  • hydroxychloroquine
  • glucocorticoids (cortisone)
  • immunoregulators / immunosuppressants
    • cyclophosphamide
    • azathioprine
    • mycophenolate
    • cyclosporine
    • methotrexate
    • leflunomide
  • biological factors
    • belimumab
    • rituximab

What is the course of the SLE?
The disease course of SLE has improved greatly in relation to the past. Nowadays, due to modern therapeutic possibilities, adverse prognosis has been overturned, since clinical manifestations can be fully controlled but also remission of the disease can be accomplished by the application of the appropriate therapeutic regimen for each patient.

By the Scientific Director Aristides Paraskevopoulos

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