Systemic lupus erythematosus

Chronic autoimmune disease affecting numerous organs. Different forms of progression. The most common symptoms are unexplained episodes of fever, joint complaints, and skin lesions. 90% of the ~35,000 affected individuals in Germany are female, and the preferred age of onset is around 30 years of age.

Since both the severity of the attack on individual organs and the course of the disease vary greatly, some physicians refer to the disease as "dicing": chronic relapsing, or more rarely, continuously progressing courses, the change of affected organs – everything is possible. Sometimes the SLE even heals.

Drug-induced lupus erythematosus: Special form triggered by drugs, e.g. B. by certain antibiotics, antiepileptic drugs, antirheumatic drugs, psychotropic drugs, thyrostatic drugs and antihypertensives. The symptoms disappear after stopping the medication. Many of these drugs are now no longer in use, so drug-induced lupus has become rare.

The disease

Skin symptoms in lupus erythematosus. Above, the typical butterfly erythema in a 29-year-old female patient. Below the skin symptoms on the hand. Georg Thieme publishing house, Stuttgart

In lupus erythematosus, the immune regulation is disturbed. The disease often breaks out during or after pregnancy, use of the contraceptive pill can promote the disease, and it is not uncommon for it to resolve after menopause. External factors such as UV rays (sunbathing) not only cause skin changes, but can also trigger relapses. A genetic predisposition is supported by the accumulation in different population groups; the disease occurs twice as often in Asia and seven to eight times as often in Africa as in Europe.

Patients almost always feel tired, ill and listless or have fever. In addition, there are other organ-specific complaints and findings:

– Skin symptoms (90 % in total): redness, thickening of the cornea and pigment disorders in areas exposed to sunlight. In 50% of patients, the typical butterfly-shaped reddening of the skin on the face (butterfly erythema) appears. 20 % have secondary Raynaud's syndrome. But symptoms such as circular, usually persistent hair loss or oral mucosal inflammation also occur. Sometimes lupus erythematosus affects only the skin. Often the otherwise typical autoantibodies are not even found in the blood (discoid lupus erythematosus, also known as skin lupus and cutaneous lupus erythematosus). – Joint problems (90%): Mostly painful, swollen joints in the morning v. a. in the knee and hand area, often the tendon sheaths are also affected. The joints are not destroyed. – Blood count changes with anemia (i.e., lack of red blood cells), but also leukopenia and/or thrombocytopenia (lack of white blood cells or white blood cells). platelets). (50 %) with recurrent severe pain when breathing. – Glomerulonephritis (45%) or other inflammation of the kidney (45%). , Occasional myocardial or pericardial inflammation (40%). – Various disorders of the central nervous system (30%): These include seizures and psychoses, severe headaches, which often also herald a new episode, depression, disorders of memory and logical thinking.

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What the doctor does

Confirm diagnosis. Since symptoms vary greatly, a definite diagnosis in early stages is only possible together with laboratory findings. Blood shows mildly elevated levels of inflammation and antinuclear antibodies (ANA) and their subgroups (ds-DNA-AK). In order to detect an inflammation of the kidneys, the urine is examined for protein (proteinuria). If proteinuria is detected, a kidney biopsy helps to assess the extent of the damage.

Therapy. A cure is generally not possible; the aim of treatment is rather to prevent or at least shorten the relapses, to alleviate the symptoms and to prevent permanent organ damage. Special attention is paid to the preservation of kidney function. Due to the hardly predictable course of the disease, continuity of medical care and a relationship of trust between the rheumatologist and the patient are particularly important.

Drug therapy follows the principle of "as little as possible, but as much as necessary."

– In cases of low disease activity (without organ involvement), many patients are able to cope for a long time with non-steroidal anti-inflammatory drugs such as diclofenac (z. B. Voltaren® ) from. Cortisone are for pronounced skin lesions. joint complaints necessary. – For moderate disease activity (without involvement of the heart, central nervous system, or kidneys), the immunosuppressive agent azathioprine ( Imurek® ) is used. – If vital organs such as kidneys, lungs, brain or spinal cord are threatened, high doses of cortisone and cyclophosphamide ( Endoxan® , a relatively well-tolerated cytostatic drug) are used, the latter often as an infusion. If these drugs are also not sufficient or are not tolerated, further cytostatic drugs such as methotrexate ( Lantarel® ), cyclosporine ( Sandimmun® ), mycophenolate or high-dose immunoglobulins are available.

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The consequences of the disease for the affected person are different. Most patients are little affected in daily life, for others the lupus is so drastic that full occupation is no longer possible and help is needed in the household.

In order not to give despair and resignation a chance, three things are important:

– Learn to understand your disease. Counselors can help. If there is a self-help group in the vicinity, contact it. Find the doctor you trust. Work consistently with him. This means above all that you take the agreed medicines. If you no longer want this in the previous dosage, discuss it openly with your doctor beforehand. Take the control appointments, just kidney problems you do not notice yourself. Otherwise you risk permanent damage up to organ destruction. See a doctor if you have exacerbations, but also if you have symptoms that you do not associate with your lupus. The symptoms of lupus are so varied that it is better to ask the rheumatologist for advice once too often than too little. – Make the sun your enemy: relapses are easily triggered by sun rays. And if you can't help it, use sunblock with sun protection factor 60 (they are no longer covered by health insurance). Other relapse triggers include the pill and psychological and physical stresses. Many patients are also sensitive to medications, z. B. on local anesthetics at the dentist.

Further information

– M. Schneider: Lupus erythematosus. Steinkopff, 2004. Detailed and up-to-date specialist medical advice.


Important note: This article has been written according to scientific standards and reviewed by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start a therapy.

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