Introduction
The body’s immune system plays a critical role in preventing various body organs from diseases. However, systemic lupus erythematosus (SLE) is an autoimmune disease that is depicted by organs and tissues being damaged by immune complexes and autoantibodies (Harrison, 2008). According to Ben-Menachem (2010), SLE is a chronic inflammatory disease characterized by protease manifestation. All the body organs are susceptible to SLE. Statistics show that SLE is more prevalent in women than men. In relation to race, there are also considerable racial disparities with African Americans and Asians showing high prevalence and incidence rates than the whites. For example, the prevalence of SLE in the US is high among Black American women compared to whites. The pathogenic mechanism for the disease follows a relapsing and remitting course. Most of the SLE cases start at the child-bearing age; the peak age of onset is between 15 and 40 years.
Signs and Symptoms
The symptoms vary from one patient to another. However, the main manifestation is that everyone with SLE suffers from joint pains and swelling. Ben-Menachem (2010) noted that the disease presentation is very variable and can range from indolent to fulminant; thus, the patients suffering from SLE may manifest fever, changes in body weight and fatigue. In relation to the musculoskeletal, patients depict avascular necrosis, myalgia, arthropathy, and arthralgia. In cases the skin organ is affected, the patient manifests malar rash, discoid lupus, and photosensitivity. SLE is also manifested as cytopenias such as anemia and leukopenia. Other manifestations include renal failure, myocarditis, and pulmonary fibrosis.
Pathogenic Mechanism
According to Harrison (2008), the causal factors for SLE include environmental, gender and gene factors. The interaction between susceptible genes, hazardous environments, and gender factors leads to immune responses which are abnormal. The pathogenic mechanism varies depending on the patients. Some of the abnormal responses include CpG DNA activating innate immunity, decreased clearance of the immune complexes of apoptotic cells and ineffective regulatory CD8+ T and CD4+ cells. Therefore, genes subjected to innate immunity reduced clearance of immune complexes, apoptotic cells, and acquired immunity in relation to lymphocyte function when combined with environmental factors such as the UV light, some medications, emotional and physical stress, smoking and gender factors lead to defective suppressive networks. The networks are marked by abnormal immune responses that result in autoantibodies immune complexes. The pathogenic autoantibodies cause inflammation of the affected organs. Chronic inflammation and chronic oxidation eventually cause damage to the organs resulting in conditions such as renal failure, stroke, pulmonary fibrosis, atherosclerosis and other conditions.
Diagnosis
The diagnosis entails a combination of clinical findings and laboratory results. The accurate standard of diagnosis is provided by American College of Rheumatology (ACR). Almost all people with SLE test positive for antinuclear antibody (ANA). However, this is not an absolute indicator of SLE. Hence the need for the combination of the different diagnosis such as the ANA tests, CBC differential, the serum creatinine, urinalysis, and chest x-ray. Also, imaging studies are carried out for the diagnosis purpose. Examples of the imaging studies include cardiac MRI, brain MRI/MRA, CT scan and chest radiography and joint radiology. The function of various organs can also be evaluated as a diagnostic measure. According to Ben-Menachem (2010), serological biomarkers play a critical role in the diagnosis of SLE. This is attributed to the fact the pathogenesis is due to deregulation of the body’s immunity. However, it is worth noting that there is no specific laboratory test for the SLE. Thus, the diagnosis should be in the context of the patient’s clinical history.
Implication of SLE
There are various effects of SLE. As noted, it affects more women than men. Therefore, studies carried out by Smyth et al. (2010) in conjunction with Euro-Lupus Project to investigate the implication of SLE on pregnant women found that the disease results in spontaneous abortion and stillbirths. For instance, the study established that 16% of pregnant women who participated in the study had spontaneous abortion while 6.1% had neonatal or stillbirths.
Treatment and Management
There is no cure for SLE; however, it can be managed through pharmacotherapy in which various drugs such as anti-malarials and NSAIDs are combined with immunosuppressive drugs to lessen the effects of the disease. The immune-suppression regiments depend on the affected organs. While using the drugs, it is advisable to understand the possible toxicities of the drugs. SLE is also managed through monitoring. This entails routine laboratory tests for the patients to determine the level of creatinine protein, liver functions tests, blood count, and erythrocyte sedimentation rates. The monitoring enables the health professionals to take precautionary measures to suppress inflammation and damage to the organs. The other management entails the anesthetic consideration in cases of surgery. However, the provision of the anesthesia on the SLE is not backed by evidence. Thus, there is the need for preoperative consultation to obtain information about the flares of the disease and the extent of organ damage (Ben-Menachem, 2010). In the case of patients with flares of the disease, it is advisable to delay surgeries that are not urgent to allow recovery from disease flares.
Conclusion
SLE has a complex pattern of signs and symptoms manifestation. The heterogeneity of SLE and susceptibility of all body organs to the disease makes the diagnosis and management to be very complex. Thus, the need to approach SLE based on patient’s context.
References
Ben-Menachem, E. (2010). Systemic lupus erythematosus: a review for anesthesiologists. Anesthesia & Analgesia, 111(3), 665-676.
Harrison, T. R. (2008). Harrison’s principles of internal medicine. New York: McGraw- Hill.
Smyth, A., Oliveira, G., Lahr, B., Bailey, K., Norby, S., & Garovic, D. (2010). A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis. Clinical Journal of the American Society of Nephrology, 5(11), 2060-2068.