Recognizing systemic lupus erythematosus

  • The course of clinical illness in SLE can range from subtle to dramatic and is determined by the interplay between susceptibility genes and environmental triggers. Researchers know that lupus autoantibodies are present up to five years prior to development of clinical disease, with onset occurring once genetic load is sufficient and immune triggers present themselves. Serologic presence of antinuclear antibodies (ANA) is widely considered the first and most appropriate confirmatory test for SLE,

  • Lupus often presents with nonspecific signs and symptoms, including fatigue, fever with no other cause, chest pain when taking a deep breath, general discomfort, and uneasiness or malaise.

  • The preponderance of SLE disease burden is among young black and Hispanic women in their 20s and 30s, followed by Native American women. However, SLE can also affect white women, and men -- with the disease being especially severe in black and Hispanic men.

  • Exposure to UV radiation from the sun causes disease flares, as shown here, in approximately 70% of patients with SLE. In addition to photosensitive rashes, polyarthritis (not mere arthralgias) of the hands and nephritis are among the SLE symptoms often noticed first.

  • A butterfly-shaped rash (partially seen here) over the cheeks and bridge of the nose is characteristic feature noted in diagnostic criteria.

  • When the skin is affected, patchy skin color is common, and some patients develop Raynaud’s phenomenon (pictured here), in which the fingers change color when cold.

  • Discoid lupus, pictured here, is a chronic rash typically found on the face and scalp that has characteristic skin findings and is generally negative on antinuclear antibody tests. Fewer than 5% of cases progress to SLE.

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Systemic lupus erythematosus (SLE) is a long-term autoimmune disorder that may affect the skin, joints, kidneys, brain and other organs. Although factors such as sunlight, certain drugs and viral infections are known to trigger SLE, the underlying cause is not fully understood.

Because SLE is uncommon – it currently affects approximately 40 to 50 persons per 100,000 in the United States – it can be challenging to treat in clinical practice. However, care for the patient with lupus and other autoimmune diseases has changed dramatically over the past few decades, with five year survival improving from 50% in the 1960s to 95% today. View the images in this slideshow to learn more.

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