Therapeutic diet for systemic lupus erythematosus. Neutralization of side effects of drugs. Systemic lupus erythematosus and other systemic connective tissue diseases, how to differentiate

Systemic lupus erythematosus (SLE)– a chronic autoimmune disease caused by dysfunction immune mechanisms with the formation of damaging antibodies to own cells and fabrics. 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 skin sensitivity to sun rays(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)
  • Small punctate hemorrhages, ulcerative lesions oral mucosa

Respiratory system damage

Damage to the cardiovascular system

• Pericarditis - inflammation 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.
• Damage to the 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
  • WITH - 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 decline erythrocytes, leukocytes, 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 CT scan 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 complex treatment SCV.

• 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 antibodies causing disease SCV.
• 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, more long periods remissions, 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 agent – 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 for 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 may not have symptoms of SLE, but when 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 can be established by histological examination of the skin and microscopic and bacteriological examination of scrapings - 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 replacement occurs normal tissue connective tissue (non-functional), 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 – sharp violation 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 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 the 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 intestinal tract(motility and absorption); violation heart rate(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; disturbance of movements, 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 quantity shaped elements blood; 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 for LE cells; rarely anti-DNA.
Principles of treatment	Long-term hormonal therapy (Prednisolone) + cytostatics + symptomatic therapy and other drugs (see article section "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 diseases , 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 almost simultaneous damage to all organs, including the central nervous system, which can lead to death little patient in the first six months from the onset of the disease;
• frequent development of 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 state of shock DIC syndrome – disseminated intravascular coagulation;
• Systemic lupus erythematosus in children often occurs in the form of vasculitis – inflammation 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 of 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 characteristic features systemic diseases include 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 It 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 early period illness in adolescents in most cases is observed damage to the gastrointestinal tract(hepatitis, peritonitis and so on).
9. Damage to the central nervous system in children is characterized by capriciousness, irritability, 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 in adults, based mainly on immunological research(detection of autoimmune antibodies).
IN general analysis blood in all cases and from the very beginning of the disease, a decrease in the number of all formed elements of blood (erythrocytes, leukocytes, platelets) is determined, 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 the hospital (rheumatology department, if it develops severe complications– 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 of 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 I, or in III trimester 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 of SLE.
  • In acute cases 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 supplements, aspirin (up to the 35th week of pregnancy) and other symptomatic and anti-inflammatory drugs.
  9. Mandatory treatment of late toxicosis and others pathological conditions 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 it is postpartum period dangerous for the development of severe exacerbations of the disease.

  Previously, all women with systemic lupus erythematosus were not recommended to become pregnant, and in case of conception, everyone was recommended to have an artificial 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 contact path pathogen transmission.

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

  As with any disease, with lupus erythematosus important place takes food . 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 quantity 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 possible only after selection individual scheme therapy in a hospital setting and correction of 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 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 means traditional medicine 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. In addition to 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.
  

Systemic lupus erythematosus cannot be cured by any specific magic foods, but still, good healthy eating for lupus, is an important part of the overall treatment plan for this disease.

Without a doubt, people with lupus should strive to balanced diet- The diet for lupus should consist of large quantity fruits, vegetables and whole grains. The diet for lupus erythematosus should also include meat, poultry and fatty fish in moderation.

If you have systemic lupus erythematosus, eating a varied, healthy diet will help:

• Reduce inflammation and other symptoms
• Maintain strong bones and muscles
• Deal with side effects of medications
• Maintain a healthy weight
• Reduce risk cardiovascular diseases

In this article, you will learn what to do to get these benefits from the lupus diet.

Reducing inflammation and other symptoms of lupus

Systemic lupus erythematosus is inflammatory disease. So it's possible, although not proven, that foods that fight inflammation may help reduce lupus symptoms. On the other hand, foods that cause inflammation can make it worse.

Foods with possible anti-inflammatory properties include fruits and vegetables, which are rich in substances called antioxidants. In addition, foods containing omega-3 fatty acid such as fish, nuts, flax-seed, rapeseed oil, olive oil also help fight inflammation.

Saturated fats, on the other hand, can raise cholesterol levels and may contribute to inflammation. Therefore, the lupus diet should limit the intake of saturated fat. Sources of saturated fat include fried food, commercial baked goods, creamy soups and sauces, red meat, animal fats, processed meats, and high-fat dairy products. This includes whole milk, cream, aged cheeses, butter, and ice cream.

What food to avoid if you have lupus erythematosus is alfalfa sprouts . Alfalfa tablets have been linked to lupus outbreaks, with symptoms that include muscle pain, fatigue, abnormal blood test results and kidney problems. This occurs due to a reaction to an amino acid found in alfalfa sprouts and seeds. This amino acid may activate the immune system and increase inflammation in people with lupus. Garlic may also stimulate the immune system.

A Lupus Diet Should Help Maintain Strong Bones and Muscles

Good nutrition has important to strengthen bones and muscles. For people with lupus, bone health is of particular concern because medications used to treat lupus can increase the risk of osteoporosis, a condition in which bones become less dense and break easily.

Eating foods high in calcium and vitamin D is important for bone health. When purchasing dairy products, choose those that are either low-fat or nonfat. Good food choices for lupus include:

• 1% or 1/2% skim milk
• low fat yogurt
• low-fat cheese

If you have a milk intolerance, or just don't like milk, here are some options for you:

• lactose-free milk
• soy milk
• almond milk
• juices that are fortified with calcium and vitamin D
• Dark green vegetables are another source of calcium.

If you don't get enough calcium in your diet, your doctor will likely recommend calcium supplements.

Side effects of medications

• A diet rich in calcium and vitamin D may help counteract the harmful effects of corticosteroids.
• Diet may also be helpful in combating the side effects of other medications. For example, a low-sodium diet helps reduce fluid retention and lower blood pressure, which can increase with corticosteroid use.
• A diet high in folate that includes greens leafy vegetables, fruits and grain breads, is especially important if you are taking methotrexate (Rheumatrex). To relieve nausea caused by medications, you need to eat small, frequent meals and foods that are easy to digest. Try dry cereal, bread and crackers. Also avoid fatty, spicy and sour foods.

If corticosteroids or nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen cause upset or irritation, taking them with food may help. Be sure to tell your doctor if you experience some stomach upset after taking the medications.

Lupus Foods Should Help You Maintain a Healthy Weight

Lupus may be associated with unhealthy weight loss or weight gain. Therefore, it is important to eat in a way that helps you achieve and maintain a healthy weight.
Weight loss and poor appetite common among people newly diagnosed with lupus, this may be a result of the disease itself, as well as medications that cause stomach upset or mouth ulcers. Weight gain can be a result of inactivity. It may also be caused by the corticosteroids used to fight the disease.

If weight loss or weight gain is a serious problem, it is important to consult with a doctor who can accurately assess your diet and suggest a lupus nutrition program that can control your weight. A lupus diet will likely include low-fat foods and exercise.

Reducing your risk of heart disease with a lupus diet

People with lupus have a higher risk of heart disease, making a heart-healthy diet an important part of your lupus treatment plan.

If your doctor thinks you have risk factors for heart disease, including high blood pressure or high cholesterol, a low-fat diet and exercise may help your lupus. Your doctor may prescribe a low-sodium diet to reduce high blood pressure.

Research shows that omega-3 fatty acids from fish or fish oil can improve some risk factors for cardiovascular disease. Foods rich in omega-3 fatty acids:

• salmon
• sardines
• mackerel
• herring
• mullet
• tuna
• halibut
• lake trout
• Rainbow trout
• flax-seed
• walnuts
• pecans
• rapeseed oil, oil walnut, and linseed oil

These foods should be part of your heart-healthy diet.

Denial of responsibility : The information presented in this article about nutrition for Lupus is for informational purposes only and is not a substitute for consultation with a healthcare professional.

Healthy nutrition is an important component of treatment for patients suffering from lupus. A balanced diet is extremely important to maintain the functioning of the body. There is no strictly planned diet for patients suffering from lupus, however, certain general rules will be useful for them. A person with lupus should consult a doctor before starting a specific diet. The doctor will give more detailed information about the features proper nutrition, and can also recommend a highly qualified nutritionist.

Weight loss, poor appetite: People with lupus often lose weight. Loss of appetite and weight can be caused by both the disease and lupus medications, which can cause stomach upset and mouth ulcers.

If you have a problem with weight loss, you should consult a doctor who will conduct an examination, evaluate other symptoms and advise necessary changes in the diet.

Weight gain: Common in patients taking corticosteroids. Drugs in this group increase appetite, which leads to weight gain.

To solve the problem of weight gain, you should consult a doctor who will advise you on a diet and other ways to reduce body weight. These can include both physical and psychological exercises. Particularly effective can be long-term cooperation between the patient and a nutritionist, who will develop an individual diet for the patient.

Side effects of drugs: some drugs cause gastrointestinal disorders– heartburn, indigestion, nausea and vomiting, mouth ulcers.

If the patient experiences such disorders, he should immediately consult a doctor. Sometimes changing the dose and method of taking the drug is enough to save the patient from unpleasant side effects. The doctor may also prescribe a different drug. Many medications are designed to be taken with food, which reduces side effects. For example, if you have mouth ulcers, your doctor may prescribe the same drug in liquid form. The anesthetic will ease the pain and make painful breathing easier.

Osteoporosis: This is a disease in which the patient's bones become more brittle and their density decreases. This disease is more common in older women and can develop in people who take corticosteroids for a long time.

The doctor may prescribe a diet fortified with calcium (1,000-1,500 mg/day) and vitamin D (100-500 mg/day), and also recommend certain exercises.

Steroid-induced diabetes: In diabetes, the human body does not produce enough insulin to maintain the required level of glucose (sugar) in the blood. Long-term use corticosteroids can cause diabetes, which is treated like regular diabetes.

Kidney disease: With lupus, kidney damage is often observed, so the doctor will order several tests to determine the condition of the kidneys. If the doctor detects kidney damage, his task is to prevent the progression of this process. The doctor may advise the patient to follow a diet low in salt, potassium, and protein.

Diseases of the cardiovascular system: Among these diseases that often accompany lupus are atherosclerosis and high blood pressure. In atherosclerosis, fatty deposits accumulate in the arteries, blocking the flow of blood. High blood pressure increases risk heart attack and stroke. High blood pressure in lupus is caused by kidney disease, which helps the body control blood pressure levels.

If a doctor determines that a patient is at risk for developing atherosclerosis, he or she may advise the patient to eat a low-fat diet as well as exercise. This will help lower cholesterol levels in the blood and control body weight. If a patient has high blood pressure, they may be given a low-sodium diet, medications, or both to help restore normal blood pressure levels.

Lupus is a chronic autoimmune disease that predominantly affects women. It can appear either on the skin ( discoid lupus), or in the form of a general lesion of connective tissue with widespread distribution ( systemic lupus erythematosus, SLE).

There are no foods that cause lupus or that can cure it. However, good nutrition is an important part of the overall treatment plan for the disease.

People with lupus should eat a balanced diet that includes plenty of fruits, vegetables and whole grains. It should also contain moderate amount meat, poultry and fatty fish.

The amino acids phenylalanine and tyrosine aggravate the disease. Most likely, they cause certain metabolic disorders. Animal and human studies have confirmed the effectiveness of eliminating these amino acids from the diet.

In addition, studies in an animal model of SLE have shown that a high-fat diet may contribute to the onset and progression of the disease, weakening the immune response; Based on this, we can conclude that A low fat diet is good for the body.

If you have lupus, then eating a varied, healthy diet will help you:

• reduce inflammation and other symptoms
• keep bones and muscles strong
• neutralize the side effects of medications
• maintain a healthy weight
• reduce the risk of cardiovascular diseases

This article describes what you need to know about lupus, diet and nutrition in order to achieve positive results.

Reduce inflammation and other symptoms

Lupus is an inflammatory disease. Therefore, it is quite possible, although not proven, that Foods that reduce inflammation may help reduce lupus symptoms. On the other side, products, causing development inflammatory processes may have a negative impact.

For products with anti-inflammatory properties, include fruits and vegetables enriched antioxidants. In addition, products containing omega-3 fatty acids foods such as fish, nuts, flaxseed meal, canola and olive oil help reduce inflammation.

As for saturated fats, they can raise cholesterol levels and cause inflammation. Therefore, it is necessary to limit their content in the diet. Sources of saturated fat include fried foods, baked goods, creamy soups and sauces, red meat, processed meats and high-fat dairy products. These include whole milk, milk and cream mixtures, cheese, butter and ice cream.

Avoid alfalfa. Alfalfa tablets may aggravate lupus or lupus-like syndrome, resulting in symptoms such as muscle pain, fatigue, bad results blood tests and kidney problems. These problems are a reaction to the amino acids found in alfalfa and seeds. These amino acids can boost the immune system and increase inflammation in people with lupus. Garlic can also boost the immune system.

Maintaining strong bones and muscles

Good nutrition is very important for maintaining strong bones and muscles. For people with lupus, bone health is a particular concern. Why? Because Medicines taken to treat lupus may increase the risk of osteoporosis, is a disease in which bones become more fragile and, as a result, break easily.

For bone health It is very important to eat foods containing plenty of calcium and vitamin D. When buying dairy products, choose low-fat ones or those that contain almost no fat. Good choices would be:

• 1% or 0.5% skim milk
• low fat and sodium yogurt
• low fat cheese

If you can't drink milk, good alternatives include:

• lactose-free milk
• soy milk
• almond milk
• juices fortified with calcium and vitamin D
• dark green vegetables are another source of calcium

If you are not getting enough calcium, then your doctor may recommend calcium supplements.

Neutralization of side effects of drugs

A diet enriched with calcium and vitamin D will help protect bones from damaging effects. corticosteroids.

Following a diet will also help combat the side effects of medications. For example, a low-sodium diet can help combat fluid retention and lower blood pressure, which is increased by corticosteroid use.

A diet high in folic acid, based on green leafy vegetables, fruits, enriched breads and grain dishes, or folic acid supplements is important if you take methotrexate (Rheumatrex). In order to reduce nausea caused by some medications, you need to eat small, easy-to-digest meals often. Try dry cereals, breads and crackers. Also try not to eat fatty, spicy and sour foods.

Corticosteroid or non-steroidal anti-inflammatory drugs, such as ibuprofen or naproxen, may cause stomach upset or irritation. You may feel better if you take them with meals. However, tell your doctor if you are experiencing stomach upset while taking the medications.

Maintaining a Healthy Weight

Lupus is often associated with unhealthy weight loss or weight gain. It's important to eat to maintain a healthy weight.

The weight loss and poor appetite experienced by people with lupus may be a result of the disease itself. It can also be caused by medications that cause stomach upset or mouth ulcers.

Lack of movement can lead to weight gain. Also, corticosteroids taken to treat the disease may influence weight gain.

If you have problems losing or gaining weight, it is very important to talk to your doctor about it. Healthcare professionals will help you review your diet and suggest a program to help you control your weight.

This program will likely include a low-fat diet and exercise. Qualified nutritionists can help you tailor a diet to suit your needs and lifestyle.

Reducing the risk of cardiovascular disease

People with lupus have a higher risk of heart disease compared to the general population. Therefore, eating a heart-healthy diet is an important part of lupus treatment.

If your doctor thinks you have risk factors for heart disease, including high pressure And high cholesterol, in which case your best option would be a low-fat diet and exercise.

Research shows that omega-3 fatty acids found in fish and fish oil may reduce some risk factors, such as high triglycerides and high blood pressure.

Foods fortified with omega-3 fatty acids:

• salmon
• sardine
• mackerel
• bluefin tuna
• herring
• mullet
• tuna
• halibut
• lake trout
• Rainbow trout
• flaxseed meal
• walnuts
• pecan
• canola oil, walnut oil and flaxseed oil

These products should be included in overall plan nutrition aimed at strengthening the cardiovascular system.

What is SCV?

Systemic lupus erythematosus (SLE) is a type of immune system disorder and is therefore classified as an autoimmune disease. The point is that the immune system begins to perceive body tissues as foreign and attacks them. This leads to damage to various tissues and organs, and can cause inflammation of joints and muscles, damage to the kidneys, heart, lungs, blood vessels, brain and skin. It is known that women suffer from SLE much more often than men. Today, SLE is considered a disease whose symptoms can be controlled. With adequate treatment, most people with this disease will active life, remain operational. In almost all patients, periods of low disease activity (remission) alternate with moments of its exacerbation, “outbreaks”.

What causes lupus?

The cause of SLE is not well known. It is likely that this is not even one reason, but a combination of several: environmental factors, genetic and, possibly, hormonal. The provocateurs of the disease can be stress, infection, hormonal changes in the body. Scientists believe that family genetic predisposition plays an important role in the development of the disease, but the specific “lupus gene” has not yet been identified and this disease cannot be considered hereditary. It is also important to understand that lupus is not an infectious disease and you cannot become infected with it.

Types of lupus

Systemic lupus erythematosus. The common form of the disease is what most people mean when they say lupus. The word “systemic” means that the disease can affect many systems of the body. Symptoms of SLE can be mild or severe. Although SLE primarily affects people between the ages of 15 and 45, it can show up in both childhood and old age. A special variant is SLE in childhood, with disease onset before age 16, which accounts for 8 to 15% of all cases of SLE. However, SLE rarely occurs before 5 years of age and is more common after 10 years of age. SLE is much less common after the age of 50 - this age period accounts for 18% of all cases. In recent decades, reports have appeared in the literature about more frequent development SLE in old age.

Discoid lupus erythematosus. It primarily affects the skin. A red, raised rash may appear on the face, scalp, or other areas of the skin. The raised areas become thick and scaly. The rash can last for years, then go away and reappear. U small quantity People with discoid lupus erythematosus later develop SLE.

Drug-induced lupus erythematosus. This form of the disease is associated with certain medications. They cause symptoms similar to manifestations of SLE(arthritis, rash, fever and chest pain, but usually does not involve the kidneys). All symptoms disappear when you stop taking the medicine.

Neonatal lupus. Approximately 3% of newborns born to mothers with SLE may have neonatal lupus. It manifests itself as skin rashes, liver abnormalities, or cytopenia (low blood cell counts) and most often disappears without any treatment after 3-6 months. However, children with neonatal lupus may have severe heart damage. Currently, doctors can, in most cases, determine the risk of developing neonatal lupus, which allows them to quickly begin treatment for a child with heart damage. Neonatal lupus is very rare. Most children whose mothers have SLE are completely healthy.

SLE with antiphospholipid syndrome. It is characterized by the presence of antiphospholipid autoantibodies, which cause increased blood coagulation in blood vessels (including during pregnancy), cause thrombosis of placental vessels and, accordingly, lead to pregnancy loss.

Common symptoms of SLE:
. tenderness and swelling of the joints, muscle pain;
. unexplained fever;
. chronic fatigue syndrome;
. red rashes on the face or discoloration of the skin;
. chest pain when breathing deeply;
. increased hair loss;
. whitening or blueness of fingers or toes due to cold or stress (Raynaud's syndrome);
. increased sensitivity to the sun (appearance of rashes on the skin when exposed to it for less than 30 minutes);
. swelling around the eyes and swelling of the legs;
. enlarged lymph nodes.

Diagnosis of SLE

Diagnosing lupus can be difficult. It can take doctors a long time—months or even years—to collect symptoms and accurately diagnose this complex disease. Contact between doctor and patient is very important; it is imperative to tell the doctor complete, accurate medical history(for example, what health problems did you have and for how long, what triggered the onset of the disease). There is no single test that can help determine whether a person has SLE, but evidence from several laboratory tests in combination with clinical manifestations allow the doctor to make a diagnosis.

Lupus treatment

Treatment strategies for SLE vary from person to person and may change over time. Typically, treatment for lupus is a joint effort between the patient and the doctor, as well as various specialists. The patient can consult a therapist or rheumatologist. In addition, lupus patients may be seen by clinical immunologists (doctors who specialize in immune system disorders). It is very important for the patient to work closely with the doctor and take an active part in the treatment. The doctor plans therapy taking into account the patient’s gender, age, onset of the disease, condition at the time of examination, symptoms of the disease and living conditions.

Several types of medications are used to treat SLE. The selection of therapy for each patient is individual. Today, the main treatment for SLE is hormones - glucocorticoids (GCs). HA therapy can be obtained in tablet form, skin cream or injections. These are powerful drugs that have side effects. With high disease activity, GC doses range from medium to very high; this is necessary to suppress severe autoimmune inflammation, but over time, the doctor selects the lowest dose that allows you to maintain remission. The rate of dose reduction depends on the initial manifestations of the disease, the speed of response of the disease to the treatment and the patient’s tolerance. The ultimate goal is to achieve the minimum dose of GC to maintain SLE remission. Side effects usually disappear when the dose is reduced or the drugs are discontinued. But you cannot immediately stop taking GCs or quickly reduce their dose.

The speed of response to taking GC is associated with various reasons: these are individual sensitivity, and factors of SLE itself, as well as organ-specific factors (the severity of the involvement of vital organs in the process: kidneys, central and peripheral nervous systems). The longer patients take GCs, the more careful the rate of dose reduction should be. Sometimes, when SLE activity is very high, doctors use a very high dose of GC to more quickly suppress autoimmune inflammation.

It is important that the patient keep a diary of medication intake, which should indicate the initial dose of GC, the onset and rate of its reduction. This will help the doctor evaluate both the results of therapy and the course of the disease.

IMPORTANT! SLE patients using GCs, as well as women receiving heparin during pregnancy, should take calcium and vitamin D to reduce the risk of osteoporosis.

Another undesirable effect of synthetic GCs is a decrease (“shrinkage”) of the adrenal glands, which stops or reduces the production of natural steroids. This is also why you should not suddenly stop taking it. synthetic hormones. It takes time (up to several months) for the adrenal glands to begin producing sufficient amounts of natural hormone again.

IMPORTANT! Sudden cessation of GC use is life-threatening, and acute vascular crises may develop.

To treat SLE, drugs that reduce autoimmune inflammation (antimalarials, immunosuppressants, etc.) are also used. This makes it possible to prescribe a lower dose of GC, as well as to maintain suppression of autoimmune organ damage while reducing the dose of GC. Today, progress in the treatment of SLE is associated with the development of drugs that act on the cells that produce autoantibodies. These include genetic engineering biological drugs(GIBP). Their creation and implementation in clinical practice allows you to reduce the dose of GC to a minimum in order to reduce the entire range of adverse reactions. But you need to know that there must be indications for the use of GEBD and that initially they are used in combination with standard therapy for SLE.

Pregnancy and postpartum period in SLE

Just 25 years ago, pregnancy with SLE was prohibited. Today, most women with SLE can become pregnant, and their pregnancy, if properly planned, as well as following all the recommendations of a rheumatologist and obstetrician, ends safely. Before planning a pregnancy, SLE must be in remission or at least a low degree of disease activity. Pregnancy against the background of severe SLE activity can end unfavorably for both the mother and the fetus. It is important that obstetricians monitor the course of pregnancy together with rheumatologists. Hospitalization of such patients in maternity wards usually planned, since in most cases the birth is premature. Another problem of pregnancy with SLE is exacerbation of the disease. It has now been shown that exacerbation rarely occurs during pregnancy against the background of low SLE activity. But still, this can happen in the first or second trimester or in the first few months after childbirth. In most cases, if it is recognized in a timely manner, the exacerbation is easily stopped with small doses of GC. Such women require careful medical supervision postpartum period when, with increased physical activity, signs of exacerbation may again appear. Breast-feeding in SLE it is not prohibited and is desirable in the absence of signs of exacerbation of the disease, if the maintenance dose of GC does not exceed 12 mg.

In the next few years after childbirth, it is necessary to use effective methods of contraception.

IMPORTANT! Pregnant women with SLE should not stop taking GCs. Only a rheumatologist can decide the dose of these drugs. You cannot plan a pregnancy during an exacerbation of the disease and while taking cytotoxic drugs. In women with SLE and antiphospholipid syndrome, when planning pregnancy, warfarin, which has an anticoagulant effect, should be discontinued and replaced with heparin. After delivery, such patients need to continue treatment with blood thinning drugs.

Lupus and quality of life

Today we can say with confidence that patients with SLE live long. Despite the symptoms of the disease and possible side effects of treatment, they can also reach High Quality life. However, a common complaint from patients is increased fatigue, sometimes even in the absence of clinical and laboratory signs of SLE activity. Fatigue affects every aspect of life. Patients suddenly notice that it is difficult for them to carry out their usual, daily responsibilities at work and in the family, and that their social activity decreases. The exact causes of this fatigue remain unclear. In addition, patients themselves are often not very willing to accept advice about changing their lifestyle, and a competent psychologist is required to get out of this state. But there are some things you can do on your own.

To prevent symptoms of chronic fatigue, a person with SLE must:
. get enough sleep. Sleep should be at least 8 hours, sometimes more is required;
. to plan additional periods rest during the day, do not exhaust yourself;
. engage in physical exercise. Good vacation does not mean complete inaction. A well-thought-out exercise program is important for maintaining strength and overall health. physical training;
. plan your work and activity weekly. Planning will help you be more organized and correctly alternate between rest and work;
. do not try to plan and do more than your strength allows;
. eat right (the menu should be balanced);
. do not be nervous. Stressful situations take a lot of energy, you need to learn to find a way out of them.

It is also very important to try to prevent exacerbations of the disease and reduce the severity of symptoms.

Signs of exacerbation of the disease:
. increased fatigue;
. pain in muscles, joints;
. rash;
. fever;
. swelling of the legs;
. puffiness of the face;
. stomach discomfort;
. headache;
. dizziness.

How to prevent exacerbation:
. learn to recognize the initial signs of exacerbation;
. strive for maximum mutual understanding with the doctor;
. avoid exposure to the sun, use sunscreen, umbrellas, hats;
. maintain a balanced diet;
. try to avoid stress;
. plan adequate rest;
. If possible, do as much physical exercise as possible.

Exercise and SLE

Patients with SLE should do daily morning exercises. It is indicated during remission or if you feel better during an exacerbation. The best exercises are those that do not require much physical exertion. Physiotherapists can help you choose an individual set of exercises to train your respiratory and cardiovascular systems to overcome muscle weakness.

Short walks with a gradual increase in their time and distance will help improve your health and overcome chronic fatigue syndrome.

It must be remembered that it is very important for patients with SLE to alternate physical and mental stress with rest. Don't try to do many things at the same time. It is worth planning all important things in advance, trying to do all the most difficult things during the period of remission. But during a period of exacerbation, it is better to postpone for some time matters and activities that require significant stress.

Your friends are cottage cheese and cheese, dried apricots and prunes

A balanced diet is one of the important conditions successful treatment SCV. There is no special diet for this disease in the absence renal failure or severe autoimmune inflammation of the kidneys. The diet should contain all the main groups of substances: proteins, fats, carbohydrates, vitamins, minerals and clean water.

It is better if the main source of protein is dairy and fish products. There is no need to give up meat, but you should not eat it more than once a day. It is advisable to arrange once or twice a week fast days. A useful addition to the diet is two or three soft-boiled eggs or in the form of an omelet.

Let us emphasize that dairy products are an irreplaceable source of protein. The beneficial properties of kefir, yogurt, and acidophilus make them mandatory in the diet of patients with SLE. Cottage cheese and cheese are the main suppliers of calcium salts, and therefore they must also be included in the diet, including for the prevention of osteoporosis. This is especially important for patients who take GC. When using HA, the amount of protein should be increased by 10-15%; foods rich in potassium are recommended: dried apricots, prunes, potatoes.

The amount of fat in the diet of patients with SLE should be limited and it is better to give preference to vegetable fats. But a certain amount of animal fat from dairy products will not hurt, but we must keep in mind that sour cream and cream are healthier butter: They contain a lot of lecithin.

IMPORTANT! The amount of carbohydrates in food must be limited; their excess (especially while taking GC) leads to the accumulation excess weight and increased blood sugar levels.

Vitamins, minerals and water have no caloric value but are essential for proper operation body. During the period of exacerbation of the disease, when appetite worsens, taking multivitamins may be useful if you are not allergic to them.

In general, the diet of a patient with SLE is not fundamentally different from the diet healthy people, if the process does not involve the kidneys. But you still need to remember what products are needed daily. These include fish or seafood, lean meat, milk, wholemeal bread, buckwheat and oat groats, a variety of vegetables and fruits, as well as dried fruits, herbs, vegetable oil. At the same time, you should limit your consumption of sugar, honey, confectionery and flour products, chocolate, cocoa, coffee, fatty meats and smoked meats. If the kidneys are damaged, it is necessary to adhere to a salt-free diet.

Watch out, sun!

More than a third of SLE patients are too sensitive to sunlight. Even short exposure to the sun (less than 30 minutes) or treatments with ultraviolet radiation cause skin rashes in 60-80% of patients. We are often asked whether such patients can sunbathe, use a solarium, or be treated with ultraviolet rays. And we never tire of repeating that sun exposure for patients with SLE is very harmful, and can even be dangerous. Often the onset of the disease or the next exacerbation of the disease occurs precisely after prolonged exposure to the sun (for example, after a trip to the south). The degree of sensitivity to sunlight is individual for each patient.

Illness is stress

Maintaining health requires additional effort from the patient. Thus, all patients with SLE should periodically undergo gynecological and mammological examinations, as well as regular sanitation of the oral cavity, which will help avoid potentially dangerous infections. If the patient is taking GCs or antimalarial drugs, it is necessary to visit an ophthalmologist annually for timely detection of eye problems. It is especially important to develop a strategy for maintaining wellness, and this implies the need increased attention to body, mind and soul. It is also important to understand that chronic illness- stress for any person. And one of the most important goals is to overcome it.