| Lupus erythematosus (also known as systemic lupus erythematosus - SLE) is an autoimmune disorder in which antibodies are created against the patient's own DNA. It classically presents with a butterfly-shaped malar rash, causing a wolf-like appearance (Lupus is Latin for wolf).
Signs and symptoms
Common initial and chronic complaints are fever, malaise, myalgias, fatigue and weight loss. Because they are so often seen with other diseases, these signs and symptoms are not part of the diagnostic criteria for SLE, but when occurring in conjunction with other signs and symptoms, they are considered suggestive.
Dermatological manifestations
As many as 30% of patients present with some dermatological symptoms (and 65% suffer such symptoms at some point), but only 30% to 50% suffer the classic malar (or ?butterfly?) rash associated with the disease. Patients may present with discoid lupus, thick red scaly patches on the skin. Alopecia, mouth and vaginal ulcers and lesions on the skin are also possible manifestations.
Musculoskeletal manifestations
Patients most often seek medical attention for joint pain, with small joints of the hand and wrist usually affected, although any joint is at risk. Unlike rheumatoid arthritis, SLE arthropathy is not usually destructive of bone, however, deformities caused by the disease may become irreversible in as many as 20% of patients.
Hematological manifestations
Anemia and iron deficiency may develop in as many as half of patients. Low platelet and white blood cell counts may be due to the disease or a side effect of pharmacological treatment.
Cardiac manifestations
Patients may present with inflammation of various parts of the heart: pericarditis, myocarditis and endocarditis. The endocarditis of SLE is characteristically non-infective (Libman-Sacks endocarditis), and involves either the mitral valve or the tricuspid valve. Atherosclerosis also tends to occur more often and advance more rapidly in SLE patients than in the general population. (Asanuma, et al., 2003) (Bevra, 2003) (Roman, et al., 2003)
Renal involvement
Painless hematuria or proteinuria may often be the only presenting renal symptom. Because of early recognition and management of SLE, end stage renal failure occurs in less than 5% of patients.
Neurological manifestations
About 10% of patients may present with seizures or psychosis. A third may test positive for abnormalities in the cerebrospinal fluid.
T cell abnormalities
Abnormalities in T cell signaling are associated with SLE, including deficiency in CD45 phosphatase, increased expression of CD40 ligand. Also associated with SLE is increased expression of FcεRIγ, which replaces the TCR ζ chain, which is deficient in some SLE patients. Other abnormalities include:
increased and sustained calcium levels in T cells
moderate increase of inositol triphosphate
reduction in PKC phosphorylation
reduction in Ras-MAP kinase signalling
And deficiencies in:
protein kinase A I activity
Common Skin Disorders
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