From: Salud (About Health)
PABLO PÉREZ MARTÍNEZ, JOSÉ MANUEL RAMOS RINCÓN, ANA MAESTRE PEIRÓ
Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease, which is characterized by a dysregulation of the immune system. It results in loss of tolerance to one’s own antigens, so that the body recognizes them wrongly as foreign, producing an attack on the different organs and tissues by antibodies (autoantibodies).
Prevalence rates generally range from 20 to 70 cases per 100,000 people, with more frequent prevalence in young women between 20 and 40 years of age.
Its origin is unknown, but it is believed that there is an interrelationship between genetic and environmental factors. Genetically, an association has been found with certain HLAs such as B8, DR3, DQW2, C4AQ0.
In addition to genetic factors, environmental factors such as infections (Epstein-Barr virus) or exposure to xenobiotics (UV light or tobacco) appear to be related to the development of the disease.
These genetic and environmental factors will culminate in the production of autoantibodies and immune complexes. The main autoantibodies present in SLE are antinuclear antibodies (ANA), a marker that identifies patients at risk of developing or having this disease, as well as others such as anti-DNA or anti-Sm antibodies, which can be diagnostic of the disease.
The clinical picture of SLE is very variable, depending on which organs are involved. It can affect several organs such as skin, kidneys, central nervous system (CNS), lungs, vascular system, and serous membranes such as pleura or pericardium, joints, etc. Lupus nephritis is a common, serious, and feared complication in women with SLE.
Its diagnosis is based on clinical and serological criteria and depends very much on clinical suspicion. The presence of typical clinical manifestations, especially cutaneous or nephritis, photosensitivity, or hair loss in a young woman of childbearing age, guide the diagnosis of SLE.
The clinical course is usually chronic, with periods of activity or flare-ups and others of remission, although complete remission of the disease is rare.
The prognosis varies not only because of the severity of the activity in the different organs, but also because of the accumulated chronic damage which may result from the immunosuppressive treatments used, such as hydroxychloroquine, glucocorticoids, methotrexate or cyclophosphamide.
To avoid the side effects of immunosuppressive drugs, new biological treatments are being developed, targeting B lymphocytes, such as rituximab and belimumab or anifrolumab, which are the only biologicals with a specific indication for SLE.