Clinical manifestations of SLE-Health awareness

Clinical manifestations of SLE

Systemic lupus erythematosus (SLE) is a disease that involves the whole system. Common constitutional features of SLE are fatigue, fever, malaise (generelazid tiredness) and weight loss. Rashes are common cutaneous manifestation of SLE. The rashes are common at the body surface that is exposed to sunlight like over the face, upper limbs and chest. One common presentation is “butterfly” rash. Other cutaneous lesions include photosensitivity (skin sensitivity to sun light), vasculitis, alopecia (loss of hair) and oral ulcers.

Other manifestations include arthritis and hematological disorder. Arthritis is characterized by inflammatory joints, often symmetrical and non erosive. As for hematological, it can presents as anemia which is most likely hemolytic in nature. It is also known as autoimmune hemolytic anemia (AIHA). Reticulocytosis is one of the concurrent features of hemolysis (1). Other features are neutropenia, thrombocytopenia (low platelets), lymphadenopathy, splenomegaly, venous or arterial thrombosis.

Thrombosis is a major risk factor in patients with SLE especially patients with antiphospholipid (aPL) antibodies (2). Antiphospholipid syndrome can be primary or secondary to SLE. The clinical course is mainly defined by the occurrence of recurrent thrombotic event. Recurrent miscarriage is a major manifestation of APS where it has been thought to be due to placental thrombosis (2). AIHA usually occurs at the onset of SLE and the recurrence rate among treated patient is low. The association between anticardiolipin and thrombosis suggests that the occurrence of AIHA may define a subgroup of patients who have serology characteristic and clinical manifestations (3).

Nephritis is also another important manifestation of SLE. Patients with lupus nephritis may be presented with proteinuria and hematuria. In suspicion of lupus nephritis, renal biopsy should be performed to confirm the diagnosis.

Cardiopulmonary is another organ that can be affected. The patients might have pleuritis, pericarditis, myocarditis and endocarditis. Other organs are gastrointestinal and neurologic. In gastrointestinal, it may lead to peritonitis and vasculitis. Neurologically, SLE may cause organic brain syndromes, seizures, psychosis and cerebritis (1). It is also known as cerebral lupus.

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Reference:

Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. Harrison’s principle of internal medicine. Manual of medicine, 16^th edition, International edition, editors.Mc Graw Hill.2005
Guillermo RI, Munther, KA. Management of Thrombosis in Antiphospholipid Syndrome and Systemic Lupus Erythematosus in Pregnancy.Annals of the New York Academy of Sciences. 2005; 1051:606-612.
Kokori, SIG, Ioannidis, JPA, Voulgarelis, M, Tzioufas, AG, Moutsopulos, HM.Autoimmune hemolytic anemia in patients with systemic lupus erythematosus .The American Journal of Medicine. The American journal of Medicine . 2000;108 (3): 198-204 .