DR. CORA LIM-MEDICAL INSIDER
Systemic Lupus Erythematosus
Part 1
We start discussing the topic: Systemic
lupus erythematosus (SLE) today. Book
definition will say that SLE is a chronic
multisystem autoimmune disease that is
highly heterogeneous in its presentation.
Research says that this can pose
significant challenges for physicians
responsible for the diagnosis and treatment
of such patients.
SLE arises from a combination of genetic,
epigenetic and environmental factors.
Pathologically, the disease is primarily
driven by loss of immune tolerance and
abnormal B- and T-cell function. Major
organ involvement may lead to significant
morbidity and mortality.
Classification criteria for SLE have been
developed largely for research purposes;
however, these are also widely used in
clinical practice.
Antinuclear antibodies are the hallmark
serological feature, occurring in over 95%
of patients with SLE at some point during
their disease.
The mainstay of treatment is antimalarial
drugs such as hydroxychloroquine,
combined with corticosteroids and
conventional immunosuppressive drugs.
An increasing understanding of
pathogenesis has facilitated a move
towards the development of targeted
biologic therapies, with the introduction of
rituximab and belimumab into clinical
practice.
As an introduction, we have to know that
Systemic Lupus Erythematosus (SLE) is a
chronic multisystem autoimmune rheumatic
disease in which disease flares are
interspersed with episodes of remission.
In contrast to organ specific autoimmune
diseases, SLE comprises a constellation of
signs and symptoms that can affect multiple
organ systems.
This diversity of presentation, changing
clinical features and fluctuating disease
course often presents challenges in
diagnosis and management.
We have learned that the prevalence of
SLE is variable, dependent on ethnic origin
and ranges from 40–200 per 100,000 of
population.
SLE is more common in those of African
and Asian ancestry than in Europeans. It is
predominantly a disease of females, with a
female to male ratio of 9:1. Non-European
patients with SLE tend to have a younger
onset of disease and greater incidence of
serious organ involvement, reflective of a
more severe clinical phenotype.
The broad spectrum of clinical
presentations includes mucocutaneous,
musculoskeletal, haematological,
cardiopulmonary, renal and central nervous
system manifestations.
Lupus nephritis and neuropsychiatric lupus
are considered the most severe forms of
organ involvement and can result in
significantly reduced life expectancy.
Again, research says that this has led to
recognition of the need for early intensive
immunosuppression. Current treatment
regimens consist of antimalarial drugs,
corticosteroids, conventional disease-
modifying anti-rheumatic drugs,
cyclophosphamide and biologics.
However, conventional therapies fail to
adequately suppress disease activity in a
significant proportion of patients and newer
targeted therapies are being developed to
address this unmet need.