SLE, or "lupus," is the classic example of an autoimmune disease in which the immune system attacks not a specific tissue or organ in the body, but rather a wide range of self tissues. Like most autoimmune diseases of this type, lupus is seen most frequently in females, almost always setting in during the peak reproductive years. Lupus is 10 times more common in women than men, and more common in people of color than in Caucasians. The erythematosus in SLE refers to a rash that often breaks out on the face, particularly around the nose. This so-called "butterfly rash" is one manifestation of the general sensitivity of lupus patients to ultraviolet light, including sunlight. Other symptoms include fever, weakness, pleurisy, anemia, and heart and kidney problems. Joint pain from arthritis is a common concomitant of lupus throughout all its stages. No one really knows what causes it, but it is often associated with recurrent Epstein-Barr virus infections and certain prescription medications.
Lupus is accompanied by antibodies to a wide range of self antigens, one of the most unusual being DNA. Although many other autoantibodies (e.g., against thyroid or liver tissue; muscle; and blood cells and serum proteins) are found in lupus patients, antibodies to DNA are the most prominent, and are in fact diagnostic for the disease. It is likely that the DNA antibodies are formed against DNA released by dying cells. It is not clear whether the DNA antibodies themselves cause any harm. Such antibodies are not formed in other diseases in which cells die and release their contents, so their appearance in lupus is still something of a mystery. If we knew why these particular antibodies were formed in the first place, we would likely understand a great deal more than we do about this disease.
Like other antibody-mediated autoimmune disorders, much of the serious damage in SLE comes from the deposition of antigen-antibody complexes, not consumed by macrophages, into blood vessels throughout the body. When this occurs in blood vessels in the kidneys, for example, a condition known as glomerulonephritis can develop, which eventually may lead to serious kidney problems and even kidney failure. Because the antigens in lupus (and other autoimmune diseases) are a part of self, there is in effect an endless supply of them, and an endless stream of immune complexes just keep on forming. In advanced cases, lupus may also affect the nervous system. This can result in pain throughout the body, but may also result in actual damage to the central nervous system, manifesting as headache, paralysis, seizures, or other neu-ropsychiatric problems.
Lupus is not really curable. It can be controlled in many cases with steroids such as prednisone. Mild immunosuppressive drug treatments can also help. But these kinds of drugs are not without their own risks. Arthritis and kidney problems often worsen with age, causing considerable distress and affecting the general quality of life. On the other hand, with careful monitoring by an experienced physician, it is not obvious that lifespan per se is greatly affected by diseases such as lupus.
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