An autoimmune disease is a condition in which the body’s immune system
classifies healthy and normal parts of the body as foreign and begins to attack
them. As a result of the attack, widespread inflammation and tissue damage to
the affected area can occur.
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A common example
of this is
rheumatoid arthritis (RA), in which the body attacks the joints, but
inflammation and tissue damage are relatively contained to areas of the hands,
wrists, and knees in RA.
Lupus is an
autoimmune disease that is fairly unique due to its ability to affect and cause
inflammation in numerous areas of the body.
There are a few
different types of lupus, but the most common and well-known form is systemic
lupus erythematosus (SLE). Global estimates are difficult to establish, but SLE
global prevalence is estimated to be between 13 and 7,713 per 100,000 people.
Unfortunately, the
prevalence in Jordan has yet to be thoroughly investigated.
Lupus is an autoimmune disease that is fairly unique due to its ability to affect and cause inflammation in numerous areas of the body.
What is SLE, and
what are some of the physical manifestations?
SLE is a chronic,
lifelong condition with no cure. By nature, this condition has cyclic phases of
symptoms, periods where symptoms worsen, also known as flare-ups, and other
periods when symptoms return to a milder state, also known as remission. SLE
attacks many different organs and systems in the body, including the kidneys,
skin, joints, heart and blood vessels, nervous system, and lungs.
The symptoms of SLE can range from mild to severe
depending on how badly and which organs are most affected. Common symptoms and
manifestations of SLE include headaches, extreme fatigue, anemia, issues
relating to blood-clotting, joint pain and swelling, and hair loss.
One of the more visible symptoms of SLE is when it
attacks the skin. The attack can manifest in a rash known as the butterfly
rash. This particular rash commonly appears as redness along the length of the
nose and across the cheeks.
Another common manifestation is known as Raynaud’s
Phenomenon. This occurs due to the body attacking blood vessels, which causes
an episode of constriction known as vasospasm. It ultimately results in
restricted or interrupted blood flow to certain areas of the body, such as the
fingers and toes, ears, or nose.
Raynaud’s Phenomenon will present as tingling in
these affected areas and cause the skin to turn white or blue.
What causes SLE?
There is no single cause of
SLE, but an intricate relationship between genetic, environmental, and hormonal
factors plays a role.
Genetically, there is no certain gene that has been
linked to SLE. However, it has been found that those with a family member with
the condition are at a higher risk of developing SLE. Many studies also
confirmed that SLE disproportionally affects Black, Asian, and Hispanic
populations.
Environmental triggers such as ultraviolet rays,
certain medications and viruses, physical or emotional stress, and trauma do
not necessarily cause SLE but instead exacerbate the condition in those already
predisposed.
Sex and hormones also seem to play an interesting
role in SLE. Internationally, regardless of race, women are consistently more
affected by SLE than men.
According to the
Center for Disease Control and Prevention, it is estimated that 4–12 women are afflicted with SLE for every
man with the condition. Furthermore, women tend to experience worsening
symptoms during pregnancy and menstrual periods. As a result, it has been
hypothesized that the female sex hormones known as estrogen may play a role in
causing SLE, although more research is needed to confirm.
How is SLE treated?
As of yet, there is no cure
for SLE.
The primary focus of treatment for SLE is managing
the symptoms brought on by the condition.
For stiffness in the joints and overall pain, it can
often be managed by over-the-counter anti-inflammatory medication. There are
also medications such as steroids that can help manage overall inflammation but
require a prescription.
Sex and hormones ... play an interesting role in SLE. Internationally, regardless of race, women are consistently more affected by SLE than men.
There is also a heavy emphasis on lifestyle changes
to help manage symptoms. Since SLE affects the skin, it can cause individuals
to become sensitive to ultraviolet (UV) light. Sunscreens that block UV-A and
UV-B and have an SPF of 55 or more are recommended to use whenever outdoors.
When it comes to diet, a well-balanced diet is
emphasized. Inflammatory diseases such as SLE may require increasing caloric
intake and certain medications used to treat symptoms, including
glucocorticoids which may increase appetite.
Generally, if a balanced diet is maintained, there
is no need for supplemental vitamins with the exception of
vitamin D, as
vitamin D deficiency in those with SLE is common, likely due to the lack of
sunlight exposure.
Additionally, due to the acute flare-ups of SLE, physical
activity can be difficult. But, it is important to exercise during milder
periods to maintain muscle mass, improve bone strength, and reduce symptoms of
fatigue.
Complications of SLE
Unfortunately, SLE is
associated with many severe complications, especially in those unable to seek
treatment, go undiagnosed, or are poorly managed. Due to the multisystem attack
on the body, many events can result in premature death with SLE.
When it comes to the cardiovascular system, many
complications can increase mortality. This includes vasculitis (inflammation of
the blood vessels), pericarditis (inflammation of the heart),
heart attack, and
stroke.
SLE can also cause complications in the lungs,
particularly inflammation of the lung tissue and lining known as pleuritis.
Another common complication of SLE is decreased
kidney function due to inflammation. If kidney function is impaired, it can
ultimately result in kidney failure.
The mortality associated with SLE is cause for
concern. A 2020 study in Jordan assessed the in-hospital mortality of patients
with SLE between 2002–2017 and found that the death rate was 14.1 percent.
The cause of death was primarily due to infection
(42.5 percent) and SLE-related complications (40 percent). Of those whose death
was attributed to SLE-related complications, the majority were due to critical
cases relating to the cardiovascular and respiratory systems.
More disturbing was the length of time between
diagnosis and death. The average time between diagnosis and death was 7.5 years
in the deceased population. Moreover, those who died during this study were
diagnosed with SLE at an early age (27.8 years on average) compared to those
who were not (37 years on average).
There is also a notable disparity between men and
women exists when it comes to SLE and mortality. At baseline, women with SLE
outweigh men by a factor of 8.4:1. However, in those deceased, that disparity
shrank to 3.4:1.
While controversy exists on the matter, this difference in
disparity has been noticed in other studies, leading to the consideration that
SLE is more aggressive in men than in women, despite women making up the
majority of those with SLE.
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