Sitinor Journey: SLE? apa tue

What is SLE?

Systemic Lupus Erythematosus (SLE) is a chronic, auto-immune disease of unknown cause where the patient’s body makes large quantities of blood proteins called anti-bodies that react against the person’s own tissues.

History

Lupus is the Latin word for wolf. Erythematosus means red rashes. In 1851, Dr. Cazenave discovered red rashes on a patient’s face that looked like wolf bites. He named the rash Discoid Lupus Erythematosus (DLE).

In 1885, Sir William Osler recognised that many people with lupus had a disease involving not only the skin but many other organs or systems. He named the disease Systemic Lupus Erythematosus (SLE).

Types of Lupus

Discoid Lupus Erythematosus (DLE)

Only involves the skin
Rarely spreads to other organs

Systematic Lupus Erythematosus (SLE)

Can spread to other organs
Can be fatal

Statistics

About 90% of SLE sufferers are women while about 10% are men and children.
About 90% of women with SLE are in their childbearing years, within the range of 15 to 50 years old.

Ratio of SLE sufferers :
In the West, among Afro-Carribeans 1 in 250-500 people
USA – 1 in 2,000 people
China – 1 in 1,000 people

In Malaysia, it is estimated that more than 10,000 people have been diagnosed with SLE over the past 30 years. However, this number may be only the tip of the iceberg. The Malaysian SLE Association believes that there are many more SLE sufferers in Malaysia who have not been diagnosed.

What are the Symptoms?

Each patient has slightly different symptoms that can range from mild to severe and may come and go over time. However, some of the most common symptoms of SLE include painful or swollen joints (arthritis), unexplained fever, and extreme fatigue. A characteristic red skin rash – the “butterfly” or malar rash – may appear across the nose and cheeks. Rashes may also occur on the face and ears, upper arms, shoulders, chest, and hands. Because many people with SLE are sensitive to sunlight (called photosensitivity), skin rashes often first develop or worsen after sun exposure. Some people experience symptoms in many parts of their body. Just how seriously a body system is affected varies from person to person.

Typical clinical features include:

Fever, fatigue, and weight loss
Arthritis, involving multiple joints for several weeks
Butterfly-shaped rash over the cheeks or other rashes
Skin rash appearing in areas exposed to the sun
Sores in the mouth or nose for more than a month
Loss of hair, sometimes in spots or around the hairline
Seizures, strokes and mental disorders
Blood clots in different locations
Miscarriages in some patients
Blood or protein in the urine or tests that suggest poor kidney function
Low blood counts (anaemia, low white blood cells or low platelets)

How is SLE Treated?

Management of SLE can be a challenge. Treatment depends on symptoms and their severity.

Treating SLE is often a team effort between the patient and several types of healthcare professionals namely, rheumatologists, nephrologists, haematologists, dermatologists, neurologists and psychiatrists. In treating a SLE patient, the doctor has to prevent flares, treat the flares, and minimise organ damage and complications.

The main medications are as follows:

NSAIDs
For people with joint or muscle pain, or fever, drugs that decrease inflammation, called nonsteroidal anti-inflammatory drugs (NSAIDs), are often used. NSAIDs may be used alone or in combination with other types of drugs to control pain, swelling, and fever.

Common side effects of NSAIDs can include stomach upset, heartburn, diarrhoea, and fluid retention.

Hydroxychloroquines
These anti-malarials are another type of drug commonly used to treat SLE. These drugs were originally used to treat malaria, but doctors have found that they are also useful for SLE. They may be used alone or in combination with other drugs and are generally used to treat fatigue, joint pain, skin rashes, and inflammation of the lungs. Clinical studies have found that continuous treatment with anti-malarials may prevent flares from recurring.

Side effects of anti-malarials can include stomach upset and, extremely rare, damage to the retina of the eye.

Corticosteroids
The main treatment in SLE involves the use of corticosteroids, the most common being prednisolone. Corticosteroids are related to cortisol, which is a natural anti-inflammatory hormone. They work by rapidly suppressing inflammation. Corticosteroids can be given by mouth, in creams applied to the skin, or by injection. Because they are potent drugs, the doctor will seek the lowest dose with the greatest benefit.

Short-term side effects of corticosteroids include swelling, increased appetite, and weight gain. These side effects generally stop when the drug is stopped. It is dangerous to stop taking corticosteroids suddenly, so it is very important that the doctor and patient work together in changing the corticosteroid dose.

Long-term side effects of corticosteroids can include weakened bones (osteoporosis), high blood pressure, high cholesterol, high blood sugar (diabetes), damage to the arteries, infections, and cataracts. The higher the dose and the longer they are taken, the greater the severity of side effects. Doctors try to limit or offset the use of corticosteroids. For example, corticosteroids may be used in combination with other, less potent drugs, or the doctor may try to slowly decrease the dose once the disease is under control. SLE patients who are using corticosteroids should talk to their doctors about taking supplemental calcium and vitamin D or other drugs to reduce the risk of osteoporosis.

Immunosuppressives
For some patients whose kidneys or central nervous systems are affected by SLE, a type of drug called an immunosuppressive may be used. Immunosuppressives, such as cyclophosphamide (Cytoxan) and mycophenolate mofetil (CellCept), restrain the overactive immune system by blocking the production of immune cells. These drugs may be given by mouth or by infusion (dripping the drug into the vein through a small tube). Side effects may include nausea, vomiting, hair loss, bladder problems, decreased fertility, and increased risk of cancer and infection. The risk for side effects increases with the length of treatment. As with other treatments for SLE, there is a risk of relapse after the immunosuppressives have been stopped.

The patient has to work closely with his or her doctor to help ensure that the treatments are as successful as possible. Because some treatments may cause harmful side effects, it is important for the patient to promptly report any new symptoms to the doctor. It is also important not to stop or change treatments without talking to the doctor first.

Rujukan: http://www.lupusmalaysia.org/en/what-is-sle

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