Lupus blood what. Lupus erythematosus: what kind of disease and how to treat it? Classification of systemic lupus erythematosus

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Lupus (systemic lupus erythematosus, SLE) is an autoimmune disease in which the immune system human cells attack connective tissue host as alien.

Connective tissue is almost everywhere, and most importantly - in the ubiquitous vessels.

The inflammation caused by lupus can affect a wide variety of organs and systems, including the skin, kidneys, blood, brain, heart, and lungs.

Lupus is not transmitted from person to person.

Science does not know the exact cause of lupus, like many other autoimmune diseases.

These diseases are most likely caused by genetic disorders in the immune system that make it possible for it to produce antibodies against its own host.

Lupus is difficult to diagnose because its symptoms are so varied and it can masquerade as other diseases. The most distinguishing feature of lupus is facial erythema that resembles butterfly wings spread across both cheeks (butterfly erythema). But this symptom is not found in all cases of lupus.

There is no cure for lupus, but its symptoms can be controlled with medication.

Causes and risk factors for lupus

Combination external factors can push the autoimmune process. Moreover, some factors act on one person, but do not act on another.

Why this happens remains a mystery.

There are many possible causes of lupus:

Exposure to ultraviolet rays (sunlight) can cause lupus or worsen its symptoms.
Female sex hormones do not cause lupus, but they influence its course. Among them may be high-dose preparations of female sex hormones for the treatment gynecological diseases. But this does not apply to taking low-dose oral contraceptives (OCs).
Smoking is considered one of the risk factors for lupus, which can cause the disease and exacerbate its course (especially vascular damage).
Some medications can aggravate lupus (in each case, you need to read the instructions for the drug).
Infections such as cytomegalovirus (CMV), parvovirus ( infectious erythema) and hepatitis C can also cause lupus. Epstein-Barr virus is associated with lupus in children.
Chemicals can cause lupus. Among these substances in the first place is trichlorethylene (a narcotic substance used in the chemical industry). Hair dyes and fixatives, previously considered the cause of lupus, are now fully justified.

The following groups of people are more likely to develop lupus:

Women get lupus more often than men.
Africans are more likely to get lupus than whites.
People between the ages of 15 and 45 are most commonly affected.
Heavy smokers(according to some studies).
People with a burdened family history.
People on a chronic basis with medications associated with a risk of lupus (sulfonamides, some antibiotics, hydralazine).

Drugs that cause lupus

One of the most common causes of lupus is the use of medicines and others chemical substances. In the United States, hydralazine (about 20% of cases), as well as procainamide (up to 20%), quinidine, minocycline, and isoniazid, are considered one of the main drugs causing drug-induced SLE.

Drugs most commonly associated with lupus include calcium channel blockers, ACE inhibitors, TNF-alpha antagonists, thiazide diuretics and terbinafine ( antifungal drug).

The following groups of drugs are commonly associated with drug-induced SLE:

Antibiotics: minocycline and isoniazid.
Antipsychotic drugs: chloropromazine.
Biological agents: interleukins, interferons.
Antihypertensive drugs: methyldopa, hydralazine, captopril.
Hormonal drugs: leuprolide.
Inhalation drugs with COPD: tiotropium bromide.
Antiarrhythmic drugs: procainamide and quinidine.
Anti-inflammatory: sulfasalazine and penicillamine.
Antifungal: terbinafine, griseofulvin and voriconazole.
Hypocholesterolemic: lovastatin, simvastatin, atorvastatin, gemfibrozil.
Anticonvulsants: valproic acid, ethosuximide, carbamazepine, hydantoin.
Other drugs: eye drops with timolol, TNF-alpha inhibitors, sulfa drugs, high-dose preparations of female sex hormones.

Additional list of drugs that cause lupus:

Amiodarone.
Atenolol.
Acebutolol.
Bupropion.
Hydroxychloroquine.
Hydrochlorothiazide.
Glyburide.
Diltiazem.
Doxycycline.
Doxorubicin.
Docetaxel.
Gold and its salts.
Imiquimod.
Lamotrigine.
Lansoprazole.
Lithium and its salts.
Mephenytoin.
Nitrofurantoin.
Olanzapine.
Omeprazole.
Praktolol.
Propylthiouracil.
Reserpine.
Rifampicin.
Sertalin.
Tetracycline.
Ticlopidin.
Trimethadione.
Phenylbutazone.
Phenytoin.
Fluorouracil.
Cefepime.
Cimetidine.
Esomeprazole.

Sometimes systemic lupus erythematosus is caused by chemicals that enter the body from the environment. This happens only in some people, for some unknown reason.

These chemicals include:

Some insecticides.
Some metal compounds.
Eosin (fluorescent liquid found in lipsticks).
Para-aminobenzoic acid (PABA).

Lupus Symptoms

The symptoms of lupus are very varied because the disease can affect different organs. Entire volumes of medical manuals have been written about the symptoms of this complex disease. We can review them briefly.

No two cases of lupus are exactly alike. The symptoms of lupus may come on suddenly or develop gradually, may be temporary, or may be lifelong. In most patients, lupus is relatively mild, with periodic exacerbations, when the symptoms of the disease become worse, and then subside or disappear altogether.

Symptoms of lupus may include:

Fatigue and weakness.
Temperature increase.
Pain, swelling and stiffness of the joints.
Erythema on the face in the form of a butterfly.
Skin lesions aggravated by the sun.
Raynaud's phenomenon (impaired blood flow in the fingers).
Breathing problems.
Chest pain .
Dry eyes.
Memory loss.
Violation of consciousness.
Headaches.

It is almost impossible to assume that you have lupus before a visit to the doctor. Seek advice if you develop an unusual rash, fever, joint pain, fatigue.

Lupus Diagnosis

Diagnosis of lupus can be very difficult due to the variety of manifestations of the disease. The symptoms of lupus can change over time and resemble other illnesses. A range of tests may be required to diagnose lupus:

1. Complete blood count.

In this analysis, the content of erythrocytes, leukocytes, platelets, hemoglobin is determined. Lupus may present with anemia. A low white blood cell and platelet count can also indicate lupus.

2. Determination of the ESR indicator.

The erythrocyte sedimentation rate is determined by how quickly your blood erythrocytes settle in the prepared blood sample to the bottom of the tube. ESR is measured in millimeters per hour (mm/h). A rapid erythrocyte sedimentation rate may indicate inflammation, including autoimmune inflammation, as in lupus. But ESR also rises with cancer, other inflammatory diseases, even with a common cold.

3. Assessment of the functions of the liver and kidneys.

Blood tests can show how well your kidneys and liver are working. This is determined by the amount of liver enzymes in the blood and the level of toxic substances that the kidneys must cope with. Lupus can affect both the liver and kidneys.

4. Urinalysis.

Your urine sample may show an increase in protein or red blood cells. This indicates damage to the kidneys, which can be observed in lupus.

5. Analysis for ANA.

Antinuclear antibodies (ANA) are special proteins produced by the immune system. A positive ANA test may indicate lupus, although it may also be the case with other diseases. If your ANA test is positive, your doctor may order other tests.

6. Chest x-ray.

Image Acquisition chest helps detect inflammation or fluid in the lungs. This may be a sign of lupus or other diseases that affect the lungs.

7. Echocardiography.

Echocardiography (EchoCG) is a technique that uses sound waves to produce a real-time image of a beating heart. An echocardiogram can reveal heart valve problems and more.

8. Biopsy.

Biopsy, taking a sample of an organ for analysis, is widely used in the diagnosis of various diseases. Lupus often affects the kidneys, so your doctor may order a biopsy of your kidneys. This procedure is performed with a long needle after preliminary anesthesia, so there is nothing to worry about. The resulting piece of tissue will help to identify the cause of your illness.

Lupus treatment

The treatment of lupus is very complex and lengthy. Treatment depends on the severity of the symptoms of the disease and requires a serious discussion with the doctor of the risks and benefits of a particular therapy. Your doctor should constantly monitor your treatment. If the symptoms of the disease subside, he may change the drug or reduce the dose. If there is an exacerbation - vice versa.

Modern drugs for the treatment of lupus:

1. Non-steroidal anti-inflammatory drugs (NSAIDs).

OTC NSAIDs such as naproxen (Anaprox, Nalgesin, Floginas) and ibuprofen (Nurofen, Ibuprom) may be used to treat inflammation, swelling, and pain caused by lupus. More strong NSAIDs, such as diclofenac (Olfen), are available on prescription. Side effects of NSAIDs include abdominal pain, stomach bleeding, kidney problems, and an increased risk of cardiovascular complications. The latter is especially true for celecoxib and rofecoxib, which are not recommended for the elderly.

2. Antimalarial drugs.

Medicines commonly prescribed to treat malaria, such as hydroxychloroquine (Plaquenil), help control lupus symptoms. Side effects: stomach discomfort and retinal damage (very rare).

3. Corticosteroid hormones.

Corticosteroid hormones are powerful drugs that fight inflammation in lupus. Among them are methylprednisolone, prednisolone, dexamethasone. These drugs are prescribed only by a doctor. They are characterized by long-term side effects: weight gain, osteoporosis, high blood pressure, risk of diabetes and susceptibility to infections. The risk of side effects is higher the higher the doses you use and the longer the course of treatment.

4. Immunosuppressors.

Drugs that suppress the immune system can be very helpful for lupus and other autoimmune diseases. Among them are cyclophosphamide (Cytoxan), azathioprine (Imuran), mycophenolate, leflunomide, methotrexate and others. Possible side effects: susceptibility to infections, liver damage, decreased fertility, risk of many types of cancer. More new drug, belimumab (Benlysta), also reduces inflammation in lupus. Its side effects include fever, nausea, and diarrhea. If you suffer from lupus, there are several steps you can take to help yourself. Simple Measures can make flare-ups less frequent and improve your quality of life.

Try the following:

1. Adequate rest.

People with lupus experience constant fatigue, which is different from fatigue in healthy people and does not go away with rest. For this reason, it can be difficult for you to judge when to stop and rest. Develop a gentle daily routine for yourself and follow it.

2. Watch out for the sun.

Ultraviolet rays can cause lupus to flare up, so you should wear cover-ups and avoid walking in hot rays. Choose yours Sunglasses darker, and a cream with an SPF of at least 55 (for especially sensitive skin).

3. Eat a healthy diet.

A healthy diet should include fruits, vegetables, and whole grains. Sometimes you will have to endure dietary restrictions, especially if you have high blood pressure, kidney problems, or gastrointestinal tract. Take it seriously.

4. Exercise regularly.

Physical exercise approved by your doctor will help you improve your fitness and recover faster from flare-ups. In the long term, fitness is a reduction in the risk of heart attack, obesity and diabetes.

5. Quit smoking.

Among other things, smoking can worsen the damage to the heart and blood vessels caused by lupus.

Alternative medicine and lupus

Sometimes alternative medicine can help people with lupus. But do not forget that it is unconventional precisely because its effectiveness and safety has not been proven. Be sure to discuss everything with your doctor. alternative methods treatments you want to try.

Well-known non-traditional treatments for lupus in the West:

1. Dehydroepiandrosterone (DHEA).

Dietary supplements containing this hormone may reduce the dose of steroids that the patient receives. DHEA relieves the symptoms of the disease in some patients.

2. Flax seed.

Flax-seed contains a fatty acid called alpha-linolenic, which can reduce inflammation. Some studies have shown the ability of flax seeds to improve kidney function in lupus patients. Side effects include bloating and abdominal pain.

3. Fish oil.

Fish oil supplements contain omega-3 fatty acids, which may be helpful for lupus. Preliminary studies have shown promising results. Side effects of fish oil include nausea, vomiting, belching, and a fishy taste in the mouth.

4. Vitamin D

There is some evidence that this vitamin improves symptoms in people with lupus. However, scientific data on this issue is very limited.

Complications of lupus

The inflammation caused by lupus can affect different organs.

This leads to numerous complications:

1. Kidneys.

Renal failure is one of the main causes of death in lupus patients. Signs of kidney problems include itching all over the body, pain, nausea, vomiting, and swelling.

2. Brain.

If the brain is affected by lupus, the patient may experience headaches, dizziness, behavioral changes, and hallucinations. Sometimes there are seizures, and even a stroke. Many people with lupus have trouble remembering and expressing their thoughts.

3. Blood.

Lupus can cause blood disorders such as anemia and thrombocytopenia. The latter is manifested by a tendency to bleeding.

4. Blood vessels.

Lupus can cause blood vessels to become inflamed various bodies. This is called vasculitis. The risk of vascular inflammation increases if the patient smokes.

5. Lungs.

Lupus increases the chance of inflammation of the pleura, called pleurisy, which can make breathing painful and difficult.

6. Heart.

Antibodies can attack the heart muscle (myocarditis), the sac around the heart (pericarditis), and large arteries. This leads to an increased risk of heart attack and other serious complications.

7. Infections.

People with lupus become vulnerable to infection, especially as a result of treatment with steroids and immunosuppressants. The most common infections genitourinary system, respiratory infections. Common pathogens: yeast, salmonella, herpes virus.

8. Avascular necrosis of bones.

This condition is also known as aseptic or non-infectious necrosis. Occurs when the blood supply to the bones decreases, leading to fragility and easy destruction of the bone tissue. There are often problems with hip joint which is under heavy load.

9. Complications of pregnancy.

Women with lupus have a high risk of miscarriage. Lupus increases the chance of preeclampsia and preterm birth. To reduce your risk, your doctor may recommend that you not conceive until at least 6 months have passed since your last outbreak.

10 Cancer

Lupus is associated with an increased risk of many types of cancer. What's more, some lupus drugs (immunosuppressants) themselves increase this risk.

Do you know how to recognize the early signs of lupus?

Lupus is a chronic and painful condition. Mayo Clinic describes it as "chronic inflammatory disease that occurs when the body's immune system destroys its own tissues and organs."

Like psoriasis, lupus is an autoimmune disease in which the body accidentally turns its disease-fighting capabilities on itself. The severity of lupus can vary widely.

Some people have only mild symptoms, while others suffer more severely and can interfere with performance. There are many different risk factors, many of which are genetic. Scientists still don't fully understand why some people have more signs of lupus than others. In 9 out of 10 cases, lupus affects women.

Take a look at some of the most common early signs lupus.

Lupus Sign #1: Butterfly rash

Image: LittleThings

A butterfly-shaped rash is one of the most characteristic early signs of lupus.

According to WebMD, it usually spreads through the top of the nose to both cheeks.

In some people, it can spread even further. This rash is usually reddish purple and may be flaky or scaly.

Lupus Sign #2: Blue fingers

Image: LittleThings

Lupus causes circulatory problems that can lead to Raynaud's disease.

In Raynaud's syndrome, due to spasm of small vessels, blood flow to the fingertips is complicated.

Therefore, you may notice that your fingers and fingertips are blue, purple, or White color due to lack of blood flow.

Lupus Sign #3: Wasted

Image: LittleThings

We all get tired, but exhaustion is something else entirely.

During exhaustion, your body and bones are so deeply tired that you can hardly move. This feeling may also be accompanied by fever.

Lupus researchers do not know why it causes such a strong feeling of fatigue, although this may be due to the body falsely trying to believe that it is fighting the disease.

Lupus Sign #4: Hair Loss

Image: LittleThings

Hair loss is common symptom a number of ailments, including stress and malnutrition.

However, if you notice that your hair seems to be falling out in clumps, this could be a sign of lupus.

Typically, baldness from lupus is temporary and the hair will start to grow back in remission.

Lupus Sign #5: Swollen Legs

Image: LittleThings

For many people with lupus, swollen feet and ankles are the first symptom.

You may experience swelling that changes the shape of your lower extremities.

Lupus nephritis, which impairs kidney function, makes it harder for your body to excrete excess water and it begins to accumulate in your body. Feet swell primarily due to gravity.

If you experience this symptom, you should be tested for kidney failure.

Lupus Sign #6: Throbbing chest pains

Image: LittleThings

Chest pain is one of the most dangerous early symptoms lupus, as it may mean that your heart is at risk.

Lupus can attack any of the tissues in the body, including the heart. When this happens, an inflammation called myocarditis sets in. This causes pain and can lead to poor heart rate.

Lupus Sign #7: Ulcers in Nose and Mouth

Image: LittleThings

Approximately 50% of people with lupus have sores in their mouth and nose.

These sores are usually not painful, but may make you feel itchy, sore, or dry.

Most often they appear at the top. oral cavity(although they can appear anywhere) and are red in the middle with a whitish "halo" around.

Lupus Sign #8: Swollen Joints

Image: LittleThings

When lupus affects the entire body, lupus arthritis may be one of the first symptoms.

Like any other type of arthritis, it causes swelling and pain in the joints.

Lupus affects the tissues and ligaments in the joint, causing them to become inflamed and swollen, leading to arthritis.

Lupus is a serious disease that can affect anyone. If you experience any of these symptoms, be sure to see your doctor.

In fact, it is more correct to call it systemic lupus erythematosus or Liebman-Sachs disease, but this is scientific, medical, and the people get by with one word - lupus, but everyone understands what kind of disease they are talking about. It refers to collagenoses or diffuse connective tissue diseases (DBST), and it proceeds with damage to all organs where this tissue is present, in addition, the walls of blood vessels () also become inflamed, so we can say that the whole body suffers.

SLE (systemic lupus erythematosus) has many epithets, unfortunately, disappointing, so this disease cannot be called benign.

It has been proven that lupus has a hereditary predisposition, which arises under the influence of initiating or provoking factors. However, first things first.

Viruses, stress, immune response… Lupus

It is somehow impossible to say unequivocally what causes lupus, since it has no specific causes. However, the prerequisites that contribute to the formation of the pathological process are known reliably.

Lupus is autoimmune disease , that is, accompanied by the production of specific proteins (immunoglobulins of various classes, called antibodies) to their own tissues and cell components (autoantibodies). This variant of the immune response in relation to one's own body is called autoimmunization and underlies the development of autoimmune processes. This type of functioning of the immune system is due to certain genetic abnormalities, that is, SLE has a hereditary predisposition, as indicated by family cases of the disease.

Infection plays an important role in the origin of the disease., while its variety is completely unimportant, since the main point is the tension of immunity and the production of antibodies. And since in acute viral infections, destructive changes occur at the site of the pathogen’s introduction (for example, the mucous membrane of the respiratory tract with influenza), a pronounced immune response is formed, conditions are created for the formation of immunoglobulins, including autoantibodies.

Other contributing factors include:

• Insolation (stay in the sun);
• Fluctuations in hormone levels (therefore, the disease is more characteristic of the female sex);
• Abortion and childbirth also affect women;
• Psycho-emotional stress, stress;
• Taking certain medications (salicylates).

The combination of these causes aggravates the situation and contributes to the development of such a bad disease as lupus, which, however, can proceed differently, exist in several different forms and, accordingly, give diverse clinical manifestations.

Depending on the predominant lesion of a particular organ and on the causes of occurrence, several varieties of lupus lesion are distinguished.

Is skin involvement only a separate form of lupus?

discoid form or discoid lupus erythematosus(DKV) is considered the lot of dermatologists, characterized by the appearance of erythematous rashes, which can affect the face, cheekbones, nose and spread to the cheeks, forming a "butterfly" (this is the name of the rash, since it is very reminiscent of this insect in its outlines).

The severity of the "butterfly" and the persistence of inflammatory manifestations are very significant in establishing the diagnosis and determine DKV options:

1. Intermittent redness with cyanosis of the middle zone of the face, which pulsates and intensifies under the influence of weather conditions ( low temperature environment, ultraviolet exposure, strong wind) or psycho-emotional state (excitement);
2. The appearance of persistent erythematous spots with edema, accompanied by a thickening of the epidermis at the site of their formation (hyperkeratosis);
3. Severely swollen eyelids, swelling of the entire face, the presence of bright pink spots, dense and edematous;
4. Distinct cicatricial atrophy is noted in the discoid elements.

In other cases, rashes can move to other parts of the body: earlobes, forehead, neck, torso, hairy part head, limbs, or appear nonspecifically - purpura, nodules (erythema polymorphism).

Rash on the mucous membrane is typical for lupus

For the diagnosis of DKV, a special role is given to the presence of a rash on the oral mucosa, as well as the presence of lupus cheilitis, which is manifested by swelling and a red border of the lips, covered with gray, dryish scales or crusts and erosions, which subsequently undergo cicatricial atrophy.

The butterfly equivalent, capillaritis (vasculitis), which is characterized by the formation of small, slightly edematous spots, with the development of mild atrophy, is another option. In this case, the fingers of the upper and lower extremities, the surface of the palms and soles are affected, trophic changes are observed. skin(fragility of nails and their deformation, the formation of ulcers and bedsores, increased hair loss).

It should be noted that DKV is not excluded with generalized lupus erythematosus, but there she comes as a symptom, not as a separate form of the disease.

Other isolated forms of lupus

As for other variants of lupus, even though they look like a classic form (“butterfly”, erythematous rashes, etc.), they have other causes, require specific treatment and differ in prognosis (tuberculous and medicinal).

Tuberculous lupus, also known as skin tuberculosis or lupus vulgaris, the beginning of which gives Koch's bacillus, which is the causative agent of tuberculosis (Tbc) of any type and localization. The disease is called lupus because its symptoms closely resemble those of DLE.

Treatment of tuberculous (vulgar) lupus is aimed at eliminating the underlying disease (Tbc) and the consequences of lupus activity (ulcers, tubercles, nodules). However, to cure tuberculosis is to get rid of lupus.

Cannot be considered as a separate symptom of SLE and drug-induced lupus resulting from the intake of certain medications ( oral contraceptives, salicylates, sulfonamides, etc.), since it is reversible and disappears after drug withdrawal.

Classification by the nature of the flow

Having considered isolated variants of lupus erythematosus, in the future there will be a description of SLE - generalized form diseases with a variety of symptoms and manifestations. The working classification of pathology considers clinical variants of the course, taking into account:

• The degree of severity of the initial period;
• Symptoms of the onset of the disease;
• The nature of the flow;
• Activity of the pathological process;
• Progression rates;
• The effect of the use of hormones;
• The length of the period.
• Morphological features of the lesion of the body.

Concerning It is customary to distinguish three types of flow:

1. spicy variant, characterized by a sudden onset, so sudden that the patient can even indicate for an hour when his illness overtook him, a rapid increase in body temperature, the appearance of a "butterfly", the development of polyarthritis and serositis. Multiple organ damage and rapid involvement of the excretory (kidney) and nervous systems in the process leads to a sharp deterioration in the condition, which can last up to 2 years. However, treatment with glucocorticosteroids can lengthen the initial period up to 5 years and even achieve a stable remission;
2. Subacute undulating course, which is characterized by the gradual development of the disease, where the joints and skin are usually the first to suffer, and the remaining organs (more and more) join the process with each relapse. The disease develops slowly (5-6 years), after which it has a multisyndromic clinical picture;
3. A gradual, imperceptible even for the patient onset, the presence of only one syndrome, the rest join only after many years, characterizes chronic course of SLE.

Clinical picture of SLE - symptoms, syndromes, variants

In most cases The following signs are the signal for the onset of SLE:

• Joint damage - recurrent polyarthritis, which is very similar to rheumatic;
• Increased body temperature;
• Skin rash;
• Weakness, feeling tired, loss of interest in life;
• Weight loss.

Start from acute manifestations the disease is less common, it is characterized by symptoms:

1. fever;
2. polyarthritis;
3. Severe skin lesions;
4. Jade;
5. Polyserositis.

Clinic chronic course , usually, long time limited to one syndrome, for example:

• Recurrent arthritis;
• Polyserositis;
• or Werlhof, epileptiform syndrome or discoid lupus.

Manifestations and complications systemic lupus. Based on the individual course of the disease, the localization of lesions can vary greatly. (More on this later).

However, sooner or later, perhaps in 10 years, as a result of the uncontrollable progression of the pathological process, other organs are still affected. Polymorphic symptoms of the disease can lead to the development of functional insufficiency of some organ, which ends in the death of the patient.

SLE. Damage to the skin, joints, heart, blood vessels

Symptoms skin lesions in SLE discussed above (description of DLE), which in the form of a skin syndrome are present in a generalized pathological process and are characterized by analogy with the symptoms of discoid lupus.

At articular syndrome almost all patients report migratory pain, limitation of mobility in the joints, often small (lupus arthritis). In some cases, these symptoms are added:

• Fusiform deformity of the fingers;
• Atrophic muscle changes;
• Painful myalgia (muscle pain);
• Myositis (muscle inflammation);
• Ossalgia (bone pain).

Pericarditis is one form of lupus' effect on the heart.

Serositis (inflammatory lesions of the serous membranes)- a rather serious component of SLE, including the diagnostic triad:

• , bilateral pleurisy, sometimes peritonitis;
• Dermatitis;
• Arthritis.

serosites have a tendency to relapse, forming adhesions in the pericardial cavity and pleura. The symptomatology of serositis is quite common: the patient feels pain, the doctor hears the friction noise of the pleura, pericardium, peritoneum.

With systemic lupus erythematosus damage to the cardiovascular system is not limited to pericarditis. The endocardium, valvular apparatus (mitral and tricuspid valves - in the first place), myocardium and large vessels suffer, and thus, in the state of the heart and vessels in SLE, pathology may be present in the form of:

• Atypical warty Liebman-Sachs;
• Raynaud's syndrome, the likelihood of developing which in SLE increases several times;

Myocarditis in lupus has a rather pronounced clinical picture:

1. Persistent increase in rhythm (tachycardia);
2. Heart pain, which the patient finds it difficult to describe, because "it is somehow indefinite";
3. Shortness of breath, especially on exertion;
4. Muffled tones, the appearance of noise on pulmonary artery or at the apex of the heart (auscultatively);
5. When diffuse process: cyanosis of the skin, decreased blood pressure, gallop rhythm;
6. Characteristic changes on the ECG.

It can be noted that almost all pathological processes in any of the organs do not leave indifferent vessels. Small and large, arterial and venous trunks are affected with development and For example, Raynaud's syndrome can noticeably outpace the clinical picture of the disease and form long before the appearance of other manifestations.

Lupus and body functions: breathing, digestion, neuropsychic activity and protection

The inflammatory process in lupus finds connective tissue in the respiratory organs , spreading around the bronchi, pulmonary vessels, between the lobules of the lungs, and sometimes even affecting the alveolar septa. These changes lead to the formation lupus pneumonitis with the development of foci of inflammatory infiltration in the lungs, the main clinical sign which is slowly increasing over time shortness of breath.

However, the inflammatory process in the lungs with lupus can behave differently and give an acute course, in which there are:

• Shortness of breath, quite pronounced;
• Painful cough, asthma attacks;
• Hemoptysis;
• Bluish discoloration of the skin of the face, arms and legs;
• Formation (maybe).

Damage to the gastrointestinal tract (gastrointestinal tract) different brightness clinical picture and many symptoms:

• Complete lack of appetite (anorexia);
• Dyspeptic disorders;
• Almost constant, but of an indefinite nature, pain in the abdomen;
• Frequent diarrhea.

The most common culprit is lupus lesions of the gastrointestinal tract:

1. Vasomotor mesenteric disorders;
2. Hemorrhagic edema of the mesentery and intestinal wall;
3. Segmental ileitis (recurrent obstruction of the small intestine);

In some cases, the lupus inflammatory process in the gastrointestinal tract can lead to ulcerative necrotic changes and give aphthous stomatitis, esophagitis, gastroenterocolitis, which can be complicated by ulcer perforation and the development of peritonitis or pancreatitis.

The most frequent and dangerous complications systemic lupus erythematosus

Approximately half of patients with SLE kidneys are affected with the development of pyelonephritis, lupus nephritis (lupus nephritis), nephrotic syndrome with and impaired renal excretory function. Rarely, lupus may begin with a pathology resembling nephropathy of pregnancy or acute nephrotic syndrome.

Violation by nervous system and mental activity is also observed in approximately 50% of cases at all stages of systemic lupus erythematosus. The initial phase is characterized by:

• General weakness;
• Fast fatiguability;
• Adynamia;
• Irritability and irascibility;
• Depressed mood;
• Decreased overall emotional background, apathy;
• Sleep disturbance;
• Hyperhidrosis (excessive sweating);
• Heaviness in the head, headache.

Due to involvement of the brain and spinal cord, meninges, nerve roots and peripheral nerves in the midst of the disease, a certain neurological symptoms, which develops into syndromes:

1. Cerebral (meningoencephalitis);
2. Cerebro-spinal (encephalomyelitis);
3. Diffuse (meningoencephalomyelopolyradiculoneuritis).

Shifts in the emotional sphere at this stage not only do not go away, but are exacerbated:

• Unstable mood (depression is replaced by euphoria);
• Insomnia;
• Intellectual-mnestic disorders (memory and intellect suffer);
• Sometimes delirium and hallucinations (visual and auditory);
• Convulsive seizures;
• Decrease in criticism, inadequacy of judgments, inability to correctly assess one's own capabilities.

In addition, it should be borne in mind that such disorders in neuropsychic activity are sometimes caused by hormone treatment (steroid psychoses).

Reticuloendothelial system(macrophage system) reacts to SLE with an increase in all groups of lymph nodes, which indicates an early generalization of the disease. In addition, there is an increase in the spleen and liver. Symptoms of liver damage (hepatitis accompanied by jaundice, fatty liver) often occur against the background of heart failure due to diffuse myocarditis or pulmonary hypertension, and resemble acute viral hepatitis.

Lupus in children and pregnant women

General description of lupus for everyone age groups, gender and states may not satisfy separate categories patients who are interested in:

1. Do children get SLE?
2. How does pregnancy proceed in a woman with lupus, what are her chances for a happy motherhood?
3. Is SLE contagious, is it not transmitted in the home?

Question one. Unfortunately, the lupus process does not spare the children's body either. Primary schoolchildren and adolescents are more susceptible to the disease, and even at this age, lupus prefers girls, they get sick 3 times more often than boys.

Causes, development of the disease, nature of the course, clinical picture and medical measures, in general, are no different from those in adults, so it is hardly worth repeating.

Second question: systemic lupus erythematosus during pregnancy. Of course, given that SLE is predominantly a disease of women, this issue cannot but worry, especially since pregnancy can provoke the onset of the disease or its exacerbation. However, it is possible that with the progression of pregnancy as a result of a decrease in the activity of the immune system, the woman's condition, on the contrary, may improve, and the risk of complications will decrease. Thanks to modern medicine, such women are no longer offered an immediate artificial interruption. Vice versa, future mother gynecologists and rheumatologists surround with attention and care, who have close contact with each other and coordinate their actions on the tactics of managing the patient.

Special account in antenatal clinic, enhanced control over the course of pregnancy and necessary treatment help half of sick women safely reach childbirth and become a mother. Although a quarter of pregnant women with lupus still have complications in the form of bleeding, thrombosis and fetal death.

Finally, third question Q: Is lupus contagious? The answer is ambiguous, because, if we are talking about skin tuberculosis, then, of course, this disease is contagious, like other forms of Tbc. In this regard, all preventive measures should be directed not against lupus, but against tuberculosis, the danger of which is undeniable. It refers to a rather serious, difficult to treat infections. Probably, people can also be reassured by the fact that lupus erythematosus just doesn’t “walk around” the streets, since patients are subject to treatment in specialized hospitals and can be discharged only when they no longer pose any danger to others.

Other variants of lupus erythematosus are not contagious. and are not transmitted even with close contact, so you can not be afraid and not shy away from patients at home, in a team and under other circumstances.

Diagnosis of SLE

It is possible to suspect systemic lupus erythematosus with severe clinical manifestations already with initial examination patient and pre-diagnose in the presence of:

• "Butterflies";
• discoid rash;
• Dermatitis, aggravated by exposure to ultraviolet radiation;
• Ulcers in the mouth or nasopharynx;
• nonerosive arthritis;
• Pericarditis or pleurisy (serositis);
• Convulsions and psychosis (CNS damage).

Additional diagnosis of SLE consists in conducting laboratory clinical and biochemical (traditional blood and urine tests) and immunomorphological ( immunological test, histological analysis biopsy material kidney and skin) studies. Lupus is indirectly indicated by the appearance of:

1. Protein in urine above 0.5 g/day or cylindruria ( renal pathology);
2. , or (hematological disorders).
3. The final diagnosis can be established by identifying immunological disorders, which are indicated by:
   • AvailabilityLE-cells with absorbed nuclear material destroyed tissues;
   • Presence of antibodies to nuclear components and antinuclear antibodies;
   • False-positive Wasserman reaction (analysis for syphilis).

However, the diagnosis of systemic lupus erythematosus is not as simple as it might seem at first glance, since there are atypical variants of the disease (combined or borderline forms with other connective tissue pathology), which is especially characteristic of the early stages of SLE. For example, the same LE cells are sometimes found in low concentrations in other pathologies.

Treatment process for systemic lupus erythematosus

The greatest success can be achieved if treatment is started on early stage development of the pathological process. Both the onset of the disease and its exacerbation require a stay in the hospital walls, therefore, during such periods, a hospital cannot be avoided.

Initial subacute and chronic, predominantly articular forms are treated with non-steroidal anti-inflammatory drugs (NSAIDs): voltaren or brufen.

If the skin is more affected in the chronic course of the disease, then preference is given to medicines quinoline series: delagil, chloroquine, etc., which, however, can give by-effect in the form of dyspeptic disorders, dermatitis, tinnitus, headache.

Diffuse lupus nephritis is treated with Plaquenil (hydroxychloroquine).

The main drugs for the treatment of SLE are glucocorticoids, which are used depending on the form, nature of the course, the activity of the process and the clinical picture of the disease. But if the hormones do not have the desired effect, they resort to the appointment of cytotoxic immunosuppressants.

In addition to the use of specific drugs, with SLE, the patient needs a special diet and the appointment of symptomatic treatment (antiulcer and antibacterial drugs, vitamins, etc.).

Exercise therapy and massage can be recommended only after the inflammatory process subsides in the parenchymal organs and always under the control of their condition. Physiotherapy and spa treatment for lupus is not indicated at all. Insolation, radon baths, ultraviolet irradiation joints very well provoke an exacerbation of the disease, which should not be forgotten.

Forecast and prevention of SLE

The prognosis depends on the form and course of SLE in direct proportion.

• Absolutely favorable prognosis - only with drug lupus.
• The discoid variant has a 40% chance of being cured.
• As for the generalized form, then with early diagnosis and adequate therapy, remission occurs in 90% of cases, which significantly lengthens life and improves its quality. The remaining 10%, unfortunately, happy outcome they can hardly count, and with the early formation of lupus nephritis, the prognosis becomes even more unfavorable.

Lupus is a serious disease and in order to prolong life, more attention should be paid to preventing exacerbations and preventing the progression of the process.

The preventive complex includes:

1. Timely, rational complex treatment (hormone therapy);
2. Strict adherence to dosages of drugs;
3. Regular visits to the doctor;
4. dispensary examination;
5. Establishment of an optimal sleep regimen (quiet hour during the daytime - 1-2 hours) and wakefulness;
6. Compliance with the diet (limiting the amount of carbohydrates and salt, enriching the diet with protein and vitamin products);
7. For skin lesions, use sunscreen(ointment, cream, powder with salol, photoprotective film) before going outside;
8. Strict bed rest, antibacterial and desensitizing treatment for various infectious diseases (ARVI, etc.).

Patients should remember that lupus does not “like” surgical interventions, vaccinations (unless they are simply vital), hypothermia and does not accept “chocolate” tan. Patients with SLE are contraindicated in treatment with ultraviolet light and gold preparations. The desire to spend a summer vacation in the southern latitudes will also be inappropriate.

One of the presenters will answer your question.

Currently answering questions: A. Olesya Valerievna, candidate of medical sciences, lecturer at a medical university

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If you hear the word lupus, you probably have a lot of questions. Lupus is not a simple disease with an easy explanation, it is tuberculosis of the skin. You can't just take a pill and get rid of lupus. It can be difficult for the people you live and work with to notice that you have a disease. Lupus does not have a clear set of symptoms that people can see. You may know that something is not as it should be, but it will still take time for you to determine the diagnosis.

Lupus has many shades. It can affect people of different races, ethnicities, and ages, both men and women. It can be similar to various other illnesses. Lupus is individual for each person.

The good news is that you can be helped. The first step is to learn about the disease. Ask questions, talk to your doctor, family and friends. People who are looking for answers are more likely to find them.

What is skin tuberculosis or lupus anyway?

Lupus is an autoimmune disease. Your body's immune system is like an army with hundreds of soldiers. The immune system's job is to fight outside substances in the body, such as germs and viruses. But in autoimmune diseases, the immune system is out of control. It attacks healthy tissue, not microbes.

You cannot contract this disease from another person. It's not cancer and it's not related to AIDS.

Lupus is a disease that can affect many parts of the body. Everyone reacts differently. One person with this disease may feel swollen knees or have a fever. Another person may be constantly tired or have kidney failure. Someone else may develop a rash. Skin tuberculosis can affect the joints, skin, kidneys, lungs, heart and/or brain. If you have such a disease, it may affect two or three parts of your body. Usually, one person does not have all the possible signs.

There are three main types of lupus:

• - the most common form. It is also sometimes called a stationary set, or simply lupus. The word "systemic" means that the disease can involve many parts of the body such as the heart, lungs, kidneys and brain. The symptoms may be mild or severe.
• Disc-shaped erythematous skin tuberculosis mainly affects the skin. A red rash may appear, or skin color may change on the face, scalp, or elsewhere.
• Tuberculosis of the skin caused by drugs. This type of illness is similar to the systemic type, but the symptoms are usually milder. In many cases, the disease goes away when the drugs no longer work. Many men develop TB by forced medication because they take drugs disease-causing, hydralzine, and procainamide are used to treat heart conditions commonly seen in men.

Signs and symptoms of skin tuberculosis.

Lupus is difficult to diagnose. It is often mistaken for other diseases. That's why lupus has been called the "great imitator." The symptoms of this disease differ from person to person. Some people have only some of the symptoms; others have more.

Common signs of skin tuberculosis:

• Red rash or discoloration on the face, often in a butterfly shape across the nose or cheeks
• Strong pain or swollen joints
• Groundless fever or fever
• Chest pain and rapid breathing
• Swollen tonsils
• Extreme fatigue (permanent feeling of tiredness)
• Unusual hair loss (mainly on the scalp)
• Pale or purple fingers or toes from cold or tension
• Sun sensitivity
• Poor blood counts
• Depression, unpleasant thoughts, and/or memory problems

Other signs mouth sores, unexplained body vibrations (convulsions), hallucinations, repetitive mistakes and unexplained kidney problems.

What is Flash?

When signs appear, they are called "outbursts". These signs may come and go. You may have swelling and a rash for one week and then no sign. You might think that you have such a spike in symptoms after being out in the sun for a long time or after a hard day at work.

Even if you are on lupus medication, you may find that there are times when the symptoms worsen. It can help to recognize that a symptom flare is occurring so you can take steps to deal with it. Many people feel very tired or have pain, rash, fever, abdominal discomfort, headache, or dizziness just before an outbreak. Steps such as reducing sun exposure, spending more time recovering, and being quiet and calm can also be helpful in preventing such outbreaks.

Flash Prevention:

• Learn to accept that you are having an outbreak.
• Talk to your doctor.
• Try to set realistic goals and priorities.
• Limit the time you spend in the sun.
• Maintain a healthy diet.
• Develop endurance skills to limit stress.
• Try to get enough rest and quiet.
• Exercise moderately whenever possible.
• Develop a support system by surrounding yourself directly with people you trust and feel comfortable with (family, friends, etc.).

A new lupus test could help stem the growing list of deaths among young women.

American Office of sanitary supervision Food and Drug Administration recently launched a new diagnostic test for lupus, which promises to increase recovery rates and alleviate more early treatment this disease, which takes more and more lives every year.

"Any test that can improve the rate of diagnosis is a significant breakthrough for patients with skin TB," says Duane Peters, vice president of advocacy and communications at the Skin TB Foundation of America (LFA) in Rockville, Maryland. "Timely detection will allow doctors to study the disease early stage prevent organ removal or even death."

Lupus - also known as Systemic erythematous skin tuberculosis is a not well understood condition in which the body's misdirected immune system attacks its own healthy one, causing tissue pain, fatigue and damage to vital important organs. Approximately 90% - 1.4 million Americans have this disease - young women aged 15 to 45 years. A recent report from the Centers for Disease Control and Prevention (CDC) showed a 70 percent increase in the proportion of African American women who died from lupus in the last 20 years. The same study found that mortality rates were more than five times higher for women with lupus than for men with the disease.

Since the symptoms of lupus are somewhat unpredictable and often vary from patient to patient, getting a timely and accurate diagnosis can create distrust and delay the process. In fact, half of lupus patients consult three or more doctors for four or more years before they are correctly diagnosed.

The newly-approved scanning method has the potential to simplify diagnoses for patients and physicians. New test could help detect disease earlier, according to Mark Roth, Ph.D., who developed this test with colleagues at the Fred Hutchinson Cancer Research Center in Seattle.

"This test will improve the ability of doctors to make the right decisions when diagnosing lupus, and we also know for sure that this test will help in determining which part of the body the disease originally settled in," said Roth, a professor of biochemistry at the University of Washington School of Medicine.

Yet experts warn that it is far from categorical and 100% precise test. "It's not a great scanner," said George Tsokos, director of the department of rheumatology, "it will complement the tests already available, but not all patients with lupus may be a good fit." However, this new method helps clarify important information for diagnosis.

The strength of the new test depends on its ability to correlate antibodies to the so-called SR proteins. Antibodies target a specific protein when the body goes on an immune attack. Two years ago, Roth and colleagues discovered that most lupus patients produce antibodies for SR proteins, while patients with other diseases cannot "manufacture" SR antibodies.

Based on these findings, Roth and colleagues developed a new scanner. If the patient has produced antibodies to the SR proteins, the sera will react with the proteins and turn the purple liquid. This test can identify 50%-70% of patients who respond positively to eser proteins.

It may take some time before the results appear in patients after this study. Currently Research Center Rakah Fred Hutchinson is looking for a commercial partner who can sponsor the production of the test, then it will be available to everyone.

Is there a cure for lupus?

Remember that every person has various signs. Treatment depends on the symptoms. The doctor may prescribe you an aspirin or something to treat swollen joints and fever. Creams may be prescribed for the rash. From more serious problems are used more strong medicines containing narcotic substances such as corticosteroids and chemical drugs. Your doctor will choose a treatment based on your symptoms and needs.

Always tell your doctor if you have problems with your medications. Tell your doctor if you are taking herbal or vitamin supplements. Your medications may not work with those prescribed by your doctor. You and your doctor must work together to find The best way to solve all your problems.