Curriculum · Musculoskeletal / Orthopedic / Rheumatology
Systemic lupus erythematosus
What it is
Systemic lupus erythematosus is an autoimmune disorder leading to inflammation and tissue damage in multiple organ systems. It is an idiopathic chronic inflammatory disease with genetic, environmental and hormonal factors, and being systemic it can affect any part of the body.
Causes and risk
There is a genetic predisposition, with HLA-DR2 and HLA-DR3 named, and environmental and hormonal factors play a role. Women are affected far more than men and the peak age is 20-40 years. It typically affects non-Caucasian females with the age of onset in early adulthood.
How it presents
General symptoms are fever, fatigue and weight loss. The skin and the mouth give a malar or butterfly rash, discoid lupus, photosensitivity, nonscarring alopecia, oral ulcers, which are painless, and cheilitis. The joints give arthralgia, myalgia, morning stiffness and a nonerosive arthritis, that is a symmetrical small joint polyarthritis that does not erode. Serositis appears as pleuritis or pericarditis, with pleural effusion. Renal involvement is lupus nephritis, with protein in the urine or red blood cell casts. CNS involvement covers seizures, psychosis and personality changes. The blood shows thrombocytopenia, leukopenia or lymphopenia and a warm hemolytic anemia. Other features are Raynaud phenomenon, periungual telangiectasia, dry eyes as part of a sicca syndrome, esophagitis and peripheral neuropathy.