Majority of the individuals with SLE experience joint pain, accompanied by swelling. Arthritis is also a common complaint. In addition to these, individuals also experience pain in chest, hair loss, and development of sores inside mouth, anemia, malaise, fatigue, fever and sensitivity to light. Affected individuals also develop “butterfly” skin rash. The rash gets worse, when exposed to sunlight, and it commonly appears in areas of bridge of nose and check [8].

Other symptoms of SLE vary with the type of body part that is affected. Individuals also experience numbness, headache, seizures, abdominal pain, arrhythmias, swelling in legs, difficulty in breathing and Raynaud phenomenon [9].

• Splenomegaly

  Presentation SLE is a remitting and relapsing illness, with a variety of different presentations. [ 5, 6 ] Symptoms and signs are often nonspecific - eg, fatigue (can be severe and debilitating), malaise, fever, splenomegaly, lymphadenopathy, weight loss [patient.info]

  Enlargement of the spleen (splenomegaly) occurs in about 10% of people. [msdmanuals.com]

• Easy Bruising

  bruising Anxiety Depression Memory loss [web.archive.org]

  Sometimes changes in blood counts may contribute to symptoms of fatigue (low red blood cell count, anemia), serious infections (low white blood cell count), or easy bruising (low platelet count). [my.clevelandclinic.org]

  Signs and symptoms include easy bruising or bleeding due to a decrease in the number and size of platelets ; susceptibility to infections and to immune and inflammatory disorders; and an increased risk for some cancers (such as lymphoma). [rarediseases.info.nih.gov]

  This platelet abnormality, which is typically present from birth, can lead to easy bruising, bloody diarrhea, or episodes of prolonged bleeding following nose bleeds or minor trauma. [ghr.nlm.nih.gov]

• Pain

  Majority of the individuals with SLE experience joint pain, accompanied by swelling. Arthritis is also a common complaint. [symptoma.com]

  Challenges of Pain Management In SLE A key challenge is determining the source of the patient’s pain. Sometimes the pain is clearly related to active SLE, and treatment of the active inflammation relieves the pain. [practicalpainmanagement.com]

  Inflammation of the lining of the lungs (pleuritis) and of the heart (pericarditis) can cause sharp chest pain. The chest pain is aggravated by coughing, deep breathing, and certain changes in body position. [web.archive.org]

• Fever

  The patient showed a high spiking fever and myalgia. Laboratory data revealed pancytopenia and immunological abnormalities. Pulse methylprednisone plus intravenous immunoglobulin (IVIG) failed to improve the clinical symptoms and laboratory data. [ncbi.nlm.nih.gov]

• Fatigue

  Disease activity as measured by SLE Disease Activity Index (SLEDAI) did not significantly predict self-reported levels of fatigue. Medication usage did not predict fatigue levels. Pain and depression were both unique positive predictors of fatigue. [ncbi.nlm.nih.gov]

  Search terms included systemic lupus erythematosus, antiphospholipid syndrome, lupus nephritis, central nervous system disease in lupus, and fatigue. Articles were selected according to their impact on clinical practice. [doi.org]

• Anemia

  She was diagnosed with SLE with pernicious anemia and iron deficiency anemia. The rare association of SLE with pernicious anemia was reported previously in few patients. Treatment of SLE along with B12 supplementation is necessary for such patients. [ncbi.nlm.nih.gov]

  […] assoc w SLE Hemolytic anemia associated with systemic lupus erythematosus Hemolytic anemia with Systemic lupus erythematosus Inflammatory myopathy due to lupus Inflammatory myopathy due to SLE Lung disease with systemic lupus erythematosus Lupus erythematosus [icd9data.com]

• Weight Loss

  A 44-year-old Chinese female was admitted with three months history of painless abdominal distension accompanied by watery diarrhea 5-6 times daily, shortness of breath, fatigue, lower limb swelling, and 10 kg weight loss. [ncbi.nlm.nih.gov]

  But, in general, lupus signs and symptoms may include: Fatigue Fever Weight loss or gain Joint pain, stiffness and swelling Butterfly-shaped rash (malar rash) on the face that covers the cheeks and bridge of the nose Skin lesions that appear or worsen [web.archive.org]

• Pleural Effusion

  Eosinophilic pleural effusion in elderly patients is most commonly due to malignancies and infections. In rare cases, pleural eosinophilia is associated with connective tissue disease. [ncbi.nlm.nih.gov]

  Pleuritis and Pleural Effusion Inflammation of the lining surrounding the lungs, or pleuritis, can occur in people with lupus. This can cause symptoms such as chest pain and shortness of breath, says Luk. [everydayhealth.com]

  Pleural effusions may occur, and the lung parenchyma may be involved. These conditions have only recently been recognized and differentiated; accurate diagnosis has been much improved by refinements in radiological methods, by the use… Read More [britannica.com]

• Pleuritic Pain

  Serositis a) Pleuritis--convincing history of pleuritic pain or rubbing heard by a physician or evidence of pleural effusion OR b) Pericarditis--documented by ECG or rub or evidence of pericardial effusion 7. [pedclerk.bsd.uchicago.edu]

  Diagnostic Criteria for Systemic Lupus Erythematosus System ACR criteria* SLICC criteria † Cardiac/pulmonary Pleuritis (pleuritic pain or rub, or pleural effusion), or pericarditis (documented by electrocardiography, rub, or pericardial effusion) Serositis [aafp.org]

  Acute lupus pneumonitis presents as cough, dyspnea, pleuritic pain, hypoxemia, and fever. Infiltrates on chest radiographs may be unilateral or bilateral. [emdocs.net]

  Serositis a) Pleuritis – pleuritic pain, pleural rub, pleural effusion b) Pericarditis – ECG changes, rub, pericardial effusion 7. Renal disorder a) Proteinuria (> 3+ or 0.5 g/day) b) Cellular casts in urine 8. [ojrd.biomedcentral.com]

  Typically, the patient seeks medical help for relief of fever, weight loss, joint pain, the characteristic butterfly rash, pleural effusion and pleuritic pain, and nephritis. [medical-dictionary.thefreedictionary.com]

• Hepatomegaly

  Other signs are: Pancreatitis, Lupus Enteropathy, Hepatitis and Hepatomegaly 5. Systemic Fever, Malaise/Fatigue, Lymphadenopathy, Weight loss 6. Cardio-Vascular Pericarditis is the most common cardiac manifestation, occurs up to 30% of patients. [fidanoski.ca]

• Psychiatric Manifestation

  In clinical practice, differential diagnosis of the two diseases is necessary for patients with hepatic, neurological, and psychiatric manifestations. [ncbi.nlm.nih.gov]

  Psychiatric manifestations in systemic lupus erythematosus. Autoimmun Rev, 2007, 6(6):421–426 PubMed CrossRef Google Scholar 3. Ogawa M, Ishimaru K, Shiroto T, et al. [doi.org]

• Kidney Failure

  Kidney inflammation in SLE can cause leakage of protein into the urine, fluid retention, high blood pressure, and even kidney failure. This can lead to further fatigue and swelling of the legs and feet. [web.archive.org]

  This attack can cause inflammation throughout your body, including in your joints, skin, blood vessels and organs, such as the kidneys. Lupus most often affects your skin, joints and kidneys — which can lead to kidney damage and kidney failure. [hopkinsmedicine.org]

  failure and dialysis; blood abnormalities, etc. [azarthritis.com]

  Despite advances in therapy, a minority of patients with lupus nephritis will develop kidney failure. These patients must undergo dialysis. [hss.edu]

  Some people develop lupus nephritis, an inflammation of the kidneys that can cause them to leak protein and blood cells into urine. Left untreated, this can lead to kidney failure. [nyulangone.org]

• Hematuria

  At present, the level of complement restored to normal, hematuria and proteinuria disappeared, and liver function returned to normal. SLE may be a novel phenotype of GOF mutation in PI3CKD gene (GOF PIK3CD). [ncbi.nlm.nih.gov]

• Irregular Menstruation

  Observational studies analysing the hormonal stage in a group of Japanese women showed that irregular menstruation was associated with an increased risk of the development of this disease [ 2 ]. [ncbi.nlm.nih.gov]

• Seizure

  All of these seizures were generalized, with focal onset in five. 3 In another series of 161 SLE patients, 16 (10%) had seizures during the entire course of illness. [epilepsy.com]

  We found that APS was strongly associated with neurological manifestations and in particular with cerebrovascular diseases and seizures. [ncbi.nlm.nih.gov]

  A seizure focus may result from an acute insult or from the development of a seizure focus in an area of previous brain insult. Partial or secondarily generalized seizures are most common, but all seizure types have been reported. [emedicine.medscape.com]

  Fits Sometimes lupus first starts in the most dramatic way with a seizure or a series of epileptic fits. This is usually when the patient is untreated and the disease fairly active. [thelupussite.com]

• Headache

  The first patient presented with significant headache at time of SLE diagnosis and negative brain imaging studies on initial evaluation. The headache recurred with findings of cerebellar ataxia and obstructive hydrocephalus. [ncbi.nlm.nih.gov]

  Headaches Headaches are common in lupus. In some patients a history of headache going back to their early teens is a feature of the disease. They may be a part of the lupus itself or may be associated with a clotting (antiphospholipid) syndrome. [thelupussite.com]

  Headaches Headaches are common in lupus. In some patients a history of headache going back to their early teens is a feature of the disease. They may be a part of the lupus itself or may be associated with a clotting syndrome. [web.archive.org]

• Confusion

  When these two conditions happened to have similar clinical spectrum features, the confusion with each other occurred. [ncbi.nlm.nih.gov]

  DILE Should Not Be Confused With Medication Side Effects Drug-induced lupus should not be confused with the drug side-effects that often occur after short-term therapy for gastrointestinal, neurologic, or allergic symptoms. [web.archive.org]

• Peripheral Neuropathy

  Peripheral neuropathy Peripheral neuropathy occurs in as many as 18% of patients with SLE. [emedicine.medscape.com]

  In addition to headache, lupus can cause other neurological disorders, such as mild cognitive dysfunction, organic brain syndrome, peripheral neuropathies, sensory neuropathy, psychological problems (including personality changes, paranoia, mania, and [malacards.org]

• Guillain-Barré Syndrome

  He was clinically diagnosed with the acute motor and sensory axonal neuropathy variant of Guillain-Barré syndrome. Despite intravenous immunoglobulin therapy, he deteriorated with loss of all voluntary motor function and cranial nerve reflexes. [ncbi.nlm.nih.gov]

  Papulonodular mucinosis Guillain-Barré syndrome and nephrotic syndrome in a patient with systemic lupus erythematosus: a case report. BMC Nephrol, 18 (2017), pp. 43 [7] Q. Nadri, M.M. Althaf. [elsevier.es]

  Additional symptoms include demyelinating syndrome, movement disorders, a confusional state, aseptic meningitis, Guillain-Barré syndrome, plexopathy, myelopathy, cranial neuropathy and myasthenia gravis. [pubs.sciepub.com]

• Nausea

  Gastrointestinal manifestations of SLE are described as being common in SLE, with nausea and vomiting occurring in >50% of cases in some series. Poor eating habits and vomiting are well-described causes of non-alcoholic WE. [ncbi.nlm.nih.gov]

  Symptoms SLE may cause general symptoms such as fever, fatigue, mouth sores, hair loss, stomach pain, nausea and vomiting, abnormal heart rhythm, chest pain with deep breaths, headaches, seizures, difficulty breathing, and hemoptysis. [rheumatologyspecialistcare.com.au]

  Side/Adverse Effects Dermatologic: rash, mild skin reaction at injection site Gastrointestinal: abdominal cramps, nausea, vomiting Musculoskeletal: chest, back or hip pain; muscle pain; joint pain Neurologic: anxiety, chills, dizziness, fever, headache [theodora.com]

• Vomiting

  Gastrointestinal manifestations of SLE are described as being common in SLE, with nausea and vomiting occurring in >50% of cases in some series. Poor eating habits and vomiting are well-described causes of non-alcoholic WE. [ncbi.nlm.nih.gov]

• Acute Abdomen

  During the course of steroid therapy, the patient developed acute abdomen and hypoalbuminemia. Computed tomography and Tc-labeled human serum albumin scintigraphy revealed abnormal findings, and a diagnosis of lupus enteritis and PLE was made. [ncbi.nlm.nih.gov]

  It was learned that the patient was undergone the operation of hemicolectomi with the diagnosis of acute abdomen one month ago. The pathological examination of the specimen was showed a granulomatous inflammation with caseification necrosis. [atif.sobiad.com]

  Acute abdomen in systemic lupus erythematosus: the importance of early laparotomy. Am J Med 1997;103:100–5 90. Lee CK, Ahn MS, Lee EY, Shin JH, Cho YS, Ha HK, Yoo B, Moon HB. [journals.lww.com]

• Aphthous Stomatitis

  Cutaneous Manifestations Over 90 percent of patients with systemic lupus erythematosus eventually have a cutaneous manifestation of the disease, including malar rash, discoid lupus erythematosus, alopecia or aphthous stomatitis. [aafp.org]

• Visual Impairment

  OBJECTIVES: We aimed at evaluating morphological and functional visual abnormalities in a cohort of SLE and SS patients in the absence of an overt clinical visual impairment. [ncbi.nlm.nih.gov]

  Almost any part of the eye and visual pathway can be affected by inflammatory or thrombotic processes. Ocular pain and visual impairment require urgent assessment by an ophthalmologist. Infection should be excluded. [academic.oup.com]

  Ischemic optic neuropathy is characterized by acute-onset and progressive binocular visual impairment as a consequence of occlusion of the small vessels of the optic nerves due to immune complex vasculitis. [doi.org]

  It is characterized by pain and reduced visual acuity. The severity of the visual impairment depends on the involved tissue and its location. [medical-dictionary.thefreedictionary.com]

• Eye Pain

  […] feet, legs, hands, and/or around eyes pain in chest on deep breathing (pleurisy) butterfly-shaped rash across cheeks and nose sun- or light-sensitivity (photosensitivity) hair loss abnormal blood clotting fingers turning white and/or blue when cold [web.archive.org]

  Swelling in the legs or around the eyes. Pain when breathing deeply or lying down. Headaches, dizziness, depression, confusion, or seizures. Stomach pain. [niams.nih.gov]

• Arthritis

  Arthritis Excerpt Complete Article Rheumatoid Arthritis Remission Rheumatoid Arthritis Response Sjögren's Syndrome Classification 2016 ACR/EULAR Sjögren's Syndrome Classification Criteria Complete Article 2012 ACR Sjögren's Syndrome Classification Criteria [rheumatology.org]

  Arthritis Rheum 2009 ; 61: 1396 – 1402. Google Scholar | Medline 6. Manzi, S, Selzer, F, Sutton-Tyrell, K. Prevalence and risk factors of carotid plaque in women with systemic lupus erythematosus. Arthritis Rheum 1999 ; 42: 51 – 60. [dx.doi.org]

  Arthritis Rheum 2001 ; 45: 191 – 202. Google Scholar | Medline [doi.org]

  She was treated with increasing immunosuppression as for lupus related arthritis. Subsequently she developed a wrist effusion with high inflammatory markers, and was treated as septic arthritis. Synovial biopsy features suggested tuberculosis. [ncbi.nlm.nih.gov]

• Arthralgia

  Reduced arthralgia/arthritis has been reported in Chinese ( P = 0.02) [ 23 ], Greek ( P = 0.004) [ 24 ] and Caucasian ( P < 0.03) [ 25 ] populations. [doi.org]

  Here we report a case in which an elderly female presented with malar rash, intermittent fever, and arthralgia. Her diagnosis was significantly delayed due to a close clinical resemblance to systemic lupus erythematosus. [ncbi.nlm.nih.gov]

• Joint Swelling

  While denying a history of any rash, photosensitivity, oral ulcers, or seizures, his physical examination did reveal metacarpal phalangeal joint swelling along with noted pulsus paradoxus of 15-200mmHg. [ncbi.nlm.nih.gov]

  […] common in patients taking glucocorticoids Raynaud's phenomenon Presentation Symptoms fever pain in multiple joints hip pain (osteonecrosis) Physical exam butterfly malar rash large joint swelling and synovitis hand and wrist manifestation are common [orthobullets.com]

  Common symptoms include: severe fatigue joint pain joint swelling headaches a rash on the cheeks and nose, which is called a “butterfly rash” hair loss anemia blood-clotting problems fingers turning white or blue and tingling when cold, which is known [healthline.com]

• Joint Stiffness

  The pains may 'flit' from joint to joint. Joint stiffness is common and is usually worse first thing in the morning. Mild joint swelling may occur but severe arthritis with joint damage is unusual. [patient.info]

  Synovitis involving two or more joints, or tenderness at two or more joints and at least 30 minutes of stiffness in the morning Neuropsychiatric Seizure or psychosis Seizures, psychosis, mononeuritis complex, myelitis, or peripheral or cranial neuropathy [aafp.org]

  Heat packs relieve joint stiffness and pain, and regular gentle exercise helps to maintain full range of motion. Physical and occupational therapy consultations are provided as appropriate. [medical-dictionary.thefreedictionary.com]

• Symmetrical Arthritis

  […] peripheral neuropathy. 3 CNS involvement has been reported in up to 75% of SLE patients, 3 with seizures occurring in up to 50% of patients by the time of death. 3,4 The systemic effects of SLE are widespread, most commonly involving the joints and the skin: symmetric [epilepsy.com]

• Skin Rash

  English systemic lupus erythematosus inflammation of connective tissue marked by skin rashes, joint pain and swelling, inflammation of the kidneys and inflammation of the tissue surrounding the heart. [wikidata.org]

  Affected individuals also develop “butterfly” skin rash. The rash gets worse, when exposed to sunlight, and it commonly appears in areas of bridge of nose and check. Other symptoms of SLE vary with the type of body part that is affected. [symptoma.com]

  […] inflammation of connective tissue marked by skin rashes, joint pain and swelling, inflammation of the kidneys and inflammation of the tissue surrounding the heart. [commons.wikimedia.org]

  Rash - Learn about rash causes, symptoms, diagnosis and treatment. Common skin rashes include poison ivy, hives, shingles, eczema, contact dermatitis, ringworm, psoriasis and impetigo. [web.archive.org]

• Skin Lesion

  She showed bullous skin lesions with arthralgia, mild proteinuria, resolved after steroid treatment. At the tapering of her prednisone dose, the patient had new skin lesions requiring an increased dose of prednisone. [ncbi.nlm.nih.gov]

• Discoid Rash

  SLE also causes a characteristic butterfly shaped rash on the nose and cheeks called malar rash with exposure to the sun. A raised oval discoid rash is also seen in some cases. [rheumatologyspecialistcare.com.au]

  Lupus is diagnosed when four of the following 11 criteria are present in a patient: Malar “butterfly” rash across the nose and cheeks Rash consisting of raised red patches (discoid rash) Rash resulting from sensitivity to the sun (photosensitivity) Ulcers [emedicinehealth.com]

  Malar rash – a rash over the cheeks and nose, often in the shape of a butterfly Discoid rash – a rash that appears as red, raised, disk-shaped patches Photosensitivity – a reaction to sun or light that causes a skin rash to appear or get worse Oral ulcers [web.archive.org]

  […] page=DiscoidLupusErythe Discoid rash. http://www.oocities.org/thetolesle Malar rash in pediatric SLE patient. Treatment The treatment does not differ among adults, children, and adolescents. [pedclerk.bsd.uchicago.edu]

• Alopecia

  Thai males have also been shown to have less arthralgia than females in addition to less RP and alopecia and more prevalent thrombocytopenia ( P < 0.05 for all) [ 18 ]. [doi.org]

  […] successively excluded patients with (1) at least one "SLE-specific" manifestation (biopsy-proven SLE nephropathy, arthritis, cutaneous, or neurologic SLE manifestations, pericarditis, autoimmune haemolytic anaemia, oral and nasal ulcers, non-scarring alopecia [ncbi.nlm.nih.gov]

  Criteria proposed "Preliminary Criteria for the Classification of Systemic Lupus Erythematosus [SLE]".1Any four of the 14 items listed below, when present, indicate SLE.1 Facial erythema (butterfly rash) Discoid lupus erythematosus Raynaud phenomenon Alopecia [jamanetwork.com]

• Erythema

  In 1851 Cazenave renamed erythema centrifugum, calling it lupus erythematosus and gave a classic description of discoid lupus erythematosus. [ncbi.nlm.nih.gov]

  1971, the American Rheumatism Association (ARA) Committee on Therapeutic Criteria proposed "Preliminary Criteria for the Classification of Systemic Lupus Erythematosus [SLE]".1Any four of the 14 items listed below, when present, indicate SLE.1 Facial erythema [jamanetwork.com]

• Malar Rash

  Rash) Systemic Lupus Erythematosus (Malar Rash) This raised, erythematous, acute malar rash manifests in light-exposed areas (photosensitive distribution). [msdmanuals.com]

  KEYWORDS: Antinuclear antibody; Jaccoud arthropathy; Lupus nephritis; Malar rash; Pericarditis; Pleuritis; Systemic lupus erythematosus [ncbi.nlm.nih.gov]

  The classic malar rash is absent in two-thirds of individuals. [pedclerk.bsd.uchicago.edu]

  There is consistent evidence for a reduced incidence of RP, alopecia, malar rash and arthralgia/arthritis in men at presentation and in the subsequent disease course. [doi.org]

• Facial Redness

  Patients may have a distinctive pattern of facial redness and oral lesions. [medical-dictionary.thefreedictionary.com]

A preliminary physical examination is done, to carefully study the signs and symptoms of the disease. To be diagnosed with SLE, the individuals should exhibit at least 4 out of 11 common signs and symptoms of the disease.

Antinuclear antibody test is done using the indirect immunofluorescence technique. The pattern of flurorescence that is obtained suggests SLE. In addition, complete blood count, chest X-ray, urinalysis and kidney function tests are also carried out. Depending on the organ involved, other tests would also be required to arrive at a definite conclusion [10].

• Pericardial Effusion

  […] of pericardial effusion. [ncbi.nlm.nih.gov]

• Esophageal Motility Disorder

  Esophageal motility disorders in the rheumatic diseases: a review of 150 patients. Clin Exp Rheumatol 1994;12:515–21 86. Vergara-Fernandez O, Zeron-Medina J, Mendez-Probst C, Salgado-Nesme N, Borja-Cacho D, Sanchez-Guerrero J, Medina-Franco H. [journals.lww.com]

• Pyuria

  […] increases in the SLEDAI of 3 or more or 12 or more points, respectively, from the previous visit. 29 The data were also analyzed with the use of a new version of the SLEDAI (SLEDAI-2K) 30 and a modified SLEDAI (SLEDAIm) that excludes microhematuria and pyuria [nejm.org]

• Antinuclear Autoantibodies

  Systemic lupus erythematosus is characterised by the presence of antinuclear autoantibodies (ANA). [hungary.pure.elsevier.com]

  Press RI, Peebles CL, Kumagai Y, Ochs RL, Tan EM (1992) Antinuclear autoantibodies in women with silicone breast implants. Lancet 340:1304–1307 PubMed CrossRef Google Scholar 57. [dx.doi.org]

• Hyperglobulinemia

  […] resembling rheumatoid arthritis, diffuse erythematous skin lesions on the face, neck, or upper extremities, with liquefaction degeneration of the basal layer and epidermal atrophy, lymphadenopathy, pleurisy or pericarditis, glomerular lesions, anemia, hyperglobulinemia [medical-dictionary.thefreedictionary.com]

• Decreased Platelet Count

  platelet count in 22.3%, hemolytic anemia in 4.8%, glomerulonephrites in 42.3%, anti-dsDna in 33.3%, anti-Ro in 37.3%, anti-La in 21.2%, anti-Sm in 23.5%, and anti-RNP in 27.3%. [scielo.br]

• Fibrinoid Necrosis

  necrosis at dermoepidermal junction with liquefactive degeneration and atrophy of epidermis More mucin deposition in reticular dermis than discoid lupus Edema, small hemorrhages and a mild infiltrate of inflammatory cells, principally lymphocytes, in [pathologyoutlines.com]

  Pathological studies demonstrate infarction of the optic nerve secondary to extensive arteriolar fibrinoid necrosis [ 35 ]. Acute optic neuritis may also be bilateral and associated with transverse myelopathy. [academic.oup.com]

• HLA-DR3

  MCPs, and carpus ligamentous laxity Raynaud's phenomenon dorsal subluxation of ulna at DRUJ Imaging Studies Radiographs usually no evidence of joint destruction osteonecrosis of hips is common Labs Usually positive for ANA (95%) anti-DNA antibodies HLA-DR3 [orthobullets.com]

  It is important to note that the HLA-DQ2 haplotype found in 95 % of celiac patients shares a strong linkage to the HLA-DR3 haplotype associated with AIH [ 52 ]. [dx.doi.org]

  AIH is characterized by the elevated levels of liver enzymes, hypergammaglobulinemia, the presence of autoantibodies and typical histological changes [ 25 ], and association with the Human Leukocyte Antigens (HLA) DR3 or DR4 [ 24 ]. [omicsonline.org]

  The presence of human leukocyte antigen (HLA)–B8 and HLA-DR3 in the mother may predispose the infant to NLE and congenital heart block. [emedicine.medscape.com]

• HLA-B8

  Factors leading to SLE include: Genetic predisposition, incuding haplotype HLA -B8, -DR 3 Exposure to sunlight Viral infection, particularly Epstein-Barr virus Hormones Toxins such as cigarette smoke Drugs in drug-induced LE Emotional upset The manifestations [dermnetnz.org]

  The presence of human leukocyte antigen (HLA)–B8 and HLA-DR3 in the mother may predispose the infant to NLE and congenital heart block. [emedicine.medscape.com]

  reveal that HLA-A1, HLA-B8, and HLA-DR3 are more common in persons with SLE than in the general population. [emedicine.com]

• HLA-DR2

  Specific combinations of HLA-DR2 and DR3 class II haplotypes contribute graded risk for disease susceptibility and autoantibodies in human SLE. Eur J Hum Genet. 2007; 15 :823–830. [ PubMed ] [ Google Scholar ] 17. [ncbi.nlm.nih.gov]

• Pleural Effusion

  Eosinophilic pleural effusion in elderly patients is most commonly due to malignancies and infections. In rare cases, pleural eosinophilia is associated with connective tissue disease. [ncbi.nlm.nih.gov]

  Pleuritis and Pleural Effusion Inflammation of the lining surrounding the lungs, or pleuritis, can occur in people with lupus. This can cause symptoms such as chest pain and shortness of breath, says Luk. [everydayhealth.com]

  Pleural effusions may occur, and the lung parenchyma may be involved. These conditions have only recently been recognized and differentiated; accurate diagnosis has been much improved by refinements in radiological methods, by the use… Read More [britannica.com]

• Pleural Rub

  […] effusions, or pleural rub or Typical pericardial pain (pain with recumbency improved by sitting forward) for > 1 day, pericardial effusion, pericardial rub, or pericarditis by electrocardiography in the absence of other causes (eg, infection, uremia, [merckmanuals.com]

  • Serositis – Typical pleurisy for > 1 day OR pleural effusions OR pleural rub – Typical pericardial pain (pain with recumbency improved by sitting forward) for > 1 day OR pericardial effusion OR pericardial rub OR pericarditis by electrocardiography [slideshare.net]

  (pleurisy for more than one day, pleural effusion, or pleural rub; pericardial pain more than one day, pericardial effusion, pericardial rub, or pericarditis) Hematologic Hemolytic anemia, or leukopenia (< 4,000 cells per mm 3 ), or lymphopenia (< 1,500 [aafp.org]

  Serositis a) Pleuritis – pleuritic pain, pleural rub, pleural effusion b) Pericarditis – ECG changes, rub, pericardial effusion 7. Renal disorder a) Proteinuria (> 3+ or 0.5 g/day) b) Cellular casts in urine 8. [ojrd.biomedcentral.com]

Systemic lupus erythematosus cannot be cured. The symptoms can however be managed, with effective treatment regimes. For mild forms, treatment includes administration of non-steroidal anti-inflammatory drugs (NSAIDs) which are indicated for joint pain, and pleurisy. For skin rashes, corticosteroid creams are also given for topical application.

For severe forms of SLE, high doses of corticosteroids are administered along with cytotoxic drugs. Cytotoxic drugs work by blocking the cell growth and by suppressing the immune system. These drugs are recommended, when corticosteroids do not seem to produce favorable results [11].

The past few decades have witnessed a significant decline in the mortality rates in patients with SLE [6]. It has also been estimated, that with introduction of better treatment methods, about 80% individuals have a 15–year survival rate and more than 90% individuals have a 10-year survival rate. The prognosis of the disease depends on the severity of the condition. Individuals with mild symptoms generally do well with proper treatment. Women with SLE can successfully become pregnant and deliver a baby. However, individuals with underlying disease conditions have poor outcome [7].

The exact cause that triggers the immune system to behave in an abnormal fashion is not clearly understood. However, several factors that can trigger the development of SLE are as follows:

• Genetic predisposition: Individuals with family history of SLE are at an increased risk of developing the same.
• Environmental stimuli such as exposure to ultraviolet rays, stress, drugs, trauma and viral agents, are known to play a role in causation of the disease.
• Hormonal involvement: The hormone estrogen can to some extent, trigger attacks of SLE in women of child bearing age [2].

Annually, about 5 cases of SLE occur in 100,000 populations. According to CDC, in the US, about 1.8 to 7.6 cases occur per 100,000 persons every year. As per the statistics provided by the Lupus Foundation of America, it has been estimated that about 1.5 million Americans live with SLE [3].

SLE is a common phenomenon amongst the women population. In addition, black women are 4 times more likely to develop the autoimmune disease than white women [4].

Under normal conditions, the immune system produces antibodies that protect the body against infections. SLE occurs due to abnormalities in apoptosis, which disturbs the immune tolerance ability and speeds up cell death. T cells also have a major role to play in development of SLE. Abnormalities in T cells cause defect in signaling which in turn, leads to development of abnormalities in immune response [5].

In the condition of SLE, the body’s immune system attacks the healthy cells, considering them as invaders, and in the process destroys them. Such sequence of events causes tissue damage, giving rise to various symptoms of swelling and pain. Interplay of environment and genetic factors, are known to play a role in causation of SLE.

Onset of SLE cannot be prevented; however, the associated complications can be kept at bay by following certain preventive steps. It is necessary, that individuals with SLE should be closely monitored for several other disease conditions. Individuals should receive all immunizations to prevent development of new disorders. In addition, they are also advised to get regularly tested for osteoporosis. SLE also predisposes an individual to develop heart diseases, and therefore preventive steps should be taken to protect the heart [12].

In women, systemic lupus erythematosus (SLE) usually begins during the child bearing age. SLE can affect the joints, brain, kidney and other body organs. Apart from women of child bearing age, the condition can also affect children and adults [1]. SLE is a chronic disease condition, wherein the affected individuals experience alternate bouts of mild and severe symptoms. SLE cannot be cured; however the symptoms can be well managed with an appropriate treatment regime.

Definition

Systemic erythematosus lupus (SLE) is an autoimmune disorder, in which the body’s immune system mistakenly attacks the healthy tissues of the body. Such a kind of phenomenon gravely affects the various organs of the body.

Cause

The exact cause of SLE is not known. However interplay of genetic, and environmental factors, is known to trigger abnormal immune response. Individuals with family history of the disease are at an increased risk of developing SLE.

Symptoms

Symptoms of SLE include onset of joint pain and swelling in majority of the cases. In addition, individuals also experience fever, fatigue, malaise, sensitivity to light and development of butterfly shaped rashes.

Diagnosis

A preliminary physical examination followed by antinuclear antibody test is done. This is followed by blood tests, and urinalysis to diagnose underlying disease conditions. Liver function and kidney function tests are also necessary.

Treatment

Mild forms of SLE are treated through non-steroidal anti-inflammatory drugs (NSAIDs) for managing joint pain and pleurisy. Corticosteroid cream is also administered to be applied on the skin rashes. In more severe cases, high dose corticosteroids are administered. If these do not work then cytotoxic drugs are given.

1. Rahman A, Isenberg DA. Systemic lupus erythematosus. N Engl J Med. Feb 28 2008;358(9):929-39.
2. Cooper GS, Dooley MA, Treadwell EL, et al. Hormonal, environmental, and infectious risk factors for developing systemic lupus erythematosus. Arthritis Rheum 1998; 41:1714.
3. Petri M. Epidemiology of systemic lupus erythematosus. Best Pract Res Clin Rheumatol 2002; 16:847.
4. Danchenko N, Satia JA, Anthony MS. Epidemiology of systemic lupus erythematosus: a comparison of worldwide disease burden. Lupus. 2006;15(5):308-18.
5. Lo MS, Tsokos GC. T cells in systemic lupus erythematosus: progress toward targeted therapy [August 2011]. The Rheumatologist [serial online].
6. Trager J, Ward MM. Mortality and causes of death in systemic lupus erythematosus. Curr Opin Rheumatol. Sep 2001;13(5):345-51
7. Pons-Estel GJ, Alarcón GS, Scofield L, et al. Understanding the epidemiology and progression of systemic lupus erythematosus. Semin Arthritis Rheum 2010; 39:257.
8. Edworthy SM. Clinical Manifestations of Systemic Lupus Erythematosus. In: Harris ED, et al, eds. Kelley's Textbook of Rheumatology. 7th ed. Philadelphia, Pa: WB Saunders; 2005:1201-24.
9. Rothfield N. Clinical features of systemic lupus erythematosus. In: Textbook of Rheumatology, Kelley WN, Harris ED, Ruddy S, Sledge CB (Eds), WB Saunders, Philadelphia 1981
10. Tierney LM, McPhee SJ, Papadakis MA, eds. Current Medical Diagnosis and Treatment. 40th ed. New York, NY: McGraw-Hill; 2001:841-4.
11. Bertsias G, Ioannidis JP, Boletis J, et al. EULAR recommendations for the management of systemic lupus erythematosus. Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics. Ann Rheum Dis 2008; 67:195.
12. Schmajuk G, Yelin E, Chakravarty E, Nelson LM, Panopolis P, Yazdany J. Osteoporosis screening, prevention, and treatment in systemic lupus erythematosus: application of the systemic lupus erythematosus quality indicators. Arthritis Care Res (Hoboken). Jul 2010;62(7):993-1001.