The immune system helps the body fight against the invasion of foreign agents. In systemic lupus erythematosus, the immune system loses the ability to distinguish between self and non-self, turning against the body.
Understanding Lupus Erythematosus
Systemic lupus erythematosus, commonly referred to as lupus, was first described in 1845 by Hebra. It is a chronic autoimmune disease of unknown cause that can damage most organ systems in the body and, in severe cases, can be life-threatening. In individuals with lupus erythematosus, the immune system fails to protect the body against foreign agents causing disease and instead attacks the body by producing antibodies against the cells of most organs.
The term “lupus” is Latin for “wolf,” originating from the characteristic rash that patients often develop on their faces resembling a wolf’s bite. The term “erythematosus” refers to a common sign among most patients with this condition. The word “systemic” is used because the disease affects a large number of organ systems in the body.
Systemic lupus erythematosus is a global issue, with millions of new cases diagnosed each year worldwide, yet it remains largely unknown in society. According to research by the Lupus Foundation of America, there are currently about 2 million people with systemic lupus erythematosus in the United States, with the number of deaths from the disease increasing from 879 in 1979 to 1,046 in 2002, and 40% of patients have had to stop working.
In Vietnam, according to research from the Allergy and Clinical Immunology Center at Bach Mai Hospital, which primarily treats systemic lupus erythematosus patients from northern provinces, the number of patients seeking treatment at the center consistently ranges from 400 to 500 each year, accounting for more than one-third of all hospitalized patients.
Patients receiving treatment for systemic lupus erythematosus at the Allergy and Clinical Immunology Center, Bach Mai Hospital. (Photo: MT).
Causes of the Disease
The exact cause of the disease is not well understood. It is believed that systemic lupus erythematosus is caused by a combination of multiple factors, among which are particularly important:
- Genetics: Siblings of patients with systemic lupus erythematosus have a 20-fold higher risk of developing the disease compared to the general population.
- Environmental factors: Such as infections, exposure to chemicals, sunlight, etc.
- Endocrine factors: The disease primarily affects women of childbearing age (occurring 9 times more than in men). After menopause, both the incidence and severity of the disease decrease significantly, while during pregnancy, the disease often worsens.
Symptoms of the Disease
Symptoms of systemic lupus erythematosus can appear suddenly or gradually over months or years. Due to its impact on most organs in the body, the symptoms are highly varied and often worsen during the winter months, possibly due to increased exposure to sunlight during the previous summer.
More than 90% of patients who seek medical attention present with nonspecific symptoms such as weight loss, fatigue, mild fever, hair loss, mouth ulcers, pain in small joints, muscle pain, and menstrual irregularities. About three-quarters of patients experience abnormal rashes on the skin, with the most common being the butterfly rash on the face, a very characteristic sign of systemic lupus erythematosus (redness across the cheeks bridging over the nose).
Organ damage such as in the heart (pericardial effusion, myocarditis), lungs (pleural effusion, pneumonia), kidneys (glomerulonephritis), nervous system (seizures, psychiatric disorders), and blood system (anemia, hemorrhage) commonly occurs during the acute phase of the disease in approximately 50-85% of patients and is a major cause of death. These symptoms often present in flare-ups alternating with periods of remission.
In the early stages of the disease, symptoms are often vague and resemble many other conditions, so it may take several years from the onset of the first symptoms until an accurate diagnosis is made.
Treatment of the Disease
Systemic lupus erythematosus cannot be completely cured but can be controlled with proper treatment. The main goal of treatment is to minimize symptoms and limit severe organ damage. During acute phases, patients need to rest more but still require a reasonable exercise regimen to avoid muscle atrophy and joint stiffness.
Non-steroidal anti-inflammatory drugs (NSAIDs) such as Aspirin, Ibuprofen, Naproxen, and Nimesulide are effective for symptoms in muscles and joints. The most common side effect is causing gastric ulcers, so to minimize this, they should be taken with meals.
This disease cannot be completely cured but can be controlled with appropriate treatment.
Corticosteroids such as prednisolone, methylprednisolone (Solu-medrol, Medrol), prednisone (Cortancyl), and betamethasone (Celeston) have stronger anti-inflammatory effects than NSAIDs but also have more side effects and are used only in severe cases with organ damage. Common side effects of this group of medications include gastric ulcers, elevated blood sugar, osteoporosis, skin striae, increased risk of infections, and adrenal suppression. They should be taken once after breakfast.
Antimalarial drugs such as Hydroxychloroquine and Chloroquine are quite effective for skin and joint lesions. Immunosuppressive drugs such as azathioprine (Imuran), cyclophosphamide (Endoxan), and cyclosporine (Sandimmun) are used only in severe cases unresponsive to corticosteroids due to their significant and dangerous side effects.
So far, no herbal remedy has been proven effective in treating systemic lupus erythematosus. Therefore, patients should exercise caution when using these medications as they can also cause many unwanted effects, potentially threatening their lives.
How to Prevent Flare-Ups of the Disease
Individuals with systemic lupus erythematosus need to maintain a healthy lifestyle, stay active, and minimize psychological stress. Additionally, ultraviolet radiation from sunlight often triggers or exacerbates flare-ups of the disease, so maximal avoidance is necessary. Abruptly stopping medications, especially corticosteroids, is also a significant cause of disease flare-ups and should be avoided.
