What is systemic lupus erythematosus (SLE)?

Systemic lupus erythematosus (SLE), or simply lupus, is a chronic disorder that affects more than five million people worldwide.

Here, Professor Tom Sheeran, renowned consultant rheumatologist, provides an expert insight into SLE. He discusses the symptoms and treatment of SLE, among other important points.

What is SLE and what are the symptoms?

SLA is a multi-organ inflammatory disorder that mainly affects women of all ages. It often presents in younger age groups, and in various patterns of illness.

A pattern of illness that is commonly recognised with SLE involves: patients going to see a rheumatologist because they have joint pain; patients going to see a dermatologist because they have skin rashes, often on light-exposed areas such as the face, the arms or even the neck; or patients presenting with bleeding problems and going to see a haematologist because they have low platelets.

As well as this, patients can also present with slightly rarer conditions affecting the lungs, the brain, and in particular, kidney illness. Patients can present with many different symptoms, and everybody has to be aware of these patterns of illness. Depending on the organ affected, the symptoms will direct patients towards one specialism area or another.

How does SLE differ from other forms of lupus?

SLE and lupus are umbrella terms that are used interchangeably to refer to the same disorder.

SLE affects the kidneys, and patients may not even be aware themselves that they have kidney problems. These kidney problems may develop because patients have high blood pressure, and thus, patients may also have problems that are directly related to high blood pressure.

Sometimes, SLE can occur at the end of pregnancy, and thus, some patients may present with a pre-eclampsia type syndrome. Likewise, patients can also present with ankle oedema as a result of losing so much protein through their kidneys that the protein in their body drops and they develop swelling in the ankles.

These are the main problems with renal disease. In addition, some unfortunate patients can also present with end stage renal failure.

Other areas of presentation involve the skin. These areas are often photosensitive, occurring in light-exposed parts of the body.

Haematological features include low platelets, which cause bleeding or bruising problems. I recently met a patient who visited their dentist because of bleeding gums, and that was how they were subsequently diagnosed with lupus.

As well as this, patients can also present with joint pain.

Each individual patient with lupus has its own individual lupus type of illness, which is very particular to them. It all depends on the organ system that is affected the most.

What are the different treatment options for SLE?

The key to treatment is early intervention, which depends on early diagnosis. Getting to the right specialist quickly is of utmost importance.

Early treatments for SLE include painkillers if patients have joint pain, which falls in the rheumatology specialism area.

Quite often, steroids are used very early for the treatment of haematological problems, renal problems and lung problems, as well. This can quickly escalate to slightly more aggressive treatments, which will stop the disease process. These can be cytotoxic agents and agents that affect the disease process, such as mycophenolate and methotrexate.

One very recent discovery for SLE has been the benefit of hydroxychloroquine. While not regarded as a very potent treatment for lupus, hydroxychloroquine does stop significant flares of illness if patients can be maintained on a dose over a long period of time.

When it comes to biologic therapies, therapies that affect B-cells (that seem to drive all the auto-antibody or the antibody production in lupus) are effective to some degree. There are other types of treatments available that affect B-cell receptors, called Bliss, and there is a lot of trial evidence now to support the use of these drugs in patients with lupus.

Depending on the severity of the illness, plasma exchange can also be used to try and target pathogenic antibodies. However, this can only be really delivered in specialist units.

Professor Tom Sheeran is an esteemed consultant rheumatologist with over 35 years’ expertise.

If you are worried about possible symptoms of systemic lupus erythematosus (SLE), do not hesitate to book an appointment with Professor Sheeran via his Top Doctors profile today to receive expert assessment and treatment.