Systemic Lupus Erythematosus


## Basic introduction

  • Systemic Lupus Erythematosus (SLE) is a chronic inflammatory disease that has varied presentations that follow a relapsing and remitting course[b]
  • Over 30 different genes predispose to SLE[d]

## Classification of LE

  • Drug-induced LE
  • Only 1% of cases persist after the offending medicine has been stopped
  • The common drugs that are associated with LE include;







  • Neonatal LE
  • This is caused by the passive transfer of autoantibodies from the mother.
  • Babies (5-7%) have transient rashes that can last for 6-8 months
  • Some babies (2%) will suffer from cardiac disorders
  • Cutaneous LE (CLE)
  • CLE is classified into 3 main categories;

|||Acute CLE

|||Sub acute CLE

|||Chronic CLE

  • Chronic CLE is further divided into 3 classes;

       |||Discoid LE (DLE)

       |||Tumid lupus

       |||Lupus panniculitis

  • SLE

## Pathophysiology of LE

  • There is production of autoantibodies
  • These autoantibodies form immune complexes that are deposited on the endothelia causing inflammation and tissue damage

## Similarities between LE and Systemic sclerosis (SS or scleroderma), both are;

  • Associated with genetic predisposition
  • Autoimmune diseases
  • More common in women than men
  • Characterized by the manifestations of common symptoms such as;
  • Esophageal dysfunction (but more common in SS)
  • Raynaud’s syndrome (but more common in SS)
  • Swollen joints (but more common in LE)
  • The presence of Antinuclear antibodies (ANA)

## Differences between LE and SS;

  • Anti-Scl 70 anti-centromere antibody are found only in SS
  • SLE is more affected by the genetic factors than SS
  • Sun sensitivity is found only in LE
  • The age of onset is 15-45yrs for LE and 20-60yrs for SS
  • The pathology of LE is mainly an inflammatory process while that of SS involves inflammation, cross-linking of collagen that leads to tight skin, fibrosis or scarring of tissues, and vascular endothelial changes.

## Statistics

  • > 90% of cases of SLE occur in women
  • Globally, the prevalence of SLE in the generally population is 30 to 50/100,000[e]
  • Incidence of SLE in USA:18 - 76 per million persons / year [a]
  • The female predominance of SLE in a study in Kenya was 97%[b]
  • Non-specific symptoms and signs
  • Fatigue
  • Weight loss
  • Malaise
  • Fever
  • Anorexia
  • Anemia
  • Hair loss
  • Articular diseases
  • These are the commonest clinical manifestations of SLE (present in 90% of cases in a study in Kenya)[b]
  • The symptoms include: arthritis (joint pains and swellings) that mainly affect the joints of the fingers, hands, wrists, and knees
  • Skin manifestations
  • Malar rash or butterfly rash or cheekbone rash (with a prevalence of 69.2% in Kenya)[c]
  • Photosensitivity
  • Discoid rashes
  • Oral ulcers
  • Neurological disease
  • Neuropathies
  • Stroke
  • Psychosis
  • Seizures
  • Renal diseases
  • Glomerulonephritis is the leading cause of death among SLE
  • Renal diseases affect 50-70% of SLE
  • Clinical review
  • Antinuclear antibody (ANA) assay
  • Anti - dsDNA
  • ESR and CRP (are elevated)
  • Urinalysis
  • Complete Blood Count with differential
  • Complements C3 and C4 are low
  • LFTs are elevated
  • Acrodermatitis chronicum atrophicans
  • Behçet’s syndrome
  • Dermatomyositis and polymyositis
  • Fibromyalgia
  • Infections such as EBV and CMV
  • Kikuchi’s disease
  • Mixed connective tissue disease
  • Primary Raynaud's phenomenon
  • Rheumatoid arthritis (RA)
  • Rhupus (overlapping features of both SLE and RA)
  • Serum sickness
  • Sjögren’s syndrome
  • Systemic sclerosis or scleroderma
  • Vasculitis
  • It is not possible to prevent LE but the following factors can reduce its incidence;
  • Avoiding stress
  • Avoiding sunshine exposure
  • Exercise
  • Good sleep hygiene
  • Healthy diet
  • Smoking cessation
  • Sun-protective clothing
  • Use of the Sun Protective Factor (SPF)

1. Centres for Disease Control and Prevention. Systemic lupus erythematosus (SLE or lupus). Available at

  1. Genga, E. K., Shiruli, B. C., Odhiambo, J., Jepkorir, S., Omondi, E. A., Otieno, F. O., & Oyoo, G. O. (2015). Clinical Characteristics of Patients with Systemic Lupus Erythematosus in Nairobi, Kenya. African Journal of Rheumatology, 3(2), 62-66
  2. Ekwom PE. Systemic lupus erythematosus (SLE) at the Kenyatta National Hospital. Clin Rheumatol. 2013; 32(8):1215-1217.
  3. Ramos, P. S., Brown, E. E., Kimberly, R. P., & Langefeld, C. D. (2010, March). Genetic factors predisposing to systemic lupus erythematosus and lupus nephritis. In Seminars in nephrology (Vol. 30, No. 2, pp. 164-176). WB Saunders.
  4. Osio-Salido, E., and H. Manapat-Reyes. "Epidemiology of systemic lupus erythematosus in Asia." Lupus 19, no. 12 (2010): 1365-1373.
  • Immunosuppressants;
  • Azathioprine
  • Belimumab
  • Cyclophosphamide
  • Cyclosporine
  • Dapsone
  • Leflunomide
  • Methotrexate
  • Mycophenylate Mofetil
  • Rituximab
  • Corticosteroids (mainly prednisolone)
  • Antimalarials
  • Hydroxychloroquine (the most commonly used drug for the treatment of SLE in Africa, and Kenya) [b][c]
  • Chloroquine
  • Quinacrine
  • Belimumuab
Drug Index 2.0 is here
Our new update features a more powerful search feature and easier login. Having any issues? Contact us today. Contact Us