How does systemic lupus erythematosus manifest? Factors for diagnosing the disease. Manifestation of orthopedic type

The appearance of a specific rash on the face, which is red in color, is very often confused with an allergy and the wrong treatment is used. The formation of the first symptoms of lupus erythematosus on the skin can only be diagnosed by a specialist. Many people have no idea about the concept of lupus erythematosus, what kind of disease it is and how it is dangerous to health.

This type of disease is most common in young women and belongs to the category of complex types of skin diseases. At an advanced stage, the disease can begin to progress greatly and spread to healthy areas of the body.

What kind of disease is lupus erythematosus?

The disease refers to skin infections of the autoimmune type.

When manifested, it has the following types of characteristics:

• Appears as, which is localized in the cheeks and nose;
• As the disease progresses, increased production of antibodies begins body and damage to healthy cells;
• The human body recognizes healthy epidermal cells as infected, and starts the processes of eliminating this type of cell;
• Females under 30 years of age are most often affected.;
• Belongs to a rare type of disease and is hereditary;
• Most often, with this type of skin disease, damage to connective cells occurs and epithelium.

The disease tends to reduce and increase its symptoms, and is transmitted from mother to child at birth.

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Disease history

The disease lupus erythematosus is very often popularly called simply lupus, which arose a long time ago and has its own history.

It has the following development features:

After a detailed study of the disease, experts came to the conclusion that lupus erythematosus tends to affect not only the skin, but also internal organs, which is why the disease is called systemic lupus erythematosus.

For many years, patients with psoriasis and eczema have been hostage to their illnesses. There were remedies that could alleviate the course of the disease, but not eliminate them completely. After the appearance of this gel, dermatologists recognized that this was a completely new word in medicine.

Forms and classifications

The disease lupus erythematosus can be of various forms, which is reflected in the rate of progression of the disease and the manifestation of unpleasant symptoms.

Forms

The following forms are distinguished:

• Acute form– the disease develops quickly and tends to affect large areas of skin. Accompanied by a large number of symptoms, including an increase in body temperature up to 40 degrees;
• Subacute form– manifested by general symptoms of weakness, clear boundaries of the rash on the epidermis. The disease gradually spreads to new areas of the body;
• Chronic form– this type of disease very often does not attract much attention and is confused with other types of skin infections. Symptoms appear vaguely, the rash on the body can disappear on its own, and after a while it appears with renewed vigor.

Classifications

In addition to the forms of the disease, the following types of classification are distinguished:

• Discoid lupus erythematosus– Symptoms most often appear on the butterfly-shaped face. The epidermis becomes red and swollen, and may gradually move to the ears and scalp;
• Lupus erythematosus deep- characterized by symptoms small sizes all over the body. In this case, the color of the rash may be dark red with blue impurities;
• Centrifugal lupus– appears on the face in the form of mild symptoms of a rash on the cheeks and nose. Gradually, scales form, the skin begins to peel and swell;
• Systemic lupus erythematosus– is considered the most complex class of this type of disease. The first signs of lupus are observed on the face, the disease quickly spreads throughout the body and is accompanied by a large number of symptoms. As the disease progresses, the joints are damaged and their normal functioning is disrupted;
• Drug-induced lupus - manifests itself as a reaction to the use of medications.

Only a specialist can correctly determine the form and type of lupus erythematosus after carrying out the necessary diagnosis.

Causes

Medical experts have not yet identified the causes of the formation of a disease such as lupus erythematosus.

However, there are the following types of reasons that may contribute to the formation of such symptoms:

Some experts say that lupus can occur as a result of hormonal imbalances or after using contraceptives. However, this opinion remains controversial and direct evidence does not yet exist.

Clinical picture

What doctors say about skin diseases

Work in private clinic I have been providing consultations on skin problems for many years now. You can’t imagine how many people come to me with different types of dermatological skin diseases; as a rule, these are all kinds of rashes, redness and suppuration on various parts of the body.

Mechanism of disease development

The disease develops as follows:

• Failure in the immune system, as a result of which the body begins to produce antibodies;
• High concentration of antibodies in the body after a certain time;
• Starting the foreign body removal process, for which the body mistakes healthy cells;
• As a result of a pathogenic reaction formation of an inflammatory process is observed;
• Change blood vessels and connective tissue;
• Skin damage and internal organs.

Depending on the type of lupus, the mechanism of action of lupus may develop rapidly or over several years.

There are cases that a person, ignoring all the symptoms, can live for more than 10 years, however, such types of disease progression are fatal and cannot be treated with medication.

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Symptoms and signs

Depending on the type of manifestation of the disease, there are various symptoms and signs of lupus erythematosus.

Each patient may have individual symptoms and signs of disease progression, which depend on general condition immune system and body characteristics.

Manifestation of dermatological type

Characteristic manifestations of this type of lupus are the presence of a rash of varying intensity on the skin.

The first signs of disease formation:

• Swelling of the skin;
• Pain when touched;
• Manifestation of single formations in the face and neck.

Symptoms of the disease:

The person may feel a lack of appetite and an upset stomach. Very often, such symptoms can lead to long-term headaches. A rash throughout the body can appear in the genital area, arms and abdomen.

Manifestation of orthopedic type

Very often when running and complex types The disease lupus erythematosus causes a decrease in the functions of the human skeletal system.

Signs:

• Burning in joints;
• Painful symptoms at the end of the day;
• Violation of bone integrity;
• Rheumatology;
• When moving the limbs, unpleasant symptoms occur.

The following symptoms are observed:

The person experiences decreased joint function and frequent pain symptoms. The joint area becomes red and the skin becomes swollen.

Hematological signs of the disease

The development of the disease lupus erythematosus can be manifested by the following symptoms:

• Anemia;
• Formation of blood clots in blood vessels;
• Leukopenia.

IN in rare cases There may be a violation of the walls of blood vessels, a reduced level of blood clotting.

Manifestation of heart character

On the part of the heart organs, the manifestation of the disease lupus erythematosus can be manifested by the following symptoms:

Signs:

• A sharp increase in heart rate;
• Pain in the chest area;
• General weakness.

The symptoms are chaotic in nature, often go away on their own, after which they appear with renewed vigor. Very often these types of symptoms are confused with other types of heart muscle damage and inappropriate treatment is used.

Significant factors associated with kidneys

In cases where lupus erythematosus disease affects the kidney area, the following symptoms may appear:

Symptoms:

• Swelling in the eye area;
• Observation large quantity protein in urine;
• Pyelonephritis;
• Kidney disease.

Very often, the manifestation of such symptoms affects all nearby organs and disrupts the normal functioning of the genitourinary system.

Manifestation of a neurological nature

The disease can manifest itself with neurological symptoms:

Signs and manifestations:

• Disturbance of normal sleep;
• Irritability;
• Overexcitement;
• Nervousness.

In addition to nervous system disorders, symptoms of indigestion, breathing problems and pain in the stomach are very common.

Situations can often be observed when the patient suffers from partial loss of vision or the formation of inflammatory processes in the visual organs.

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Is the disease contagious?

Lupus erythematosus is not a contagious disease, despite the large number of unpleasant symptoms. This is primarily due to the fact that the causes of the development of the disease are located inside the body.

The only cases of infection from another patient can be observed during childbirth from mother to child.

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• Prevents the appearance of new plaques and an increase in their area

Features of the disease in children

The onset of lupus disease is much more complex than in adulthood. This is primarily due to weakened immunity, which is unable to resist this type of damage to the body.

The very first signs of the formation of this type of disease are:

• Specific red color in different parts of the body;
• The rash most often appears on the face and scalp., which leads to complete baldness;
• The most obvious signs of the disease appear in the lip area, mucous membranes, causing ulcerative skin lesions.

IN childhood lupus is manifested by the following features:

This type of disease is very difficult to treat and often leads to severe cases of consequences. The child loses his mobility and may experience sudden weight loss and blockage normal development internal organs.

Disease during pregnancy

Symptoms of lupus disease can occur during pregnancy in any trimester. Very often, many women confuse the first signs of the disease with changes in the body during pregnancy.

If lupus develops during pregnancy, a woman may experience the following types of complications:

If a woman is diagnosed with a disease during pregnancy, the entire period of prenatal work is carried out under the close supervision of doctors in a hospital setting.

Diagnostics

Only a specialist can make a correct diagnosis after conducting an appropriate examination.

Diagnostics consists of:

Depending on the complexity of the disease, additional types of diagnostics may be prescribed, which will determine the intensity of treatment.

Treatment

Treatment of lupus erythematosus involves the use of various treatment methods that are aimed at eliminating unpleasant symptoms and blocking further development of the disease.

The most commonly used treatment methods are:

• Drug effects– is prescribed to reduce the symptoms of the disease and eliminate damage to healthy areas of the skin. The use of medications helps strengthen the natural functions of the immune system and eliminate the disease;
• Local impact problem– used to activate the natural processes of restoration of damaged cells;
• Complementary therapy– the most commonly used blood purification procedure is plasmapheresis. This method allows you to reduce the production of antibodies and stop the body from eliminating healthy cells;
• Compliance with a special diet– necessary to strengthen the body and supply all the necessary substances.

Treatment methods for the disease depend on the degree of damage and are selected individually for each patient.

Use of medications

Implies complex use medications to reduce symptoms of the disease.

Depending on the type of disease, the following types of drugs may be prescribed.

Hormonal agents

The action of the drugs is aimed at influencing the immune system to suppress the inflammatory response. The duration and course of use of the drugs depends on the complexity of the disease and the individual characteristics of the patient’s body.

The most commonly used types of medications are:

• Methylprednisolone– a corticosteroid substance is aimed at eliminating antibodies that damage healthy skin cells. Reduces inflammation in joints. It is used once a day in a course prescribed by the attending physician individually for each patient. It is not used for children; it is recommended to carry out treatment strictly according to the recommendations of specialists. At improper treatment tends to cause an overdose, which leads to complications of systemic lupus erythematosus. Price 220 rubles ;
• Prednisolone– used to treat various skin diseases, including systemic lupus erythematosus. The drug suppresses the development of the inflammatory process and blocks the further development of the disease. For the treatment of lupus erythematosus, it is recommended to use the drug three times a day for up to 21 days. Prohibited for use in diabetes mellitus and patients suffering from low blood pressure. Not suitable for children, average cost 130 rubles ;
• Dexamethasone- recommended for use as injections. The hormonal substance is aimed at restoring damaged cells, reducing the production of natural enzymes that negatively affect healthy areas of the skin. Apply once a day, the course of treatment is individual. Not recommended for use under 6 years of age. It tends to cause a large number of side effects. Price 400 rubles ;
• Advantan ointment– hormonal ointment for topical treatment is used to reduce the external symptoms of the disease. Proper use eliminates inflammation and reduces swelling of the epidermis. Apply twice a day to affected skin. The course of treatment is 14 weeks. If it is necessary to use in childhood, the duration of treatment should not exceed 5 weeks. Appointed from the age of 6 years. Price 460 rubles ;
• Flucinar gel– eliminates unpleasant symptoms, soothes the skin and initiates cell membrane restoration processes. Apply twice a day for a course of no more than 14 days. Prohibited for children under 12 years of age and for elderly patients. Price 220 rubles .

Cytostatic drugs

They are used for complex types of lupus for more effective treatment with hormonal drugs.

Most prescribed:

• Azathioprine– has an immunosuppressive effect, reduces the production of the body’s protective functions. Promotes rapid elimination of antibodies in the blood. The course and method of use are prescribed individually for each patient. Contraindicated for people under 14 years of age and during periods of reduced kidney function. average cost 1300 rubles ;
• Endoxan– powder for preparing a solution is used to reduce inflammation and as an antitumor agent. It is forbidden to use under 18 years of age and for the elderly. It is used twice a day, the duration of treatment is determined individually by a specialist. Price 800 rubles .

Non-steroidal anti-inflammatory substances

Used for mild symptoms of the disease in childhood.

Most nominated:

• Nurofen– used to relieve symptoms of pain and fever. It is recommended to take as unpleasant symptoms occur, no more than once every 8 hours. Suitable for children from 3 months. average cost 350 rubles ;
• Ibuprofen– a remedy for relieving inflammation and pain symptoms. Suitable for various ages. Recommended to be used as needed. Prescribed from the age of 6 months. Price 90 rubles .

Antimalarials

The action of such medications is aimed at blocking the symptoms of lupus and reducing their manifestation.

The most popular drug is:

• – suitable for long-term use. The course of administration is prescribed by the attending physician. Suitable for treating children over 5 years of age. Price 600 rubles .

Each patient may have individual characteristics of the course of the disease, so the list of drugs is selected individually.

Therapy using folk remedies

The use of traditional medicine methods can help improve the condition and reduce the manifestation of unpleasant symptoms.

The most commonly used types of recipes are:

The use of traditional medicine methods cannot completely cure lupus, however, regular use will reduce symptoms and improve the overall well-being of a person.

Complications of the disease

The disease lupus erythematosus tends to cause a large number of side effects that require additional treatment.

The most common types of complications that may occur are:

If left untreated, lupus erythematosus is often fatal.

Forecast values

Lupus erythematosus is difficult to treat.

Very often the following picture of the development of the disease is observed:

• For complex types of disease, which progresses very quickly over several years, occurs complete defeat internal organs;
• With timely treatment there is an 80% chance of getting rid of unpleasant symptoms;
• After diagnosis 60% of patients die due to infectious diseases;
• If affected during pregnancy Premature birth occurs in 60% of cases.

This type of disease does not go away without leaving a trace; even with timely treatment, a person may experience some disruptions in the functioning of the body.

It is easiest to cope with the disease in the first stages of its occurrence, otherwise it is necessary to undergo long and complex treatment.

Prevention

To prevent the formation of lupus erythematosus, it is recommended to follow the following prevention methods:

Compliance with such methods allows not only to reduce the risk of developing symptoms of the disease, but also, if they do occur, to improve the overall well-being of the patient.

Conclusion

The occurrence of lupus erythematosus greatly reduces the patient's normal life process. However, with proper treatment and following the doctor’s recommendations, a person can reduce discomfort and lead a normal lifestyle.

Modern medicine makes it possible not only to eliminate the symptoms, but also, if necessary, to bear a healthy child. The main condition for this type of disease is to properly plan the pregnancy, visit a specialist in a timely manner for a comprehensive examination and reduce the progression of the disease.

Systemic lupus erythematosus is a disease in which the immune system a person perceives his own structures as foreign elements. This is a disease of young women. 9 out of 10 patients are young girls aged 15 to 26 years.

Other names for the pathology are SLE, Libaman-Sachs disease, diffuse connective tissue disorder. The disease got its main name because of its characteristic symptom - a rash on the face that resembles the silhouette of a butterfly. And in the Middle Ages, the affected area was associated with a place for wolf bites.

When systemic lupus erythematosus begins to progress, symptoms arise very quickly and form into entire symptom complexes. During the development of the disease, substances are formed in the body that have a detrimental effect on absolutely all organs and tissues. The only difference is that the target organs are destroyed faster than other tissues and structures.

Possible precipitating factors

The reasons why such an unfavorable autoimmune resolution process occurs are still not clear. There are only theories, as well as possible assumptions regarding the etiological role of certain factors. We are talking about the following aspects.

1. Chronic viral infection. We are talking about RNA viruses and retroviruses. In many patients with SLE, colossal amounts of antibodies to these viruses were found in the blood, which indicates a previously raging infectious process.
2. Genetic predisposition. It has been proven that cases of lupus erythematosus are recorded more often in those patients whose close relatives suffered from a similar disease.
3. Individual susceptibility to drugs can also cause serious disruption in the functioning of the entire body. cellular level. We are talking about specific types of intolerance - a negative reaction to vaccines, serums.
4. Photosensitivity and ultrasonic irradiation can cause various malfunctions.

The fact that young women get sick in the vast majority of cases suggests “purely female” provoking factors. These include frequent and difficult pregnancies, a history of multiple births, abortions and miscarriages.

Pathogenetic aspects of the development of systemic lupus erythematosus

The pathogenesis of SLE is based on dysregulation by the immune system of basic defense processes. For example, how antigens perceive protein components, primarily DNA. As a result of adhesion, chronic immune failure leads to the fact that even those cells that were previously completely free of immune complexes begin to suffer.

Classification of the disease according to the IBC

Systemic lupus erythematosus, according to the MBC classification, can be of the following types:

• SLE caused by taking pharmacological products;
• SLE, accompanied by damage to other organs and systems;
• lupus erythematosus, unspecified;
• other forms of SLE.

Clinical classification divides different types of disease according to other criteria. First of all, the nature of the flow is taken into account:

• spicy;
• subacute;
• relapsing polyarthritis;
• discoid lupus erythematosus;
• S-mRaynaud;
• S-mVerlgof;
• S-mSjögren;
• antiphospholipid syndrome.

The disease can be active to varying degrees. Depending on how rapidly the disease progresses, experts use the following designation methods:

• 0 – there is no activity at all;
• I – minimum;
• II – moderate;
• III – high.

The table below discusses another complex classification of the disease. SLE is considered from the point of view of severity clinical manifestations, depending on which system was most affected.

Systemic lupus erythematosus in children and patients over 40 years of age is relatively rare. The risk group is formed by women aged 15 to 26 years, as was previously mentioned.

Initial manifestations that patients may notice:

• weakness;
• weight loss;
• low-grade fever.

However, the progression of the disease forms a complex and quite vivid clinical picture. Let us consider separately each system involved in the pathological process.

Skin and mucous membranes

The most common symptom of lupus is characteristic skin changes. The pathological process can affect the tissues of the dermal tissue and mucous membranes in 28 different ways. The most typical of them are presented below.

1. Erythematous spots of various sizes and shapes, which can be located isolated from each other or merge into one conglomerate. The color is intensely bright. The tissues are swollen and inflamed.
2. Erythematous lesions with infiltration, dermal atrophy, peeling. Sometimes there are signs of hyperkeratosis. The symptom is characteristic of the chronic form of the disease.
3. Lupus cheilitis is redness of the lips, which over time become covered with crusts, erosions, followed by deep tissue atrophy.
4. Capillaritis is swelling spots localized in the area of ​​the fingertips, palms, and soles.
5. Enanthema of mucous tissues oral cavity– erythematous rashes, accompanied by severe hemorrhages and erosions.
6. Trophic disorders are pathological processes in which a person loses hair, nails, and skin tissue becomes excessively dry.
7. Ring-shaped rash with telangiectasia.

Musculoskeletal system

Damage to connective tissue greatly affects the functional potential of the musculoskeletal system. The following symptoms indicate that bones and joints are involved in the pathological process:

• joint pain (prolonged, intense);
• polyarthritis of a symmetrical type, which is accompanied by involvement of the interphalangeal joints of the hands in the inflammatory process;
• joint stiffness, especially in the morning;
• formation of flexion contractures of the fingers;
• development of aseptic necrotic processes in inert and cartilaginous tissues.

The muscles are no less subject to “aggression” of the autoimmune process. Patients complain of constant myalgia, as well as severe muscle weakness. Polymyositis may develop.

Respiratory system

When considering the question of how lupus erythematosus affects life expectancy, it is worth familiarizing yourself with the clinical picture of the patient’s affected lungs. The disease is accompanied by the following phenomena:

• dry or effusion pleurisy, accompanied by severe shortness of breath, difficulty breathing, severe pain;
• lupus pneumonitis is manifested by shortness of breath, pain, dry cough, hemoptysis;
• pulmonary hypertension syndrome;
• PE as one of the types of complications.

The cardiovascular system

Pancarditis, or dry pericarditis, often develops. Diffuse myocarditis develops with very active form lupus This pathological process is further complicated by circulatory failure.

In endocarditis it is affected valve apparatus hearts. Mitral insufficiency gradually develops, and then aortic valve insufficiency.

Vessels are also involved in a total destructive process. Vessels of medium and small caliber are primarily affected. Thrombophlebitis and phlebitis often occur. If the coronary arteries are damaged, the risk of myocardial infarction increases.

Organs of the digestive tract

Patients complain of a constant feeling of nausea and frequent vomiting. There is no appetite at all. Over time, the mucous membrane of the digestive canal begins to be affected by erosive processes of varying severity.

If the mesenteric vessels are affected, the patient becomes very worried severe pain. Localization - around the navel. Rigidity of the abdominal muscles is observed. Liver destruction is expressed by such pathological phenomena as organ enlargement and jaundice.

Kidney damage

There is a whole classification according to which lupus nephritis is divided into several global categories:

• I – absence of any structural abnormalities in the biopsy;
• II – mesangial nephritis;
• III – focal glomerulonephritis of proliferative type;
• IV – diffuse proliferative glomerulonephritis;
• V – membranous glomerulonephritis;
• VI – sclerosing glomerulonephritis.

The table discusses key aspects regarding basic laboratory tests. The diagnostic results allow you to accurately establish the diagnosis.

The diagnosis is based on a combination of specific symptoms. There are 11 specific criteria. If at least 4 of them are observed in a patient, he is diagnosed with systemic lupus erythematosus:

• butterfly rash;
• excessive skin sensitivity to ultraviolet rays;
• discoid rash;
• ulcerative processes localized on the mucous membranes;
• arthritis;
• pleurisy;
• kidney damage;
• damage to the central nervous system;
• immunological disorders;
• problems with blood cells (leukopenia, anemia);
• antinuclear bodies.

A number of special pharmacological products are used to treat diagnosed systemic lupus erythematosus. The table discusses all five groups of drugs that are relevant in modern therapeutic regimens for patients.

Duration of therapy and use of non-standard treatment approaches

Treatment should continue for as long as the symptoms of the disease are observed. Therapy cannot be interrupted under any pretext.

Today patients are offered many alternative options treatment of such a complex disease. Every untested method, methods associated with a number of risks and complications, or not approved by official medicine, do more harm than good.

Systemic lupus erythematosus can only be treated with medication under the close supervision of the attending physician. This is the only way to get rid of the disease and lead a full life.

Prognosis for patients

The prognosis is favorable if the disease is detected as early as possible, when tissues and organs have not yet undergone severe destruction. Mild rashes and arthritis, for example, are very easy to control.

Advanced forms of the disease require aggressive treatment with large doses of various pharmacological products. In this case, it is not known what harms the body more: colossal doses of drugs or the pathological process itself.

Preventive actions

Prevention of systemic lupus erythematosus is aimed solely at preventing relapses of the disease, as well as stopping further progression of pathological processes. The essence of secondary preventive measures is timely and adequate treatment of the disease.

Patients undertake to undergo regular medical examinations, take hormonal medications in the correctly prescribed dosage. Do not sunbathe in the sun, do not overcool, avoid injuries, do not get vaccinated. If the disease worsens, you should immediately contact a specialist who has previously treated this person.

Conclusion

Thus, systemic lupus erythematosus is a rather serious autoimmune disease that requires an integrated approach to treatment. If diagnosed early, there is a chance to live a full life. That is why it is so important to contact a specialist in time at the first unfavorable signals.

Systemic lupus erythematosus (SLE)– a chronic autoimmune disease caused by a disruption of the immune mechanisms with the formation of damaging antibodies to one’s own cells and tissues. SLE is characterized by damage to joints, skin, blood vessels and various organs (kidneys, heart, etc.).

Cause and mechanisms of disease development

The mechanisms of the disease are based on dysfunction of immune cells (T and B lymphocytes), which is accompanied by excessive formation of antibodies to the body’s own cells. As a result of excessive and uncontrolled production of antibodies, specific complexes are formed that circulate throughout the body. Circulating immune complexes (CIC) settle in the skin, kidneys, and on the serous membranes of internal organs (heart, lungs, etc.) causing inflammatory reactions.

Symptoms of the disease

• Fatigue
• Weight loss
• Temperature
• Decreased performance
• Fast fatiguability

Damage to the musculoskeletal system

• Arthritis – inflammation of the joints
  • Occurs in 90% of cases, non-erosive, non-deforming, the joints of the fingers, wrists, and knee joints are most often affected.
• Osteoporosis – decreased bone density
  • As a result of inflammation or treatment with hormonal drugs (corticosteroids).

• Muscle pain (15-64% of cases), muscle inflammation (5-11%), muscle weakness (5-10%)

Damage to mucous membranes and skin

• Skin lesions at the onset of the disease appear in only 20-25% of patients, in 60-70% of patients they appear later, in 10-15% skin manifestations of the disease do not occur at all. Skin changes appear on areas of the body exposed to the sun: face, neck, shoulders. The lesions have the appearance of erythema (reddish plaques with peeling), dilated capillaries at the edges, areas with excess or lack of pigment. On the face, such changes resemble the appearance of a butterfly, as the back of the nose and cheeks are affected.
• Hair loss (alopecia) occurs rarely, usually affecting the temporal areas. Hair falls out in a limited area.
• Increased sensitivity of the skin to sunlight (photosensitization) occurs in 30-60% of patients.
• Damage to the mucous membranes occurs in 25% of cases.
  • Redness, decreased pigmentation, impaired nutrition of lip tissue (cheilitis)
  • Finely pinpoint hemorrhages, ulcerative lesions oral mucosa

Respiratory system damage

Damage to the cardiovascular system

• Pericarditis is an inflammation of the serous membranes covering the heart muscle.

• Myocarditis is inflammation of the heart muscle.

• Damage to the heart valves, most often the mitral and aortic valves are affected.
• Defeat coronary vessels, can lead to myocardial infarction, which can also develop in young patients with SLE.
• Damage to the inner lining of blood vessels (endothelium) increases the risk of developing atherosclerosis. Peripheral vascular damage manifests itself:
  • Livedo reticularis (blue spots on the skin creating a grid pattern)
  • Lupus panniculitis (subcutaneous nodules, often painful, may ulcerate)
  • Thrombosis of blood vessels of the extremities and internal organs

Kidney damage

Damage to the central nervous system

• Headache and migraine are the most frequent symptoms for SLE
• Irritability, depression – rare
• Psychoses: paranoia or hallucinations
• Brain stroke
• Chorea, parkinsonism – rare
• Myelopathies, neuropathies and other disorders of nerve sheath (myelin) formation
• Mononeuritis, polyneuritis, aseptic meningitis

Damage to the digestive tract

• Damage to the esophagus, impaired swallowing, dilatation of the esophagus occurs in 5% of cases
• Ulcers of the stomach and 12th intestine are caused both by the disease itself and by the side effects of treatment
• Abdominal pain as a manifestation of SLE, and can also be caused by pancreatitis, inflammation of the intestinal vessels, intestinal infarction
• Nausea, abdominal discomfort, indigestion

• Hypochromic normocytic anemia occurs in 50% of patients, the severity depends on the activity of SLE. Hemolytic anemia is rare in SLE.
• Leukopenia is a decrease in leukocytes in the blood. Caused by a decrease in lymphocytes and granulocytes (neutrophils, eosinophils, basophils).
• Thrombocytopenia is a decrease in platelets in the blood. Occurs in 25% of cases, caused by the formation of antibodies against platelets, as well as antibodies to phospholipids (fats that make up cell membranes).

Diagnosis of SLE

Criteria for the diagnosis of systemic lupus erythematosus

The diagnosis of SLE is made if at least 4 out of 11 criteria are present.

Disease activity indices bySLEDAI

• Light activity: 1-5 points
• Moderate activity: 6-10 points
• High activity: 11-20 points
• Very high activity: more than 20 points

Diagnostic tests, used to detect SLE

1. ANA- screening test, specific antibodies to cell nuclei are determined, detected in 95% of patients, does not confirm the diagnosis in the absence of clinical manifestations of systemic lupus erythematosus
2. Anti DNA– antibodies to DNA, detected in 50% of patients, the level of these antibodies reflects the activity of the disease
3. Anti-Sm – specific antibodies to the Smith antigen, which is part of short RNAs, are detected in 30-40% of cases
4. Anti –SSA or Anti-SSB, antibodies to specific proteins located in the cell nucleus, are present in 55% of patients with systemic lupus erythematosus, are not specific for SLE, and are also detected in other connective tissue diseases
5. Anticardiolipin - antibodies to mitochondrial membranes (cell energy station)
6. Antihistones– antibodies against proteins necessary for packaging DNA into chromosomes, characteristic of drug-induced SLE.

• Markers of inflammation
  • ESR – increased
  • C – reactive protein, increased

• Compliment level reduced
  • C3 and C4 are reduced as a result of excessive formation of immune complexes
  • Some people have a reduced level of compliment from birth, this is a predisposing factor to the development of SLE.

• General blood analysis
  • Possible decrease in red blood cells, white blood cells, lymphocytes, platelets

• Analysis of urine
  • Protein in urine (proteinuria)
  • Red blood cells in urine (hematuria)
  • Casts in the urine (cylindruria)
  • White blood cells in urine (pyuria)

• Blood chemistry
  • Creatinine – an increase indicates kidney damage
  • ALAT, ASAT – an increase indicates liver damage
  • Creatine kinase – increases with damage to the muscular system

• X-ray of joints

• X-ray and computed tomography chest

• Nuclear magnetic resonance and angiography

• Echocardiography

• A spinal tap can rule out infectious causes of neurological symptoms.
• A kidney biopsy (analysis of organ tissue) allows you to determine the type of glomerulonephritis and facilitate the choice of treatment tactics.
• A skin biopsy allows you to clarify the diagnosis and exclude similar dermatological diseases.

Treatment of systemic lupus

• Eliminate physical and mental stress conditions
• Reduce sun exposure and use sunscreen

1. Glucocorticosteroids most effective drugs in the treatment of SLE.

• Inside:
  • Initial dose of prednisolone 0.5 – 1 mg/kg
  • Maintenance dose 5-10 mg
  • Prednisolone should be taken in the morning, the dose is reduced by 5 mg every 2-3 weeks

• Intravenous administration of methylprednisolone in large doses (pulse therapy)
  • Dose 500-1000 mg/day, for 3-5 days
  • Or 15-20 mg/kg body weight

Indications for pulse therapy: young age, fulminant lupus nephritis, high immunological activity, damage to the nervous system.

• 1000 mg methylprednisolone and 1000 mg cyclophosphamide on the first day

1. Cytostatics: cyclophosphamide (cyclophosphamide), azathioprine, methotrexate, are used in the complex treatment of SLE.

• Acute lupus nephritis
• Vasculitis
• Forms refractory to treatment with corticosteroids
• The need to reduce corticosteroid doses
• High SLE activity
• Progressive or fulminant course of SLE

• Cyclophosphamide during pulse therapy is 1000 mg, then 200 mg every day until a total dose of 5000 mg is reached.
• Azathioprine 2-2.5 mg/kg/day
• Methotrexate 7.5-10 mg/week, orally

1. Anti-inflammatory drugs

• Naklofen, nimesil, airtal, katafast, etc.

1. Aminoquinoline drugs

• delagil, plaquenil, etc.

1. Biological drugs are a promising treatment for SLE

• Anti CD 20 – Rituximab
• Tumor necrosis factor alpha – Remicade, Gumira, Embrel

1. Other drugs

• Anticoagulants (heparin, warfarin, etc.)
• Antiplatelet agents (aspirin, clopidogrel, etc.)
• Diuretics (furosemide, hydrochlorothiazide, etc.)
• Calcium and potassium preparations

1. Extracorporeal treatment methods

• Plasmapheresis is a method of purifying blood outside the body, in which part of the blood plasma is removed, and with it the antibodies that cause the disease SLE.
• Hemosorption is a method of purifying blood outside the body using specific sorbents (ion exchange resins, activated carbon, etc.).

What are the complications and prognosis for life with systemic lupus erythematosus?

Variants of the course of systemic lupus erythematosus:

1. Acute course- characterized by a lightning-fast onset, a rapid course and the rapid simultaneous development of symptoms of damage to many internal organs (lungs, heart, central nervous system, and so on). The acute course of systemic lupus erythematosus, fortunately, is rare, since this option quickly and almost always leads to complications and can cause the death of the patient.
2. Subacute course– characterized by a gradual onset, alternating periods of exacerbations and remissions, predominance common symptoms(weakness, weight loss, low-grade fever (up to 38 0

C) and others), damage to internal organs and complications occur gradually, no earlier than 2-4 years after the onset of the disease.
3. Chronic course– the most favorable course of SLE, there is a gradual onset, damage mainly to the skin and joints, longer periods of remission, damage to internal organs and complications occur after decades.

Damage to organs such as the heart, kidneys, lungs, central nervous system, and blood, which are described as symptoms of the disease, in fact, are complications of systemic lupus erythematosus.

But we can highlight complications that lead to irreversible consequences and can lead to the death of the patient:

1. Systemic lupus erythematosus– affects the connective tissue of the skin, joints, kidneys, blood vessels and other structures of the body.

2. Drug-induced lupus erythematosus– unlike the systemic type of lupus erythematosus, a completely reversible process. Drug-induced lupus develops as a result of exposure to certain medications:

• Medicines for the treatment of cardiovascular diseases: phenothiazine groups (Apressin, Aminazine), Hydralazine, Inderal, Metoprolol, Bisoprolol, Propranolol and some others;
• antiarrhythmic drug – Novocainamide;
• sulfonamides: Biseptol and others;
• anti-tuberculosis drug Isoniazid;
• oral contraceptives;
• herbal preparations for the treatment of venous diseases (thrombophlebitis, varicose veins of the lower extremities, and so on): horse chestnut, venotonic Doppelgerz, Detralex and some others.

3. Discoid (or cutaneous) lupus erythematosus may precede the development of systemic lupus erythematosus. With this type of disease, the skin of the face is affected to a greater extent. Changes on the face are similar to those with systemic lupus erythematosus, but blood test parameters (biochemical and immunological) do not have changes characteristic of SLE, and this will be the main criterion differential diagnosis with other types of lupus erythematosus. To clarify the diagnosis, it is necessary to conduct a histological examination of the skin, which will help differentiate from diseases that are similar in appearance (eczema, psoriasis, cutaneous form of sarcoidosis, and others).

4. Neonatal lupus erythematosus occurs in newborns whose mothers suffer from systemic lupus erythematosus or other systemic autoimmune diseases. At the same time, the mother SLE symptoms There may not be any, but when they are examined, autoimmune antibodies are detected.

Symptoms of neonatal lupus erythematosus In a child, they usually appear before the age of 3 months:

• changes on the skin of the face (often have the appearance of a butterfly);
• congenital arrhythmia, which is often determined by ultrasound of the fetus in the 2nd-3rd trimesters of pregnancy;
• lack of blood cells in a general blood test (decrease in the level of red blood cells, hemoglobin, leukocytes, platelets);
• identification of autoimmune antibodies specific for SLE.

5. The term “lupus” is also used for tuberculosis of the facial skin - tuberculous lupus. Skin tuberculosis is very similar in appearance to systemic lupus erythematosus. The diagnosis will be helped by histological examination of the skin and microscopic and bacteriological examination scraping - Mycobacterium tuberculosis (acid-fast bacteria) is detected.

Photo: This is what tuberculosis of the facial skin or tuberculous lupus looks like.

Systemic lupus erythematosus and other systemic connective tissue diseases, how to differentiate?

• Systemic lupus erythematosus.
• Idiopathic dermatomyositis (polymyositis, Wagner's disease)– damage by autoimmune antibodies to smooth and skeletal muscles.
• Systemic scleroderma is a disease in which normal tissue is replaced by connective tissue (not bearing functional properties), including blood vessels.
• Diffuse fasciitis (eosinophilic)- damage to the fascia - structures that are cases for skeletal muscles, while in the blood of most patients there is increased amount eosinophils (blood cells responsible for allergies).
• Sjögren's syndrome– damage to various glands (lacrimal, salivary, sweat, etc.), for which this syndrome is also called dry.
• Other systemic diseases.

Differential diagnosis of systemic connective tissue diseases.

Diagnostic criteria	Systemic lupus erythematosus	Systemic scleroderma	Idiopathic dermatomyositis
Onset of the disease	weakness, fatigue; increased body temperature; weight loss; impaired skin sensitivity; periodic joint pain.	weakness, fatigue; increased body temperature; impaired skin sensitivity, burning sensation of the skin and mucous membranes; numbness of the limbs; weight loss; joint pain; Raynaud's syndrome is a severe disruption of blood circulation in the extremities, especially in the hands and feet. Photo: Raynaud's syndrome	severe weakness; increased body temperature; muscle pain; there may be pain in the joints; stiffness of movements in the limbs; compaction of skeletal muscles, their increase in volume due to edema; swelling, blueness of the eyelids; Raynaud's syndrome.
Temperature	Prolonged fever, body temperature above 38-39 0 C.	Prolonged low-grade fever (up to 38 0 C).	Moderate prolonged fever (up to 39 0 C).
Patient's appearance (at the onset of the disease and in some of its forms appearance the patient may not be affected by all these diseases)	Damage to the skin, mostly the face, “butterfly” (redness, scales, scars). The rash can be all over the body and on the mucous membranes. Dry skin, loss of hair and nails. Nails are deformed, striated nail plates. There may also be hemorrhagic rashes (bruises and petechiae) throughout the body.	The face may acquire a “mask-like” expression without facial expressions, tense, the skin is shiny, deep folds appear around the mouth, the skin is motionless, tightly fused to deep-lying tissues. Often there is a disruption of the glands (dry mucous membranes, as in Sjögren's syndrome). Hair and nails fall out. On the skin of the limbs and neck there are dark spots against the background of “bronze skin”.	A specific symptom is swelling of the eyelids, their color can be red or purple; on the face and décolleté there is a variety of rashes with redness of the skin, scales, hemorrhages, and scars. As the disease progresses, the face acquires a “mask-like appearance”, without facial expressions, tense, may be skewed, and drooping of the upper eyelid (ptosis) is often detected.
Main symptoms during the period of disease activity	skin lesions; photosensitivity - skin sensitivity when exposed to sunlight (like burns); joint pain, stiffness of movement, impaired flexion and extension of fingers; changes in bones; nephritis (swelling, protein in urine, increased blood pressure, urinary retention and other symptoms); arrhythmias, angina pectoris, heart attack and other cardiac and vascular symptoms; shortness of breath, bloody sputum (pulmonary edema); impaired intestinal motility and other symptoms; damage to the central nervous system.	changes on the skin; Raynaud's syndrome; pain and stiffness in joints; difficulty extending and bending fingers; dystrophic changes in bones, visible on x-rays (especially the phalanges of the fingers, jaw); muscle weakness (muscle atrophy); severe violations work of the intestinal tract (motility and absorption); heart rhythm disturbances (growth of scar tissue in the heart muscle); shortness of breath (overgrowth of connective tissue in the lungs and pleura) and other symptoms; damage to the peripheral nervous system.	changes on the skin; severe muscle pain, weakness (sometimes the patient is unable to lift a small cup); Raynaud's syndrome; impaired movement, over time the patient becomes completely immobilized; in case of defeat respiratory muscles– shortness of breath, up to complete muscle paralysis and respiratory arrest; if the masticatory and pharyngeal muscles are affected, there is a violation of the act of swallowing; if the heart is damaged - rhythm disturbance, up to cardiac arrest; if the smooth muscles of the intestine are damaged - its paresis; violation of the act of defecation, urination and many other manifestations.
Forecast	Chronic course, over time, more and more organs are affected. Without treatment, complications develop that threaten the patient's life. With adequate and regular treatment, it is possible to achieve long-term, stable remission.
Laboratory indicators	increased gammaglobulins; acceleration of ESR; positive C-reactive protein; decreased level of immune cells of the complementary system (C3, C4); low blood counts; the level of LE cells is significantly increased; positive ANA test; anti-DNA and detection of other autoimmune antibodies.		increase in gammaglobulins, as well as myoglobin, fibrinogen, ALT, AST, creatinine - due to the breakdown muscle tissue; positive test on LE cells; rarely anti-DNA.
Principles of treatment	Long-term hormonal therapy (Prednisolone) + cytostatics + symptomatic therapy and other drugs (see section of the article "Treatment of systemic lupus").

Systemic lupus erythematosus in children, what are the symptoms and treatment?

Considering the nature of the immune system, hormonal background, growth rate, systemic lupus erythematosus in children occurs with its own characteristics.

Features of the course of systemic lupus erythematosus in childhood:

• more severe course of the disease , high activity of the autoimmune process;
• chronic course the disease occurs in children only in a third of cases;
• more common acute or subacute course diseases with rapid damage to internal organs;
• also isolated only in children acute or lightning-fast course SLE is an almost simultaneous lesion of all organs, including the central nervous system, which can lead to the death of a small patient in the first six months from the onset of the disease;
• frequent development complications and high mortality;
• the most common complication is bleeding disorder in the form of internal bleeding, hemorrhagic rashes (bruises, hemorrhages on the skin), as a result - the development of a shock state of DIC syndrome - disseminated intravascular coagulation;
• Systemic lupus erythematosus in children often occurs in the form of vasculitis – inflammation of blood vessels, which determines the severity of the process;
• children with SLE are usually malnourished , have a pronounced deficiency of body weight, up to cachexia (extreme degree dystrophy).

1. Onset of the disease acute, with an increase in body temperature to high numbers (over 38-39 0 C), with pain in the joints and severe weakness, sudden loss of body weight.
2. Skin changes in the form of a “butterfly” are relatively rare in children. But, given the development of a lack of blood platelets, hemorrhagic rashes throughout the body (bruises for no reason, petechiae or pinpoint hemorrhages) are more common. Also, one of the characteristic signs of systemic diseases is hair loss, eyelashes, eyebrows, up to complete baldness. The skin becomes marbled and very sensitive to sunlight. There may be various rashes on the skin, characteristic of allergic dermatitis. In some cases, Raynaud's syndrome develops - a violation of blood circulation in the hands. In the oral cavity there may be ulcers that do not heal for a long time - stomatitis.
3. Joint pain– typical syndrome of active systemic lupus erythematosus, pain is periodic. Arthritis is accompanied by the accumulation of fluid in the joint cavity. Over time, joint pain is combined with muscle pain and stiffness of movement, starting with the small joints of the fingers.
4. For children formation of exudative pleurisy is characteristic(fluid in the pleural cavity), pericarditis (fluid in the pericardium, the lining of the heart), ascites and other exudative reactions (dropsy).
5. Heart damage in children it usually manifests itself as myocarditis (inflammation of the heart muscle).
6. Kidney damage or nephritis develops much more often in childhood than in adulthood. Such nephritis relatively quickly leads to the development of acute renal failure (requiring intensive care and hemodialysis).
7. Lung damage It is rare in children.
8. In the early period of the disease in adolescents, in most cases there is damage to the gastrointestinal tract(hepatitis, peritonitis and so on).
9. Damage to the central nervous system in children it is characterized by capriciousness, irritability, and in severe cases, seizures may develop.

That is, in children, systemic lupus erythematosus is also characterized by a variety of symptoms. And many of these symptoms are masked under the guise of other pathologies; the diagnosis of systemic lupus erythematosus is not immediately assumed. Unfortunately, timely treatment is the key to success in transitioning the active process into a period of stable remission.

Diagnostic principles systemic lupus erythematosus are the same as for adults, based mainly on immunological studies (detection of autoimmune antibodies).
In a general blood test, in all cases and from the very beginning of the disease, a decrease in the number of all formed blood elements (erythrocytes, leukocytes, platelets) is determined, and blood clotting is impaired.

Treatment of systemic lupus erythematosus in children, as in adults, involves long-term use of glucocorticoids, namely Prednisolone, cytostatics and anti-inflammatory drugs. Systemic lupus erythematosus is a diagnosis that requires urgent hospitalization of the child in a hospital (rheumatology department, if severe complications develop - in the intensive care unit or intensive care unit).
In a hospital setting they carry out full examination patient and select the necessary therapy. Depending on the presence of complications, symptomatic and intensive therapy. Given the presence of bleeding disorders in such patients, Heparin injections are often prescribed.
If treatment is started on time and regularly, you can achieve stable remission, while children grow and develop according to their age, including normal puberty. In girls, a normal menstrual cycle is established and pregnancy is possible in the future. In this case forecast favorable for life.

Systemic lupus erythematosus and pregnancy, what are the risks and treatment features?

Risks of pregnancy for a woman with systemic lupus erythematosus:

1. Systemic lupus erythematosus In most cases does not affect the ability to get pregnant , as well as long-term use of Prednisolone.
2. It is strictly forbidden to become pregnant while taking cytostatics (Methotrexate, Cyclophosphamide and others). , since these drugs will affect germ cells and embryonic cells; pregnancy is possible only no earlier than six months after discontinuation of these drugs.
3. Half cases of pregnancy with SLE ends in birth healthy, full-term baby . In 25% cases such babies are born premature , A in a quarter of cases observed miscarriage .
4. Possible complications pregnancy with systemic lupus erythematosus, in most cases associated with damage to the blood vessels of the placenta:

• fetal death;
• . Thus, in a third of cases, a worsening of the disease develops. The risk of such deterioration is greatest in the first weeks of the first or third trimester of pregnancy. And in other cases, there is a temporary retreat of the disease, but in most cases one should expect a severe exacerbation of systemic lupus erythematosus 1-3 months after birth. Nobody knows why will go the way autoimmune process.
  6. Pregnancy can be a trigger in the development of systemic lupus erythematosus. Pregnancy can also provoke the transition of discoid (cutaneous) lupus erythematosus to SLE.
  7. A mother with systemic lupus erythematosus can pass the genes on to her baby , predisposing him to develop a systemic autoimmune disease during his life.
  8. The child may develop neonatal lupus erythematosus associated with the circulation of maternal autoimmune antibodies in the baby’s blood; this condition is temporary and reversible.
  • It is necessary to plan a pregnancy under the supervision of qualified doctors , namely a rheumatologist and gynecologist.
  • It is advisable to plan a pregnancy during a period of stable remission chronic course SCV.
  • At acute course systemic lupus erythematosus with the development of complications, pregnancy can have a detrimental effect not only on the health, but also lead to the death of the woman.
  • And if, nevertheless, pregnancy occurs during an exacerbation period, then the question of its possible preservation is decided by doctors, together with the patient. After all, exacerbation of SLE requires long-term use of medications, some of which are absolutely contraindicated during pregnancy.
  • It is recommended to become pregnant no earlier than 6 months after discontinuation of cytotoxic drugs (Methotrexate and others).
  • For lupus damage to the kidneys and heart There is no talk of pregnancy; this can lead to the death of a woman from kidney and/or heart failure, because these organs are under enormous stress when carrying a baby.
  Management of pregnancy with systemic lupus erythematosus:

  1. Necessary throughout pregnancy be observed by a rheumatologist and obstetrician-gynecologist , the approach to each patient is individual.
  2. It is necessary to adhere to the following regime: don’t overwork, don’t be nervous, eat normally.
  3. Be attentive to any changes in your health.
  4. Delivery outside the maternity hospital is unacceptable , since there is a risk of developing severe complications during and after childbirth.
  7. Even at the very beginning of pregnancy, the rheumatologist prescribes or adjusts therapy. Prednisolone is the main drug for the treatment of SLE and is not contraindicated during pregnancy. The dose of the drug is selected individually.
  8. Also recommended for pregnant women with SLE taking vitamins, potassium preparations, aspirin (up to the 35th week of pregnancy) and other symptomatic and anti-inflammatory drugs.
  9. Mandatory treatment of late toxicosis and other pathological conditions of pregnancy in a maternity hospital.
  10. After childbirth the rheumatologist increases the dose of hormones; in some cases, it is recommended to stop breastfeeding, as well as prescribe cytostatics and other drugs for the treatment of SLE - pulse therapy, since the postpartum period is dangerous for the development of severe exacerbations of the disease.

  Previously, all women with systemic lupus erythematosus were not recommended to become pregnant, and if they conceived, everyone was recommended to have an induced termination of pregnancy (medical abortion). Now doctors have changed their opinion on this matter; a woman cannot be deprived of motherhood, especially since there is a considerable chance of giving birth to a normal, healthy baby. But everything must be done to minimize the risk for mother and baby.

  Is lupus erythematosus contagious?

  Of course, any person who sees strange rashes on their face thinks: “Could it be contagious?” Moreover, people with these rashes walk for so long, feel unwell and constantly take some kind of medication. Moreover, doctors previously assumed that systemic lupus erythematosus was transmitted sexually, by contact, or even by airborne droplets. But having studied the mechanism of the disease in more detail, scientists have completely dispelled these myths, because this is an autoimmune process.

  The exact cause of the development of systemic lupus erythematosus has not yet been established; there are only theories and assumptions. It all boils down to one thing: the main cause is the presence of certain genes. But still, not all carriers of these genes suffer from systemic autoimmune diseases.

  The trigger for the development of systemic lupus erythematosus can be:

  • various viral infections;
  • bacterial infections (especially beta-hemolytic streptococcus);
  • stress factors;
  • hormonal changes (pregnancy, adolescence);
  • environmental factors (for example, ultraviolet irradiation).
  But infections are not causative agents of the disease, so systemic lupus erythematosus is absolutely not contagious to others.

  Only tuberculous lupus can be contagious (facial skin tuberculosis), since a large number of tuberculosis bacilli are detected on the skin, and the contact route of transmission of the pathogen is isolated.

  Lupus erythematosus, what diet is recommended and are there any methods of treatment with folk remedies?

  As with any disease, nutrition plays an important role in lupus erythematosus. Moreover, with this disease there is almost always a deficiency, or against the background of hormonal therapy - excess body weight, lack of vitamins, microelements and biological active substances.

  The main characteristic of a diet for SLE is a balanced and proper diet.

  1. foods containing unsaturated fatty acids (Omega-3):

  • sea ​​fish;
  • many nuts and seeds;
  • vegetable oil in small quantities;
  2. fruits and vegetables contain more vitamins and microelements, many of which contain natural antioxidants; essential calcium and folic acid are found in large quantities in green vegetables and herbs;
  3. juices, fruit drinks;
  4. lean poultry meat: chicken, turkey fillet;
  5. low-fat dairy , especially fermented milk products (low-fat cheese, cottage cheese, yogurt);
  6. cereals and vegetable fiber (grain bread, buckwheat, oatmeal, wheat germ and many others).

  1. Foods with saturated fatty acids have a bad effect on blood vessels, which can aggravate the course of SLE:

  • animal fats;
  • fried food;
  • fatty meats (red meat);
  • high fat dairy products and so on.
  2. Alfalfa seeds and sprouts (legume crop).
  
  Photo: alfalfa grass.
  3. Garlic – powerfully stimulates the immune system.
  4. Salty, spicy, smoked dishes that retain fluid in the body.

  If diseases of the gastrointestinal tract occur against the background of SLE or taking medications, the patient is recommended to undergo frequent fractional meals according to the therapeutic diet - table No. 1. All anti-inflammatory drugs are best taken with or immediately after meals.

  Treatment of systemic lupus erythematosus at home is possible only after selecting an individual treatment regimen in a hospital setting and correcting conditions that threaten the patient’s life. Heavy drugs used in the treatment of SLE cannot be prescribed on their own; self-medication will not lead to anything good. Hormones, cytostatics, non-steroidal anti-inflammatory drugs and other drugs have their own characteristics and a bunch of adverse reactions, and the dose of these drugs is very individual. The therapy selected by doctors is taken at home, strictly adhering to the recommendations. Omissions and irregularity in taking medications are unacceptable.

  Concerning traditional medicine recipes, then systemic lupus erythematosus does not tolerate experiments. None of these remedies will prevent the autoimmune process; you may simply waste valuable time. Folk remedies can be effective if they are used in combination with traditional methods of treatment, but only after consultation with a rheumatologist.

  Some traditional medicines for the treatment of systemic lupus erythematosus:

  
  
  Precautionary measures! All folk remedies containing poisonous herbs or substances should be kept out of the reach of children. You have to be careful with such drugs; any poison is a medicine as long as it is used in small doses.

  Photos of what the symptoms of lupus erythematosus look like?

  
  Photo: Butterfly-shaped changes on the facial skin in SLE.
  
  Photo: skin lesions on the palms with systemic lupus erythematosus. Except skin changes, this patient shows thickening of the joints of the phalanges of the fingers - signs of arthritis.
  
  Dystrophic changes in nails with systemic lupus erythematosus: fragility, discoloration, longitudinal striations of the nail plate.
  
  Lupus lesions of the oral mucosa . The clinical picture is very similar to infectious stomatitis that do not heal for a long time.
  
  And this is what they might look like first symptoms of discoid or cutaneous lupus erythematosus.
  
  And this is what it might look like neonatal lupus erythematosus, These changes, fortunately, are reversible and in the future the baby will be absolutely healthy.
  
  Skin changes in systemic lupus erythematosus, characteristic of childhood. The rash is hemorrhagic in nature, resembles measles rashes, and leaves pigment spots that do not go away for a long time.
  

Lupus erythematosus is one of the diffuse connective tissue diseases. Under common name several clinical forms are combined. From this article you can learn about the symptoms of lupus erythematosus, the causes of its development, as well as the basic principles of treatment.

Mostly women are affected. It usually manifests between the ages of 20 and 40. It is more common in countries with a humid maritime climate and cold winds, while in the tropics the incidence is low. Blondes are more susceptible to the disease than brunettes and dark-skinned people. Common symptoms include sensitivity to ultraviolet radiation, vascular rashes on the skin (erythema) and mucous membranes (enanthema). A characteristic symptom is an erythematous butterfly-shaped rash on the face.

Classification

There is currently no unified classification, and all existing ones are very conditional. There is a common division into two types: skin - relatively benign, without damage to internal organs; systemic - severe, in which the pathological process extends not only to the skin and joints, but also to the heart, nervous system, kidneys, lungs, etc. Among the skin forms, chronic discoid (limited) and chronic disseminated (with many foci) are distinguished. Cutaneous lupus erythematosus can be superficial (centrifugal erythema of Biette) or deep. In addition, there is drug-induced lupus syndrome.

Systemic lupus erythematosus can be acute, subacute and chronic, according to the phase of activity - active and inactive, the degree of activity - high, moderate, minimal. Cutaneous forms can transform into systemic ones. Some experts tend to believe that this is one disease that occurs in two stages:

• presystemic - discoid and other skin forms;
• generalization - systemic lupus erythematosus.

Why does it happen?

The reasons still remain unknown. The disease is an autoimmune disease and develops as a result of the formation of a large number of immune complexes that are deposited in healthy tissues and damage it.

Provoking factors include certain infections, medications, chemicals, coupled with hereditary predisposition. There is drug-induced lupus syndrome, which develops as a consequence of taking certain medications and is reversible.

Discoid lupus erythematosus

Symptoms of this form of the disease appear gradually. First, a characteristic (butterfly-shaped) erythema appears on the face. The rashes are localized on the nose, cheeks, forehead, on the red border of the lips, in the scalp, on the ears, less often on the back surfaces of the legs and arms, and the upper body. The red border of the lips can be affected in isolation; rash elements rarely appear on the oral mucosa. Skin manifestations are often accompanied by joint pain. Discoid lupus, the symptoms of which appear in the following sequence: erythematous rash, hyperkeratosis, atrophic phenomena, goes through three stages of development.

The first is called erythematous. During this period, a pair of clearly defined pink spots with spider veins in the center, slight swelling is possible. Gradually, the elements increase in size, merge and form foci that are shaped like a butterfly: its “back” is on the nose, its “wings” are located on the cheeks. There may be tingling and burning sensations.

The second stage is hyperkeratotic. Characterized by infiltration of the affected areas, at the site of the lesions appear dense plaques, covered with small whitish scales. If you remove the scales, you will find an area underneath that resembles a lemon peel. Subsequently, keratinization of the elements occurs, around which a red rim is formed.

The third stage is atrophic. As a result of cicatricial atrophy, the plaque takes on the appearance of a saucer with a white area in the center. The process continues to progress, the lesions increase in size, and new elements appear. In each lesion, three zones can be found: in the center there is an area of ​​cicatricial atrophy, then there is hyperkeratosis, and at the edges there is redness. In addition, pigmentation and telangiectasia (small dilated vessels, or spider veins) are observed.

Less commonly, the ears, oral mucosa, and scalp are affected. At the same time, comedones appear on the nose and ears, and the mouths of the follicles expand. After the lesions resolve, areas of baldness remain on the head, which is associated with scar atrophy. Cracks, swelling, thickening are observed on the red border of the lips, and keratinization of the epithelium and erosion are observed on the mucous membrane. When the mucous membrane is damaged, pain and burning appear, which intensify when talking or eating.

With lupus erythematosus of the red border of the lips, several clinical forms are distinguished, including:

• Typical. It is characterized by oval-shaped foci of infiltration or the spread of the process to the entire red border. The affected areas become purple in color, the infiltrate is pronounced, and the vessels are dilated. The surface is covered with whitish scales. If they are separated, pain and bleeding occurs. In the center of the lesion there is an area of ​​atrophy, along the edges there are areas of epithelium in the form of white stripes.
• No significant atrophy. Hyperemia and keratotic scales appear on the red border. Unlike the typical form, the scales peel off quite easily, hyperkeratosis is mild, telangiectasia and infiltration, if observed, are insignificant.
• Erosive. In this case, there is quite severe inflammation, the affected areas are bright red, swelling, cracks, erosions, and bloody crusts are observed. Along the edges of the elements there are scales and areas of atrophy. These symptoms of lupus are accompanied by burning, itching and pain, which intensifies when eating. After resolution, scars remain.
• Deep. This form is rare. The affected area has the appearance of a nodular formation rising above the surface with hyperkeratosis and erythema on top.

Lupus erythematosus on the lips is often accompanied by secondary glandular cheilitis.

Much less often, the pathological process develops on the mucous membrane. It is localized, as a rule, on the mucous membranes of the cheeks, lips, and sometimes on the palate and tongue. There are several forms, including:

• Typical. It manifests itself as foci of hyperemia, hyperkeratosis, and infiltration. In the center there is an area of ​​atrophy, along the edges there are areas of white stripes reminiscent of a picket fence.
• Exudative-hyperemic is characterized by severe inflammation, while hyperkeratosis and atrophy are not too pronounced.
• In case of injuries, the exudative-hyperemic form can turn into an erosive-ulcerative form with painful elements around which diverging white stripes are localized. After healing, scars and cords most often remain. This variety has a tendency to become malignant.

Treatment of discoid lupus erythematosus

The main principle of treatment is hormonal agents and immunosuppressants. Certain medications are prescribed depending on the symptoms of lupus erythematosus. Treatment usually lasts several months. If the rash elements are small, corticosteroid ointment should be applied to them. For severe rashes, corticosteroids and immunosuppressants must be taken orally. Since sun rays aggravate the disease, you should avoid exposure to the sun, and if necessary, use a cream that protects against ultraviolet radiation. It is important to start treatment on time. This is the only way to avoid scars or reduce their severity.

Systemic lupus erythematosus: symptoms, treatment

This serious disease characterized by unpredictability of flow. Just recently, two decades ago, it was considered fatal. Women get sick much more often than men (10 times). The inflammatory process can begin in any tissues and organs where there is connective tissue. It occurs in both mild form and severe form, leading to disability or death. The severity depends on the variety and quantity of antibodies formed in the body, as well as on the organs involved in the pathological process.

Symptoms of SLE

Systemic lupus is a disease with varied symptoms. It occurs in acute, subacute or chronic forms. It may begin suddenly with a rise in temperature, the appearance of general weakness, weight loss, pain in the joints and muscles. Most have skin manifestations. As with discoid lupus, a characteristic erythema in the form of a clearly defined butterfly forms on the face. The rash may spread to the neck, top part chest, scalp, limbs. Nodules and spots may appear on the fingertips, and mild erythema and atrophy may appear on the soles and palms. Dystrophic phenomena occur in the form of bedsores, hair loss, and deformation of nails. Erosions, blisters, and petechiae may appear. In severe cases, the blisters open and areas with erosive and ulcerative surfaces form. The rash may appear on the lower legs and around the knee joints.

Systemic lupus erythematosus occurs with lesions of many internal organs and systems. In addition to skin syndrome, muscle and joint pain, diseases of the kidneys, heart, spleen, liver, as well as pleurisy, pneumonia, anemia, thrombocytopenia, and leukopenia may develop. In 10% of patients, the spleen is enlarged. In young people and children, enlarged lymph nodes are possible. There are cases of damage to internal organs without skin symptoms. Severe forms may result in death. Main causes of death - chronic renal failure, sepsis.

If systemic lupus erythematosus occurs in a mild form, the symptoms are the following: rash, arthritis, fever, headache, minor damage to the lungs and heart. If the course of the disease is chronic, then exacerbations are replaced by periods of remission, which can last for years. In severe cases, serious damage to the heart, lungs, kidneys, as well as vasculitis, significant changes in the composition of the blood, and severe disruption of the central nervous system are observed.

The changes that occur in SLE are very diverse, the process of generalization is pronounced. These changes are especially noticeable in subcutaneous fat, intermuscular and periarticular tissues, vascular walls, kidneys, heart, and immune system organs.

All changes can be divided into five groups:

• dystrophic and necrotic in connective tissue;
• inflammation of varying intensity in all organs;
• sclerotic;
• in the immune system (clusters of lymphocytes in the spleen, bone marrow, lymph nodes);
• nuclear pathologies in the cells of all tissues and organs.

Manifestations of SLE

During the course of the disease, a polysyndromic picture develops with manifestations typical for each syndrome.

Skin signs

Skin symptoms of lupus vary and are usually of primary importance in diagnosis. They are absent in approximately 15% of patients. In a quarter of patients, changes in the skin are the first sign of the disease. In about 60% they develop at various stages of the disease.

Lupus erythematosus is a disease whose symptoms can be specific and nonspecific. In total there are about 30 species skin manifestations- from erythema to bullous rashes.

The skin form is distinguished by three main clinical signs: erythema, follicular keratosis, and atrophy. Discoid lesions are observed in a quarter of all patients with SLE, and they are characteristic of the chronic form.

Lupus erythematosus is a disease whose symptoms have their own characteristics. The typical shape of erythema is a butterfly shape. Localization of rashes is exposed parts of the body: face, scalp, neck, upper chest and back, limbs.

Centrifugal erythema of Biette (superficial form of CV) has only one of the triad of signs - hyperemia, and the layer of scales, atrophy and scarring are absent. The lesions are usually localized on the face and most often have a butterfly shape. The rashes in this case resemble psoriatic plaques or have the appearance of a ring-shaped rash without scarring.

At rare form- deep Kaposi-Irgang lupus erythematosus - both typical foci and mobile dense nodes are observed, sharply limited and covered with normal skin.

The cutaneous form occurs continuously over a long period of time, worsening in the spring and summer due to sensitivity to ultraviolet radiation. Changes in the skin are usually not accompanied by any sensations. Only lesions located on the oral mucosa are painful during eating.

Erythema in systemic lupus erythematosus can be limited or confluent, varying in size and shape. As a rule, they are swollen and have a sharp border with healthy skin. Among skin manifestations of SLE should be called lupus cheilitis (hyperemia with grayish scales, with erosions, crusts and atrophy on the red border of the lips), erythema on the pads of the fingers, soles, palms, as well as erosion in the oral cavity. Characteristic symptoms lupus - trophic disorders: constant dry skin, diffuse alopecia, fragility, thinning and deformation of nails. Systemic vasculitis is manifested by ulcers on the legs, atrophic scarring of the nail bed, gangrene of the fingertips. 30% of patients develop Raynaud's syndrome, characterized by such symptoms as cold hands and feet, goosebumps. Lesions of the mucous membranes of the nasopharynx, oral cavity, and vagina are observed in 30% of patients.

The disease lupus erythematosus has skin symptoms and is more rare. These include bullous, hemorrhagic, urticarial, nodular, papulonecrotic and other types of rashes.

Joint syndrome

Joint lesions are observed in almost all patients with SLE (more than 90% of cases). It is these symptoms of lupus that force a person to see a doctor. One joint or several may hurt; the pain is usually migrating, lasting several minutes or several days. Inflammatory phenomena develop in the wrist, knee and other joints. Morning stiffness is pronounced, the process is most often symmetrical. Not only the joints are affected, but also the ligamentous apparatus. For chronic form of SLE with predominant damage to joints and periarticular tissues, limited mobility may be irreversible. In rare cases, bone erosions and joint deformities may occur.

Myalgia is found in approximately 40% of patients. Focal myositis, which is characterized by muscle weakness, rarely develops.

There are known cases of aseptic bone necrosis in SLE, and in 25% of cases this is a lesion of the femoral head. Aseptic necrosis may be due to both the disease itself and high doses of corticosteroids.

Pulmonary manifestations

In 50-70% of patients with SLE, pleurisy (effusion or dry) is diagnosed, which is considered an important diagnostic sign for lupus. With a small amount of effusion, the disease proceeds unnoticed, but massive effusions also occur, in some cases requiring a puncture. Pulmonary pathologies in SLE are usually associated with classical vasculitis and are its manifestation. Often, during an exacerbation and involvement of other organs in the pathological process, lupus pneumonitis develops, characterized by shortness of breath, dry cough, chest pain, and sometimes hemoptysis.

With antiphospholipid syndrome, pulmonary embolism (PE) may develop. In rare cases - pulmonary hypertension, pulmonary hemorrhages, fibrosis of the diaphragm, which is fraught with pulmonary dystrophy (reduction in total lung volume).

Cardiovascular manifestations

Most often, pericarditis develops with lupus erythematosus - up to 50%. As a rule, it is dry, although cases with significant effusion are not excluded. With a long course of SLE and recurrent pericarditis, even dry, large adhesions are formed. In addition, myocarditis and endocarditis are often diagnosed. Myocarditis is manifested by arrhythmias or dysfunction of the heart muscle. Endocarditis is complicated by infectious diseases and throboembolism.

Of the vessels in SLE, medium and small arteries are usually affected. Such disorders as erythematous rashes, digital capillaritis, livedo reticularis (marbled skin), necrosis of the fingertips are possible. Among venous lesions, thrombophlebitis associated with vasculitis is not uncommon. The coronary arteries are often involved in the pathological process: coronaritis and coronary atherosclerosis develop.

One of the causes of death in long-term SLE is myocardial infarction. There is a relationship between coronary artery disease and hypertension, so if high blood pressure is detected, immediate treatment is required.

Manifestations from the gastrointestinal tract

Lesions of the digestive system in SLE are observed in almost half of patients. In this case, systemic lupus has the following symptoms: lack of appetite, nausea, heartburn, vomiting, abdominal pain. During the examination, impaired motility of the esophagus, its dilatation, ulceration of the gastric mucosa, esophagus, duodenum, ischemia of the gastric and intestinal walls with perforation, arteritis, degeneration of collagen fibers.

Acute pancreatitis is diagnosed quite rarely, but it significantly worsens the prognosis. Liver pathologies include both slight enlargement and severe hepatitis.

Renal syndrome

Lupus nephritis develops in 40% of patients with SLE, which is caused by the deposition of immune complexes in the glomeruli. There are six stages of this pathology:

• minimal change disease;
• benign mesangial glomerulonephritis;
• focal proliferative glomerulonephritis;
• diffuse proliferative glomerulonephritis (after 10 years, 50% of patients develop chronic renal failure);
• slowly progressive membranous nephropathy;
• glomerulosclerosis is the final stage of lupus nephritis with irreversible changes in the renal parenchyma.

If systemic lupus erythematosus has renal symptoms, then most likely we need to talk about a poor prognosis.

Nervous system lesions

In 10% of patients with SLE, cerebral vasculitis develops with such manifestations as fever, epileptic seizures, psychosis, coma, stupor, meningism.

Systemic lupus has symptoms associated with mental disorders. Most patients experience a decrease in memory, attention, and mental performance.

Possible damage to the facial nerves, development of peripheral neuropathy and transverse myelitis. Migraine-like headaches associated with damage to the central nervous system are not uncommon.

Hematological syndrome

In SLE, hemolytic anemia, autoimmune thrombocytopenia, and lymphopenia may develop.

Antiphospholipid syndrome

This symptom complex was first described in SLE. Manifested by thrombocytopenia, ischemic necrosis, Libman-Sachs endocarditis, strokes, pulmonary embolism, livedovasculitis, thrombosis (arterial or venous), gangrene.

Drug-induced lupus syndrome

About 50 drugs can cause it, including: Hydralazine, Isoniazid, Procainamide.

Manifested by myalgia, fever, arthralgia, arthritis, anemia, serositis. The kidneys are rarely affected. The severity of symptoms is directly dependent on the dosage. Men and women get sick equally often. The only treatment is drug withdrawal. Sometimes aspirin and other non-steroidal anti-inflammatory drugs are prescribed. Corticosteroids may be indicated in extreme cases.

SLE treatment

It is difficult to talk about the prognosis, since the disease is unpredictable. If treatment began on time and the inflammation was quickly suppressed, then the long-term prognosis may be favorable.

Medicines are selected taking into account the symptoms of systemic lupus. Treatment depends on the severity of the disease.

When light form drugs that reduce skin and joint manifestations are indicated, for example, Hydroxychloroquine, Quinacrine and others. To relieve joint pain, non-steroidal anti-inflammatory drugs may be prescribed, although not all doctors approve of taking NSAIDs for lupus erythematosus. In case of increased blood clotting, aspirin is prescribed in small doses.

In severe cases, it is necessary to start taking medications with prednisolone (Metipred) as soon as possible. The dosage and duration of treatment depend on which organs are affected. To suppress the autoimmune reaction, immunosuppressants are prescribed, for example, Cyclophosphomide. For vasculitis and severe damage to the kidneys and nervous system, complex treatment is indicated, including the use of corticosteroids and immunosuppressants.

After the inflammatory process is suppressed, the rheumatologist determines the dose of prednisolone for long-term use. If the test results have improved, the symptoms have decreased, the doctor gradually reduces the dose of the medicine, but the patient may experience an exacerbation. Nowadays, it is possible to reduce the dosage of the drug for most patients with systemic lupus erythematosus.

If the disease develops as a result of taking medications, then recovery occurs after discontinuation of the drug, sometimes after several months. No special treatment is required.

Features of the disease in women, men and children

As mentioned earlier, women are more susceptible to the disease. There is no consensus on who has more severe symptoms of lupus erythematosus - women or men. There is an assumption that in men the disease is more severe, the number of remissions is less, and the generalization of the process is faster. Some researchers have concluded that thrombocytopenia, renal syndrome and central nervous system lesions in SLE are more common in men, and joint symptoms lupus erythematosus - in women. Others did not share this opinion, and some did not find any gender differences in the development of certain syndromes.

Symptoms of lupus erythematosus in children are characterized by polymorphism at the onset of the disease, and only 20% have monoorgan forms. The disease develops in waves, with alternating periods of exacerbations and remissions. Lupus erythematosus in children is characterized by an acute onset, rapid progression, early generalization and a worse prognosis than in adults. Symptoms at the onset of the disease are fever, malaise, weakness, poor appetite, weight loss, rapid hair loss. In the systemic form, manifestations are as varied as in adults.

Lupus erythematosus is a chronic disease, characterized mainly by exacerbation in the summer. It was first described by P. Raycr in 1927 under the name “Flux scbacc”. A Cazenava (1951) called this disease “lupus erythematosus.” However, according to many dermatologists, this name does not reflect the essence of the disease and it is advisable to call it erythematosis.

Lupus erythematosus is uncommon. It accounts for approximately 0.25-1% of skin diseases. Women get sick more often than men. The ratio of men to women with discoid lupus erythematosus is 1:15-1:3. This indicator in systemic lupus erythematosus is 1:4-1:9. There is an opinion that due to the delicate skin of women, it occurs more often in them. The frequent occurrence of lupus erythematosus in women is also associated with the activity of the glands internal secretion, since relapses and its severe course are often observed before menstruation or after childbirth. Lupus erythematosus most often affects adults, and it usually occurs in people exposed to environmental factors (sunlight, wind, sudden changes in temperature).

The disease can occur on all continents, but is more common in countries with high humidity (Scandinavia, England, northern Germany, Greece, Japan, etc.). Lupus erythematosus, despite increased insolation, is rare in tropical countries (Brazil, Egypt, Syria). White-skinned people get sick several times more often than black people.

Causes and pathogenesis of lupus erythematosus. The origin of lupus erythematosus is unknown, but it was previously believed that the occurrence of this disease is associated with tuberculosis (historical theory).

The detection of circulating antibodies against Epstein-Barr and herpes, oncovirus in leukocytes and liver confirm the viral origin of the disease.

Electron microscopy studies again confirmed the viral concept. Microtubular particles were found in the epithelial cells of the kidneys of patients with systemic lupus erythematosus. These particles are very similar to the ribonucleoproteins of paramyxoviruses. Also, such particles were found not only on the affected, but also on the healthy skin of patients. Despite in-depth research, the literature still does not contain sufficiently accurate information about the pure form viruses that cause disease. When studying particles using cytochemical and autoradiographic methods, the existence of phospholipids and glycoproteins, rather than nucleoproteins, was discovered in their composition.

It has now been proven that lupus erythematosus is an autoimmune disease. The immune system is of great importance in the occurrence of the disease. Antibodies (auto-antibodies) against the nucleus and its constituent parts (DNA) were found in the blood of patients with lupus erythematosus. These antibodies are directed not only against nucleoproteins, but also against nucleohistone and DNA (native and denatured). Using an immunofluorescence reaction, an antinuclear factor is always detected in leukocytes, tissues and skin. If systemic lupus erythematosus is suspected, this reaction can be used. In 70-80% of patients, the presence of IgG and IgM was detected at the border of the epidermis and dermis. In case of systemic lupus erythematosus, the presence of the above immunoglobulins was detected on unchanged skin. The presence of antinuclear antibodies as part of immune complexes circulating in the body and located in tissues has led to the idea that lupus erythematosus is a disease of immune complexes.

Changes occurring in the activity of the autonomic and central nervous systems, as well as neuroendocrine organs, are of great importance from a pathogenetic point of view. IN initial period Diseases in many patients intensify the process of excitation of the nervous system, and subsequently it turns into inhibition. Sometimes systemic lupus erythematosus begins with changes in the nervous system (psychosis, epilepsy, chorea, lupus meningitis, etc.).

Patients were found to have weakened activity of the hypothalamic-pituitary-adrenal system, progression of the disease during pregnancy, after abortion and childbirth, increased estrogen levels, decreased testosterone, hyperfunction or dysfunction of the thyroid gland, which indicates a greater significance endocrine system in the occurrence of the disease.

There is an opinion that lupus erythematosus is hereditary. Familial cases of the disease account for 1.1-1.3%. A case is described of the birth of 4 children with this disease in a sick woman suffering from the discoid form of lupus erythematosus. Some healthy relatives of patients with lupus erythematosus showed signs characteristic of this disease - hypergammaglobulinemia, an increase in the content of total and free hydroxyproline in the blood serum, and the presence of antinuclear factor.

As immunogenetic studies show, antigens A11, B8, B18, B53, DR2, DR3 are more common, and these indicators largely depend on age, gender, clinical signs, course of morbidity and the population being studied. Some scientists, having studied the HLA system in lupus erythematosus, expressed the opinion that from a pathogenetic point of view, the ring-shaped and systemic forms of this disease are a single process. A gene predisposed to cause lupus erythematosus (HLA BD/DR) was identified, which is located between the loci on short shoulder 6th chromosome.

Lupus erythematosus also develops under the influence of infectious agents (streptococci and staphylococci), various drugs (hydrolysin, antibiotics, sulfonamides, vaccine, serum), environmental factors (ultraviolet irradiation, infrared rays, radiation, etc.), pathologies of internal organs (hepatitis, gastritis, metabolic disorders of amino acids and vitamins).

Lupus erythematosus is dealt with by dermatologists and therapists, but the attitude of specialists to this problem is different. If most dermatologists consider acute and chronic lupus erythematosus to be one disease that occurs in various forms, then therapists consider them as independent diseases that do not depend on each other.

According to some scientists, annular lupus is a form of lupus erythematosus, and the pathological process is limited to its location in the skin. Systemic lupus is also a form of lupus erythematosus.

However, the pathological process that begins in the skin gradually spreads to the internal organs and the musculoskeletal system.

Classification of lupus erythematosus. There is no generally accepted classification of lupus erythematosus. Most practical dermatologists distinguish between chronic (chronic erythematosis, forming a scar), acute or systemic (acute erythematosis), and subacute forms of lupus erythematosus.

In the systemic form of the disease, internal organs are also damaged along with the skin. The clinical picture of the chronic form manifests itself in the form of discoid (or ring-shaped), disseminated lupus erythematosus, centrifugal erythema of Biette and deep form of Kaposi-Irgang lupus erythematosus.

Symptoms of lupus erythematosus. At the onset of the disease, almost no subjective signs are observed. Most often, lupus erythematosus manifests itself in the form of a chronic ring-shaped rash that can appear on various areas of the skin. The rash usually appears on the face in the form of pink-reddish spots that grow along the edges and tend to merge with each other. At first, the surface of the spots does not peel off, but subsequently chip-like scales appear that are firmly attached to the skin. The spots increase and turn into large spots, inflammation intensifies somewhat and skin infiltration develops. Over time, the infiltrate in the center of the lesion resolves, atrophy appears in its place, and a ridge covered with small scales is observed around the lesion. During this period, the peeling gradually, when scratched with a fingernail, is torn off and protrusions are visible under the peeling. When scratching or removing scales, the patient feels a slight pain, so he throws his head back. This is called the “Beignet-Meshchersky” symptom. When the scales are rejected, protrusions are observed underneath them (the “female heel” symptom), and deep spots form on the skin after the scales fall out. funnel shapes. Thus, as the disease progresses, 3 zones of the lesion are striking: the central zone is the zone of cicatricial atrophy, the middle zone is hyperkeratotic, and the peripheral zone is erythema. At the same time, telangiectasia, de- and hyperpigmentation occur in the foci of the disease. IN initial stage diseases on the surface of the skin, the lesion looks like a butterfly. In 80% of patients, the pathological process begins with damage to the skin of the nose. Erythema can also occur on other parts of the body - on the scalp, ears, neck, abdomen, and limbs. If the rash is located on the scalp, then hair loss (alopecia) is observed, and on the oral mucosa - leukoplakia, erosion and wounds. Swelling and cracks appear on the lips. The more developed the infiltration in the pathological focus, the more scar atrophy develops at the site. You can even observe ugly deep scars. Scar atrophy most often develops most quickly on the scalp. Hair falls out on atrophied skin and sometimes lupus erythematosus can recur in this area. It is possible to develop skin cancer on old scars caused by lupus erythematosus.

Depending on the clinical signs, several clinical forms of lupus erythematosus are distinguished. If brown spots appear around the pathological focus, this is a pigmented form of lupus erythematosus. In the hyperkeratotic form, small scales crumble like lime and hyperkeratosis is observed. As a result of the growth of the papillary dermis and the development of hyperkeratosis, the pathological process resembles a warty tumor. If there are bluish edematous plaques, often located in the earlobe, this is a tumor form. In the seborrheic form, the pathological process is located on the seborrheic skin and hair follicles and its surface is covered with yellow-brown fatty scales. In the mutilating form, tissue resorption is observed due to highly developed atrophy on the nose and earlobe. Sometimes in the foci of lupus erythematosus you can see the formation of vesicles and blisters - this is a pemphigoid firm.

Incorrect and irrational treatment of lupus erythematosus can lead to the development of lupus carcinoma.

With lupus erythematosus, the lower lip is affected in 9% of patients, the upper lip in 4.8% and the oral mucosa in 2.2%.

With ring-shaped lupus erythematosus, the eyes are very rarely affected. The scientific literature describes lupus ectopion, choroiditis, keratitis, blepharoconjunctivitis, and iritis.

The disseminated form of the disease accounts for 10% of all lupus erythematosus. In the disseminated form, the rash, distributed in multiples, is located like clusters on the face, scalp and upper chest and resembles discoid lupus erythematosus. However, the border of the rash is clear and non-inflamed. In addition to erythema, infiltration, hyperkeratosis and atrophy are observed in the lesions. On the legs and hands, and joints of the arms, erythema spots with a bluish tint can be seen. Consequently, the rash in the disseminated form gradually becomes similar to the rash in the systemic form of lupus erythematosus. However, with this form, the general condition of the patient changes somewhat, the temperature is subfebrile, the erythrocyte sedimentation reaction increases, leukopenia, anemia, pain in the joints and muscles are observed. Many patients have foci of chronic infection (chronic tonsillitis, sinusitis, dental caries, etc.)

Some scientists consider the disseminated form of the disease to be intermediate between the annular and systemic forms of lupus erythematosus. The boundary between these forms of the disease is not clearly defined and there is no clear boundary between disseminated and systemic forms. Therefore, the disseminated form can become systemic. In this case, it is very important to detect LE cells, since the process of nucleosis occurs in the body of such patients, that is, immunological changes characteristic of systemic lupus erythematosus. The disease lasts for many years. Recurs in the autumn and spring months.

Centrifugal erythema, being a superficial form of lupus erythematosus, was described by Biette (1928). This form occurs in 5% of patients. The disease begins with the appearance on the facial skin of a slight swelling, limited and centrifugal erythema of pink-red or blue-red color. The erythema resembles a butterfly and can be observed on both cheeks or only on the nose (“butterfly without wings”). The rashes do not show signs of hyperkeratosis and cicatricial atrophy, or due to poor development they cannot be seen. In its clinical course, centrifugal erythema differs from the annular form. When treating centrifugal erythema, good results are achieved using conventional methods. Sometimes during absence sunny days this form disappears without any treatment. However, in autumn and winter, under the influence of cold, wind, and in summer and spring, under the influence of the sun, it very quickly recurs and beyond a short time spreads over the entire skin of the face.

Dilatation of blood vessels is also observed. Apparently, this is why some authors have identified rosacea-like and telangiectatic forms of lupus erythematosus. Clinical forms are a variant of the course of centrifugal erythema. With centrifugal erythema, the rashes on the face become similar to the erythematous elements with lupus erythematosus. Erythemas in acute lupus erythematosus are very prominent, but their boundaries are blurred and indistinct. This clinical picture is observed when this form of lupus erythematosus is severe and recurs.

In subacute and chronic forms of systemic lupus erythematosus, symmetrically located erythema is almost no different from centrifugal erythema. Therefore, the question arises whether centrifugal erythema is a sign of systemic lupus erythematosus, which occurs chronically. However, the systemic course of the disease is determined not by skin rashes, but by damage to internal organs, blood and other systems.

According to some authors, clinical and hematological changes in patients with the disseminated form were very similar to changes in patients with systemic lupus erythematosus. However, these changes in centrifugal erythema are less pronounced. When the disease passes into a systemic form, staying under insolation for a long time, frequent sore throat, pregnancy and other factors are important. The gradual transition of the disease from one form to another (the disappearance of centrifugal erythema and the onset of the systemic form) is impossible to notice. As can be seen from the above data, centrifugal erythema is considered potentially dangerous disease, it cannot be compared with ring-shaped lupus erythematosus, and such patients should be left under long-term dispensary observation for a more in-depth clinical and laboratory study.

In the deep form of Kaposi-Irgang lupus erythematosus, deep-lying nodes appear in the subcutaneous tissue, their deep center atrophies, they are most often found on the head, shoulders and arms. Sometimes ulcers appear after the nodes. In this form of the disease, in addition to nodes, pathological foci characteristic of lupus erythematosus are also observed. Of the subjective signs, the most disturbing is itching. Histopathology. In the chronic form of lupus erythematosus, follicular hyperkeratosis and atrophy of the cells of the basal layer are observed in the epidermis, and proliferation of plasma cells, lymphocytes, histiocytes, and edema in the dermis.

Systemic lupus erythematosus occurs suddenly or as a result of progression of chronic erythematosis and is severe. Under the influence of various stressful conditions, infections, ultraviolet rays, chronic or disseminated lupus erythematosus can develop into a systemic form.

Depending on the clinical course, acute, subacute, chronic form diseases. The acute form of the disease most often occurs among women 20-40 years old. The temperature rises (39-40°C), pain is noted in the joints, swelling, redness, and changes in the configuration of the finger joints are observed. There are various rashes on the skin that can occur throughout the body and on the mucous membranes. Initially, the surface of the erythematous rash is covered with scales; they gradually spread to other parts of the body or, merging with each other, occupy a significant area. Blisters and crusts appear on the reddened skin, and patients are bothered by itching or burning. Sometimes the rash resembles exudative erythema multiforme or toxic-allergic dermatitis. The lips of patients are swollen, covered with bloody purulent crusts. IN in some cases On the body of patients, rashes may be absent or limited. Approximately 5-10% of patients with acute systemic lupus erythematosus do not develop a skin rash. As the disease worsens, the state of health worsens, the temperature rises, joint pain, insomnia, anorexia, and nausea are noted. In severe cases of lupus erythematosus, the patient lies in bed, he cannot get up, loses weight, becomes powerless and exhausted. During this period at laboratory research LE cells are detected in the blood, which is very important when making a diagnosis. The subacute form of systemic lupus erythematosus is less common and can develop independently or after ring-shaped chronic lupus erythematosus. The appearance of foci of the disease in closed areas of the body, changes in the general condition, the appearance of pain in the joints, and an increase in temperature are observed. The skin rash resembles a mug. Along with limited swelling, hyperemia and peeling of the skin are observed. Erythematous-papular rashes persist on the skin for a long time, and subsequently the liver and other internal organs may be involved in the process. Depending on the organ and system in which the pathological process manifests itself, cutaneous-articular, renal, pulmonary, neurological, cardiovascular, gastrointestinal, hepatic and hematological forms of lupus erythematosus are distinguished.

In the knee-articular form of lupus erythematosus, in addition to skin rashes Joint damage is also noted, occurring in the form of arthralgia and arthritis. Sometimes, before the development of skin symptoms of the disease, signs of joint damage are observed. Small ones are affected first, then large joints. Vascular deformation is observed in 10% of patients. In 25-50% of patients, muscles are damaged. Muscle damage in lupus erythematosus is difficult to distinguish between myalgia and myositis in dermatomyositis.

With systemic lupus erythematosus, kidney damage (lupus nephritis) is observed. Clinical signs of lupus nephritis depend on the degree of activity of the pathological process. In the initial period of the disease, the kidneys are usually not involved in the pathological process. Subsequently, without medical procedures or activation, protein, red blood cells, white blood cells and casts appear in the urine. Lupus nephritis most often manifests itself in the form of focal glomerulonephritis, nephrosis, nephrosonephritis, focal interstitial nephritis and the clinical picture does not differ from renal pathology caused by other factors. In severe cases of the disease, symptoms such as hypertension, general edema, uremia and renal failure, etc. appear.

With systemic lupus erythematosus, the pathological process often involves the cardiovascular system. Endocarditis, pericarditis, myocarditis are observed, and in severe cases - signs of pancarditis. Some patients develop Limbal-Sachs disease (or Limbal-Sachs endocarditis). At the same time, along with endocarditis, the following are noted: Clinical signs, such as myocarditis, polyserositis, hepatitis, splenomegaly and neuritis. Due to changes in the walls of blood vessels, Raynaud's syndrome appears.

Changes in the central nervous system (polyneuritis, myeloradiculoneuritis, encephalitis, myelitis, encephaloradiculitis, severe leptomeningitis, acute cerebral edema), lungs ( interstitial pneumonia, pleurisy), gastrointestinal tract(abdominal syndrome), liver (lupus hepatitis), leukopenia, thrombocytopenia, hemolytic anemia, lymphopenia, increase in ROE. Sometimes the spleen and lymph nodes become enlarged, hair falls out, the skin becomes dry, and nails become brittle.

Lupus erythematosus has been described, occurring with rashes similar to erythema multiforme. The combination of these diseases was first noted in 1963 by Rovel (Rovel syndrome). If some dermatologists consider Rovel's syndrome to be one of the forms of lupus erythematosus, others attribute it to two diseases that develop simultaneously.

Identification of signs of the disease (erythema, follicular hyperkeratosis, cicatricial atrophy), changes in the blood (leukopenia, lymphopenia, anemia, thrombocytopenia, gammaglobulipemia, increased ROE), antibodies opposite LE cells and the nucleus are of great importance in determining the diagnosis.

Histopathology. With systemic lupus erythematosus in the collagen fibers of the skin and internal organs fibrinous degeneration is observed, and in the dermis there is an infiltrate consisting of leukocytes.

Differential diagnosis. In the initial period of annular or disseminated lupus erythematosus, it should be distinguished from psoriasis, rosacea, tuberculous lupus, sarcoidosis, erythematous form of pemphigus and other diseases.

Treatment of lupus erythematosus. Treatment is determined depending on the form of the disease. For annular lupus erythematosus, antifever drugs are prescribed (rezoquin, hingamine, plaquenil, delagil) 0.25 g 2 times a day for 5-10 days. Why take a break of 3-5 days. These drugs accelerate the work of the adrenal glands and affect the metabolism in the connective tissue, resulting in photodesensitization. Taking Presocial, containing 0.04 g of rezohip, 0.00075 g of prednisolop and 0.22 aspirin, 6 times a day, will give a good effect. Carrying out vitamin therapy (group B, ascorbic, nicotinic acid etc.) increases the effectiveness of treatment.

For systemic lupus erythematosus it is prescribed systemic glucocorticoids together with anti-fever medications, which gives a good effect. Dose steroid drugs is prescribed depending on the clinical course of the disease and the patient’s condition (on average, 60-70 mg of prednisolone is recommended). At the same time, it is advisable to treat with vitamins (B1, B9, B6, B12, B15, PP, C), since they increase the effect of steroid hormones and antifever drugs. Good effect observed with the use of aromatic retinoids (acitretin at a dose of 1 mg/kg).

Corticosteroid creams and ointments are used externally.