Systemic Lupus Erythematosus
Systemic Lupus Erythematosus (SLE) is a disease that is a good example of an “autoimmune disease”. It is a chronic inflammatory disease where the immune system attacks the tissues of different organ systems throughout the body and can result in many problems. It occurs worldwide, and is more common in some populations than others. Overall, this disease occurs to a frequency of about one in 1000. It is most common in women, particularly in the fertile years. In these years this disease has a ratio of about 9 women to 1 man, while in other years the ratio is much closer.
There are many manifestations of systemic lupus, from mild to life threatening. The most common symptoms include: rash (with a “butterfly rash” occurring on the face being common); sun sensitivity; arthritis; mouth and other mucous membranes sores; pericarditis (inflammation around the lining of the heart); pleurisy (inflammation around the lining of the lungs); a tendency to form blood clots; a tendency for blood vessels to get inflamed; seizures; renal disease which can lead to kidney failure and dialysis; blood abnormalities, etc. As can be imagined, because of the many different manifestations this can be a very difficult disease to diagnose. Blood tests are helpful. Rheumatologists are often consulted to help confirm the diagnosis. Because of the difficulty in treating some of these problems they are also needed to take part in the management of this disease.
The cause for SLE is not known. There is a genetic predisposition to it, and it may be triggered by environmental exposures. Because of these genetic influences, it is more common in some parts of the world than in others. Many patients are also very sensitive to the sun, and sunlight can trigger diverse elements of the disease, such as renal disease.
SLE has no cure, but there are medications that help manage its varied manifestations. Medications used for the treatment of SLE include: relatively mild medications such as Plaquenil, medications for pain, varying doses of glucocorticoids (such as prednisone) which often results in many adverse effects, and immunosuppressives (such as chemotherapeutic agents) which need careful monitoring.
It is hard to believe, but there has been no new approved drug for the treatment of systemic lupus for several decades! This is in part because of the many problems of the disease. It is difficult to find patients with similar manifestations who have a similar activity to their disease. This is needed to prove that a medication is effective. This is why it is so important to continue to look for new treatments in SLE. A new medication may be approved for use in SLE soon, but much needs to be done. Arizona Arthritis and Rheumatology Associates is proud to take part in many of these trials which look for new treatments for this potentially life-threatening disease.
Cortisone (e.g. prednisone) and NSAIDs e.g. ibuprofen, naproxen can help symptoms but do not have the ability to modify the joint destruction and functional decline. They may cause stomach bleeding, poor kidney function, high blood pressure and cardiovascular side effects among other side effects.
Disease modifying anti-rheumatic drugs (DMARDs) have the capacity to drive the disease to a low activity state. The gold standard methotrexate at 15-25 mg per week, Arava, sulfasalazine, and the less potent Plaquenil are examples. But they often fail to induce remission. Newer biologic agents especially when used with methotrexate can affect good clinical outcomes. They include Enbrel, Remicade, Humira, Orencia, Rituxan, Cimzia, Simponi, and Actemra (listed in the order of approval by the FDA). However, even on these agents most RA patients do not achieve remission and they also may cause mild and serious side effect which limit their use. More research is needed to refine treatments with these agents and to identify new more effective, safe and less expensive drugs to help patients with RA. Only when RA patients volunteer for clinical research trials are better therapies discovered.
The physicians in practice at Arizona Arthritis & Rheumatology Associates and their research division Arizona Arthritis & Rheumatology Research are dedicated to the care of patients with RA. They helped develop the available RA therapies and are investigating new drugs on the horizon. We encourage patients with RA to contact us to participate in our growing research efforts and to become patients of our cutting edge rheumatology center.