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Therapeutics in Dermatology
A reference textbook in dermatology
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Systemic lupus erythematosus

1 April 2014, by MATHIAN A. , ARNAUD L. & AMOURA Z.

Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease whose exact causes are still unknown. The disease mostly affects young subjects but may also occur in children and elderly persons. Eight to nine times out of ten, systemic lupus erythematosus affects women in child-bearing years. Clinical symptoms vary significantly. The disease most often affects the skin (lupic rash appearing on areas of the skin exposed to the sun), the joints (arthritis), the kidneys (glomerulonephritis), the serous membranes (pleuritis and pericarditis), the central nervous system (very variable manifestations), and the blood cells (decreased platelet count [thrombocytopenia] or red blood cell count [anemia] or white blood cell count [leukopenia]). Systemic lupus erythematosus progresses with flares and periods of remission. On the whole, benign ambulatory forms of the disease mainly involving the skin and joints are opposed to more serious forms involving the inner organs and generally requiring immunosuppressant treatment. Diagnosis of SLE is facilitated by the presence in the serum of practically all patients of antibodies directed against various nuclear constituents (antinuclear antibodies). Non-medicinal treatment is based on decreasing exposure to ultraviolet A and B light and on the use of progestogen-only contraceptives. Medical treatment is based on long-term treatment with antimalarial drugs, mainly hydroxychloroquine, which are used as maintenance treatment for practically all the forms of SLE. Depending on which organs are affected, other medicines may also be used such as non-steroidal anti-inflammatory drugs, corticosteroids and immunosuppressants. Patients must be able to recognize the clinical signs indicative of a flare on their own. They should be strongly encouraged to enrol in a treatment education program. Thanks to the progress made in disease management, short- and medium-term outlook has improved considerably for patients. Several new treatment strategies are currently being developed. They are more adapted to the pathophysiology of SLE than the currently used corticosteroids and immunosuppressants and should lead to a decrease in treatment-related side effects and an improvement of long-term clinical outcomes.

Synonyms for the disease : lupus Nephritis, lupus Erythematosus, lupus

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