Dr Amrutha Manoharan, B.H.M.S, M.D (Hom),Dip.Yoga,
Junior Research Fellow
National Homoeopathic Reaserch Institute In Mental Health, Kottayam
Systemic lupus erythematosus (SLE, or lupus) is a systemic autoimmune disease with multiorgan inflammation. SLE is characterized by production of pathogenic autoantibodies directed against nucleic acids and their binding proteins, reflecting a global loss of self-tolerance. Lupus is an autoimmune disease, which means that the immune system, your body’s defence system, produces antibodies that attack the body’s own tissues, causing inflammation. There are two main types of lupus1. discoid lupus and 2. systemic lupus erythematosus (SLE).
SLE, Signs, symptoms , diagnosis and homoeopathic management.
Systemic lupus erythematosus (SLE) is a chronic disease that causes inflammation in connective tissues, such as cartilage and the lining of blood vessels, which provide strength and flexibility to structures throughout the body. The signs and symptoms of SLE vary among affected individuals, and can involve many organs and systems, including the skin, joints, kidneys, lungs, central nervous system, and blood-forming (hematopoietic) system. SLE is one of a large group of conditions called autoimmune disorders that occur when the immune system attacks the body’s own tissues and organs. 
The exact cause of SLE isn’t known, but several factors have been associated with the disease.
HLA B8 and DR3 and inherited deficiency of C1, C3 and C4 components are associated with higher incidence of SLE.
Environmental triggers can include:- ultraviolet rays, certain medications, viruses and physical or emotional stress.
Sex and hormones
SLE affects women more than men. Women also may experience more severe symptoms during pregnancy and with their menstrual periods. Both of these observations have led some medical professionals to believe that the female hormone estrogen may play a role in causing SLE. However, more research is still needed to prove this theory. 
SLE is an autoimmune disease characterised by insufficiency of immune regulation by Tcells , hyperactive and self – reactive Tcells and Bcells produce auto antibodies against several self components.
STAGES OF DISEASE PROGRESSION
STAGE 1 – immune insufficiency stage
STAGE 2 – hyperactivation stage in which self reactive T and B cells are activated
STAGE 3 – invasion of tissues by T and B cells, autoantibodies and immune complex are formed locally and systematically.
STAGE 4 – active disease , SLE with inflammation of tissues
STAGE 5 – organ destruction. Fibrosis and progress to end stage. 
- direct cytotoxicity cause by antibody and complement – type – II
- reaction caused by immune complex and complement – type – III
SIGNS AND SYMPTOMS
SLE may first appear as extreme tiredness (fatigue), a vague feeling of discomfort or illness (malaise), fever, loss of appetite, and weight loss. Most affected individuals also have joint pain, typically affecting the same joints on both sides of the body, and muscle pain and weakness. Skin problems are common in SLE. A characteristic feature is a flat red rash across the cheeks and bridge of the nose, called a “butterfly rash” because of its shape. 
CLINICAL PREESNTATION OF SLE IN DIFFERENT SYSTEMS
HEMATOLOGICAL MANIFESTATIONS OF SLE
Coomb’s Positive hemolytic anemia, Hemotoxylin bodies , LE cell phenomenon is seen in neutrophils, Thrombocytopenia due to increased platelet destruction is seen, Autoimmune destruction of platelets and Warm autoantibodies.
CARDIOVASCULAR MANIFESTATIONS OF SLE
Vegetations on under surface of cusp – Libman Sack’s endocarditis.
RESPIRATORY SYSTEM INVOLVEMENT IN SLE
Pleural effusion in SLE – Bilateral exudative pleural effusion and a syndrome of Shrinking lung.
RENAL INVOLVEMENT IN SLE
Lupus nephritis – Type I – minimal mesangial, type II – mesangial proliferation, type III – focal nephritis, type IV – diffuse nephritis, type V – membranous nephritis, type VI – sclerotic nephritis and Wire loop lesions.
DERMATOLOGICAL MANIFESTATIONS OF SLE
Malar Rash, Lupus profundus, lupus panniculitis, alopecia and frontal baldness.
GASTROINTESTINAL FEATURES OF SLE
Onion peel appearance of splenic capsule
RHEUMATOLOGICAL MANIFESTATIONS OF SLE
Arthritis of large joints. Reduciable non- erosive joint deformity with preservation of hand function.
CNS INVOLVEMENT IN SLE
Psychosis, convulsions, cranial nerve palsy, peripheral neruropathy, mononeuritis multiplex , chorea and cerebellar disturbance.
Over time, SLE can damage or cause complications in systems throughout your body. Possible complications may include:
- blood clots and inflammation of blood vessels or vasculitis
- inflammation of the heart, or pericarditis
- heart attack
- memory changes
- behavioral changes
- inflammation of lung tissue and the lining of the lung, or pleuritis
- kidney inflammation
- decreased kidney function
- kidney failure 
CRITERIA FOR DIAGNOSIS
The American College of Rheumatology use a standard classification scheme to confirm a diagnosis.
If a person meets 4 out of 11 criteria, a doctor will consider that they may have lupus.
The 11 criteria include:
- Malar rash: A butterfly-shaped rash appears across the cheeks and nose.
- Discoid rash: Raised red patches develop.
- Photosensitivity: A skin rash appears after exposure to sunlight.
- Oral or nose ulcers: These are usually painless.
- Non-erosive arthritis: This does not destroy the bones around the joints, but there is tenderness, swelling, or effusion in 2 or more peripheral joints.
- Pericarditis or pleuritis: Inflammation affects the lining around the heart (pericarditis) or lungs (pleuritis).
- Kidney disorder: Tests show high levels of protein or cellular casts in the urine if a person has a kidney problem.
- Neurologic disorder: The person has seizures, psychosis, or problems with thinking and reasoning.
- Hematologic (blood) disorder: Hemolytic anemia is present, with a low white blood-cell count or low platelet count.
- Immunologic disorder: Tests show that there are antibodies to double-stranded DNA (dsDNA), antibodies to Sm, or antibodies to cardiolipin.
- Positive ANA: The test for ANA is positive, and the person has not used any drugs that might induce it.
1. Blood tests:
Complete blood count. This test measures the number of red blood cells, white blood cells and platelets as well as the amount of hemoglobin, a protein in red blood cells. Results may indicate you have anemia, which commonly occurs in lupus. A low white blood cell or platelet count may occur in lupus as well.
Erythrocyte sedimentation rate. This blood test determines the rate at which red blood cells settle to the bottom of a tube in an hour. A faster than normal rate may indicate a systemic disease, such as lupus. The sedimentation rate isn’t specific for any one disease. It may be elevated if you have lupus, an infection, another inflammatory condition or cancer.
Kidney and liver assessment. Blood tests can assess how well your kidneys and liver are functioning. Lupus can affect these organs.
Urinalysis. An examination of a sample of your urine may show an increased protein level or red blood cells in the urine, which may occur if lupus has affected your kidneys.
Antinuclear antibody (ANA) test. A positive test for the presence of these antibodies — produced by your immune system — indicates a stimulated immune system. While most people with lupus have a positive ANA test, most people with a positive ANA do not have lupus. If you test positive for ANA, your doctor may advise more-specific antibody testing.
Anti-DNA antibody test – Around 70% of people with lupus have an antibody known as the anti-DNA antibody. The result is more likely to be positive during a flare-up.
Anti-dsDNA antibody – The anti-double-stranded DNA antibody (anti-dsDNA) is a specific type of ANA antibody that occurs about 30% of people with lupus. 
2. Imaging tests
Chest X-ray. An image of your chest may reveal abnormal shadows that suggest fluid or inflammation in your lungs.
Echocardiogram. This test uses sound waves to produce real-time images of your beating heart. It can check for problems with your valves and other portions of your heart. 
3 Mark remedies – ars, lyco, nit acid, rhus tox, thuja.
2 Mark remedies – bar-c, carb- ac, carb- veg, carc, caust, kali-bi, kali- chl, kail-s, kreos, phos, nat-mur, psor, rhodo, thyr, tub, X- ray. 
SLE is one of the most common autoimmune disorder that affects mostly the females homoeopathy has a great scope in treating SLE based on the symptom similarity.
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