Systemic connective tissue disease lupus erythematosus. Systemic lupus erythematosus - causes, symptoms, diagnosis and treatment of the disease

Lupus is a fairly common autoimmune disease: in the United States, for example, it affects approximately one and a half million people. This disease affects various organs such as the brain, skin, kidneys, and joints. The symptoms of lupus are easily confused with those of other diseases, making it difficult to diagnose. It is helpful to know the symptoms and methods of diagnosing lupus so that it does not take you by surprise. You should also be aware of the causes of lupus in order to avoid potential risk factors.

Attention: The information in this article is for informational purposes only. If you experience the following symptoms, consult your doctor.

Steps

Lupus Symptoms

Check to see if you have a butterfly wing rash on your face. On average, 30 percent of people with lupus develop a characteristic rash on their face that is often said to be shaped like a butterfly or a wolf bite. The rash covers the cheeks and nose and sometimes reaches the very eyes.

• Also check to see if you have a disc-shaped rash on your face, scalp, and neck. This rash looks like red, raised patches and can be so severe that it leaves scars.
• Pay particular attention to rashes that appear or worsen with sun exposure. Sensitivity to natural or artificial ultraviolet radiation can cause a rash on sunlit areas of the body and worsen a butterfly rash on the face. This rash is more profuse and appears more quickly than with a normal sunburn.

1. Check for mouth and nasal ulcers. If you often get sores in the upper palate, at the corners of your mouth, on your gums, or in your nose, this is another warning sign. Pay particular attention to painless ulcers. As a rule, with lupus, the sores in the mouth and nose do not hurt.

   • Photosensitivity of ulcers, that is, their aggravation by exposure to sunlight, is another sign of lupus.

2. Look for signs of inflammation. People with lupus often have inflammation of the joints, lungs, and tissues around the heart (the sac around the heart). The corresponding blood vessels are usually also inflamed. Inflammation can be identified by swelling of the feet, legs, hands, and eyes.

   Pay attention to the work of the kidneys. Although it is difficult to assess the condition of the kidneys at home, it can still be done by some signs. If your kidneys are unable to filter urine due to lupus, your feet may swell. Moreover, the development of renal failure may be accompanied by nausea and weakness.

   Take a closer look at possible problems with the brain and nervous system. Lupus can affect the nervous system. Some symptoms, such as anxiety, headaches, and vision problems, are also seen in many other diseases. However, lupus can also be accompanied by very serious symptoms such as seizures and personality changes.

   • Although lupus is often accompanied by a headache, this pain is very difficult to identify this disease. Headache is a common symptom and can be caused by a variety of reasons.

3. See if you feel more tired than usual. Extreme fatigue is another sign of lupus. Although feeling tired can be caused by a variety of reasons, often these reasons are associated with lupus. If fatigue is accompanied by fever, this is another sign of lupus.

   Look for other unusual signs. Under the influence of cold, the fingers and toes can change their color (white or blue). This phenomenon is called Raynaud's disease, and it often accompanies lupus. Dry eyes and difficulty breathing are also possible. If all of these symptoms occur at the same time, you may have lupus.

   Learn about tests that use visual diagnostic methods. If the doctor suspects that lupus may have affected the lungs or heart, he may order a study that will allow you to see the internal organs. To check the condition of your lungs, you may be referred for a standard chest x-ray, while an echocardiogram will allow you to judge the health of your heart.

   • A chest x-ray sometimes shows shaded areas in the lungs, which may indicate fluid buildup or inflammation.
   • An echocardiogram uses sound waves to measure the heartbeat and look for possible heart problems.

4. Find out about the biopsy. If the doctor suspects that lupus has caused damage to the kidneys, they may order a kidney biopsy. A sample of kidney tissue will be taken from you for analysis. This will assess the condition of the kidneys, the degree and type of damage. A biopsy will help your doctor determine the best treatments for lupus.

The susceptibility of women to the disease is several times higher than that of men, which is associated with the peculiarities of the structure of the female body. The most critical age for the development of systemic lupus erythematosus (SLE) is considered to be puberty, during pregnancy and some interval after it, while the body goes through the recovery phase.

In addition, a separate category for the occurrence of pathology is considered to be children's age in the period of 8 years, but this is not a determining parameter, because the congenital type of the disease or its manifestation in the early stages of life is not excluded.

What is this disease?

Systemic lupus erythematosus (SLE, Liebman-Sachs disease) (Latin lupus erythematodes, English systemic lupus erythematosus) is a diffuse connective tissue disease characterized by systemic immunocomplex lesions of the connective tissue and its derivatives, with damage to the vessels of the microvasculature.

A systemic autoimmune disease in which antibodies produced by the human immune system damage the DNA of healthy cells, predominantly connective tissue is damaged with the obligatory presence of a vascular component. The disease got its name because of its characteristic feature - a rash on the bridge of the nose and cheeks (the affected area resembles a butterfly in shape), which, as they believed in the Middle Ages, resembles the places of wolf bites.

Story

Lupus erythematosus got its name from the Latin word "lupus" - wolf and "erythematosus" - red. This name was given because of the similarity of skin signs with lesions after being bitten by a hungry wolf.

The history of lupus erythematosus began in 1828. This happened after the French dermatologist Biett first described skin symptoms. Much later, after 45 years, the dermatologist Kaposhi noticed that some of the sick, along with skin symptoms, have diseases of the internal organs.

In 1890 It was discovered by the English physician Osler that systemic lupus erythematosus can occur without skin manifestations. The description of the phenomenon of LE- (LE) cells is the detection of cell fragments in the blood, in 1948. made it possible to identify patients.

In 1954 certain proteins were found in the blood of the diseased - antibodies that act against their own cells. This detection has been used in the development of sensitive tests for diagnosing systemic lupus erythematosus.

Causes

The causes of the disease have not been fully elucidated. Only putative factors contributing to the occurrence of pathological changes have been established.

Genetic mutations - a group of genes associated with specific immune disorders and predisposition to systemic lupus erythematosus has been identified. They are responsible for the process of apoptosis (getting the body rid of dangerous cells). When potential pests are delayed, healthy cells and tissues are damaged. Another way is the disorganization of the immune defense management process. The reaction of phagocytes becomes excessively strong, does not stop with the destruction of foreign agents, their own cells are taken for "aliens".

1. Age - the most systemic lupus erythematosus affects people from 15 to 45 years old, but there are cases that have arisen in childhood and in the elderly.
2. Heredity - cases of a family disease are known, probably transmitted from older generations. However, the risk of having an affected child remains low.
3. Race - American studies have shown that the black population is sick 3 times more often than whites, and this reason is more pronounced in native Indians, natives of Mexico, Asians, Spaniards.
4. Gender - among the known sick women are 10 times more than men, so scientists are trying to establish a connection with sex hormones.

Among the external factors, the most pathogenic is intense solar radiation. Passion for sunburn can provoke genetic changes. There is an opinion that people who are professionally dependent on activities in the sun, frost, and sharp fluctuations in environmental temperature (sailors, fishermen, agricultural workers, builders) are more likely to get systemic lupus.

In a significant proportion of patients, clinical signs of systemic lupus appear during a period of hormonal changes, against the background of pregnancy, menopause, taking hormonal contraceptives, and during a period of intense puberty.

The disease is also associated with a previous infection, although it is still impossible to prove the role and degree of influence of any pathogen (targeted work is underway on the role of viruses). Attempts to identify a link with immunodeficiency syndrome or establish the contagiousness of the disease have so far been unsuccessful.

Pathogenesis

How does systemic lupus erythematosus develop in a seemingly healthy person? Under the influence of certain factors and a reduced function of the immune system, a failure occurs in the body, in which antibodies begin to be produced against the "native" cells of the body. That is, tissues and organs begin to be perceived by the body as foreign objects and a program of self-destruction is launched.

Such a reaction of the body is pathogenic in nature, provoking the development of the inflammatory process and the inhibition of healthy cells in various ways. Most often, blood vessels and connective tissue are affected. The pathological process leads to a violation of the integrity of the skin, a change in its appearance and a decrease in blood circulation in the lesion. With the progression of the disease, the internal organs and systems of the whole organism are affected.

Classification

Depending on the area of ​​the lesion and the nature of the course, the disease is classified into several types:

1. Lupus erythematosus caused by taking certain drugs. Leads to the appearance of symptoms of SLE, which may spontaneously disappear after discontinuation of drugs. Drugs that can lead to the development of lupus erythematosus are drugs for the treatment of arterial hypotension (arteriolar vasodilators), antiarrhythmic, anticonvulsants.
2. Systemic lupus erythematosus. The disease is prone to rapid progression with damage to any organ or body system. It proceeds with fever, malaise, migraines, rashes on the face and body, as well as pains of a different nature in any part of the body. The most characteristic migraine, arthralgia, pain in the kidneys.
3. neonatal lupus. It occurs in newborns, often combined with heart defects, serious disorders of the immune and circulatory systems, abnormal development of the liver. The disease is extremely rare; conservative therapy measures can effectively reduce the manifestations of neonatal lupus.
4. Discoid lupus. The most common form of the disease is Biett's centrifugal erythema, the main manifestations of which are skin symptoms: a red rash, thickening of the epidermis, inflamed plaques that transform into scars. In some cases, the disease leads to damage to the mucous membranes of the mouth and nose. A variety of discoid is a deep Kaposi-Irgang lupus, which is characterized by a recurrent course and deep lesions of the skin. A feature of the course of this form of the disease are signs of arthritis, as well as a decrease in human performance.

Symptoms of lupus erythematosus

As a systemic disease, lupus erythematosus is characterized by the following symptoms:

• chronic fatigue syndrome;
• swelling and soreness of the joints, as well as muscle pain;
• unexplained fever;
• chest pain with deep breathing;
• increased hair loss;
• red, skin rashes on the face or discoloration of the skin;
• sensitivity to the sun;
• swelling, swelling of the legs, eyes;
• swollen lymph nodes;
• blue or whitening of the fingers, toes, being in the cold or at the time of stress (Raynaud's syndrome).

Some people experience headaches, convulsions, dizziness, depression.

New symptoms may appear years later and after diagnosis. In some patients, one system of the body suffers (joints or skin, hematopoietic organs), in other patients, manifestations can affect many organs and be multi-organ in nature. The very severity and depth of damage to body systems is different for everyone. The muscles and joints are often affected, causing arthritis and myalgia (muscle pain). Skin rashes are similar in different patients.

If the patient has multiple organ manifestations, then the following pathological changes occur:

• inflammation in the kidneys (lupus nephritis);
• inflammation of the blood vessels (vasculitis);
• pneumonia: pleurisy, pneumonitis;
• heart disease: coronary vasculitis, myocarditis or endocarditis, pericarditis;
• blood diseases: leukopenia, anemia, thrombocytopenia, risk of blood clots;
• damage to the brain or central nervous system, and this provokes: psychosis (change in behavior), headache, dizziness, paralysis, memory impairment, vision problems, convulsions.

What does lupus erythematosus look like, photo

The photo below shows how the disease manifests itself in humans.

The manifestation of symptoms of this autoimmune disease can vary significantly in different patients. However, skin, joints (mainly of the hands and fingers), heart, lungs and bronchi, as well as digestive organs, nails and hair, which become more fragile and prone to falling out, as well as the brain and nervous system.

Stages of the course of the disease

Depending on the severity of the symptoms of the disease, systemic lupus erythematosus has several stages of the course:

1. Acute stage - at this stage of development, lupus erythematosus progresses sharply, the patient's general condition worsens, he complains of constant fatigue, fever up to 39-40 degrees, fever, pain and aching muscles. The clinical picture develops rapidly, already in 1 month the disease covers all organs and tissues of the body. The prognosis for acute lupus erythematosus is not comforting and often the patient's life expectancy does not exceed 2 years;
2. Subacute stage - the rate of progression of the disease and the severity of clinical symptoms are not the same as in the acute stage, and more than 1 year may pass from the moment of the disease to the onset of symptoms. At this stage, the disease is often replaced by periods of exacerbations and persistent remission, the prognosis is generally favorable and the patient's condition directly depends on the adequacy of the prescribed treatment;
3. Chronic form - the disease has a sluggish course, the clinical symptoms are mild, the internal organs are practically not affected, and the body as a whole functions normally. Despite the relatively mild course of lupus erythematosus, it is impossible to cure the disease at this stage, the only thing that can be done is to alleviate the severity of the symptoms with medication at the time of exacerbation.

Complications of SLE

The main complications that SLE provokes are:

1) Heart disease:

• pericarditis - inflammation of the heart bag;
• hardening of the coronary arteries that supply the heart due to the accumulation of thrombotic clots (atherosclerosis);
• endocarditis (infection of damaged heart valves) due to hardening of the heart valves, accumulation of blood clots. Often, valves are transplanted;
• myocarditis (inflammation of the heart muscle), causing severe arrhythmias, diseases of the heart muscle.

2) Renal pathologies (nephritis, nephrosis) develop in 25% of patients suffering from SLE. The first symptoms are swelling in the legs, the presence of protein in the urine, blood. The failure of the kidneys to function normally is extremely life-threatening. Treatment includes strong drugs for SLE, dialysis, and a kidney transplant.

3) Blood diseases that are life-threatening.

• decrease in red blood cells (which supply cells with oxygen), white blood cells (suppress infection and inflammation), platelets (promote blood clotting);
• hemolytic anemia caused by a lack of red blood cells or platelets;
• pathological changes in the hematopoietic organs.

4) Diseases of the lungs (in 30%), pleurisy, inflammation of the muscles of the chest, joints, ligaments. The development of acute lupus erythematosus (inflammation of the lung tissue). Pulmonary embolism - blockage of the arteries by emboli (blood clots) due to increased blood viscosity.

Diagnostics

The assumption of the presence of lupus erythematosus can be made on the basis of red foci of inflammation on the skin. External signs of erythematosis may change over time, so it is difficult to make an accurate diagnosis on them. It is necessary to use a complex of additional examinations:

• general blood and urine tests;
• determination of the level of liver enzymes;
• analysis for antinuclear bodies (ANA);
• chest x-ray;
• echocardiography;
• biopsy.

Differential Diagnosis

Chronic lupus erythematosus is differentiated from lichen planus, tuberculous leukoplakia and lupus, early rheumatoid arthritis, Sjögren's syndrome (see dry mouth, dry eye syndrome, photophobia). With the defeat of the red border of the lips, chronic SLE is differentiated from the abrasive precancerous cheilitis of Manganotti and actinic cheilitis.

Since the defeat of internal organs is always similar in course to various infectious processes, SLE is differentiated from Lyme disease, syphilis, mononucleosis (infectious mononucleosis in children: symptoms), HIV infection.

Treatment of systemic lupus erythematosus

Treatment should be as appropriate as possible for the individual patient.

Hospitalization is necessary in the following cases:

• with a persistent increase in temperature for no apparent reason;
• in the event of life-threatening conditions: rapidly progressive renal failure, acute pneumonitis or pulmonary hemorrhage.
• with neurological complications.
• with a significant decrease in the number of platelets, erythrocytes or blood lymphocytes.
• in the case when the exacerbation of SLE cannot be cured on an outpatient basis.

For the treatment of systemic lupus erythematosus during an exacerbation, hormonal drugs (prednisolone) and cytostatics (cyclophosphamide) are widely used according to a certain scheme. With damage to the organs of the musculoskeletal system, as well as with an increase in temperature, non-steroidal anti-inflammatory drugs (diclofenac) are prescribed.

For adequate treatment of a disease of a particular organ, it is necessary to consult a specialist in this field.

Nutrition rules

Dangerous and harmful foods for lupus:

• a large amount of sugar;
• everything fried, fatty, salty, smoked, canned;
• products for which there are allergic reactions;
• sweet soda, energy drinks and alcoholic drinks;
• in the presence of problems with the kidneys, food containing potassium is contraindicated;
• canned food, sausages and sausages of factory preparation;
• store-bought mayonnaise, ketchup, sauces, dressings;
• confectionery with cream, condensed milk, with artificial fillers (factory jams, marmalade);
• fast food and products with non-natural fillers, dyes, rippers, taste and smell enhancers;
• foods containing cholesterol (buns, bread, red meat, high-fat dairy products, sauces, dressings and cream-based soups);
• products with a long shelf life (meaning those products that quickly deteriorate, but due to various chemical additives in the composition, they can be stored for a very long time - here, as an example, dairy products with a one-year shelf life can be included).

Eating these foods can accelerate the progression of the disease, which can lead to death. These are the maximum consequences. And, at a minimum, the dormant stage of lupus will turn into an active one, because of which all the symptoms will worsen and the state of health will worsen significantly.

Lifespan

Survival rate 10 years after the diagnosis of systemic lupus erythematosus is 80%, after 20 years - 60%. Main causes of death: lupus nephritis, neuro-lupus, intercurrent infections. There are cases of survival of 25-30 years.

In general, the quality and duration of life in systemic lupus erythematosus depends on several factors:

1. Age of the patient: the younger the patient, the higher the activity of the autoimmune process and the more aggressive the disease, which is associated with a greater reactivity of immunity at a young age (more autoimmune antibodies destroy their own tissues).
2. Timeliness, regularity and adequacy of therapy: long-term use of glucocorticosteroid hormones and other drugs can achieve a long period of remission, reduce the risk of complications and, as a result, improve the quality of life and its duration. Moreover, it is very important to start treatment even before the development of complications.
3. The variant of the course of the disease: the acute course is extremely unfavorable and after a couple of years severe, life-threatening complications may occur. And with a chronic course, and this is 90% of SLE cases, you can live a full life until old age (if you follow all the recommendations of a rheumatologist and therapist).
4. Compliance with the regimen significantly improves the prognosis of the disease. To do this, you must constantly be observed by a doctor, follow his recommendations, consult a doctor in a timely manner if any symptoms of an exacerbation of the disease appear, avoid contact with sunlight, limit water procedures, lead a healthy lifestyle and follow other rules for preventing exacerbations.

Just because you've been diagnosed with lupus doesn't mean your life is over. Try to defeat the disease, maybe not in the literal sense. Yes, you will probably be limited in some way. But millions of people with more serious illnesses live bright, full of impressions life! So you can too.

Prevention

The purpose of prevention is to prevent the development of relapses, to maintain the patient in a state of stable remission for a long time. Prevention of lupus is based on an integrated approach:

• Regular dispensary examinations and consultations with a rheumatologist.
• Taking drugs strictly in the prescribed dose and at specified intervals.
• Compliance with the regime of work and rest.
• Full sleep, at least 8 hours a day.
• Diet with limited salt and enough protein.
• Hardening, walks, gymnastics.
• The use of hormone-containing ointments (for example, Advantan) for skin lesions.
• The use of sunscreen (creams).

Systemic lupus erythematosus is a chronic autoimmune disease characterized by damage to the connective tissue and blood vessels and, as a result, the involvement of almost all organs and systems of the body in the pathological process.

In the development of systemic lupus erythematosus, hormonal disorders play a certain role, in particular, an increase in the amount of estrogens. This explains the fact that the disease is more often recorded in young women and adolescent girls. According to some data, viral infections and chemical intoxication play an important role in the occurrence of pathology.

This disease is classified as an autoimmune disease. Its essence lies in the fact that the immune system begins to produce antibodies to some kind of irritant. They adversely affect healthy cells, as they damage their DNA structure. Thus, due to antibodies, a negative change in the connective tissue and blood vessels occurs.

Causes

What causes contribute to the development of systemic lupus erythematosus, and what is this disease? The etiology of the disease is unknown. In its development, the role of a viral infection, as well as genetic, endocrine and metabolic factors, is suggested.

In patients and their relatives, lymphocytotoxic antibodies and antibodies to double-stranded RNA are found, which are markers of persistent viral infection. In the endothelium of the capillaries of damaged tissues (kidneys, skin), virus-like inclusions are detected; the virus was identified in experimental models.

SLE occurs predominantly in young (20-30 years old) women, but cases of the disease are not uncommon in adolescents and older people (over 40-50 years old). Among the sick, only 10% of men are noted, but the disease is more severe in them than in women. Provoking factors are often insolation, drug intolerance, stress; in women - childbirth or abortion.

Classification

The disease is classified according to the stages of the course of the disease:

1. Acute systemic lupus erythematosus. The most malignant form of the disease, characterized by a continuously progressive course, a sharp increase and a multiplicity of symptoms, resistance to therapy. This type of systemic lupus erythematosus often occurs in children.
2. The subacute form is characterized by the frequency of exacerbations, however, with a lesser degree of symptomatology than in the acute course of SLE. Organ damage develops during the first 12 months of the disease.
3. Chronic form characterized by a long-term manifestation of one or more symptoms. The combination of SLE with antiphospholipid syndrome in the chronic form of the disease is especially characteristic.

Also, during the course of the disease, three main stages are distinguished:

1. Minimum . There are minor headaches and joint pains, periodic fever, malaise, as well as initial skin signs of the disease.
2. Moderate. Significant damage to the face and body, involvement in the pathological process of blood vessels, joints, internal organs.
3. Expressed. There are complications from the internal organs, brain, circulatory system, musculoskeletal system.

Systemic lupus erythematosus is characterized by lupus crises, in which the activity of the disease is maximum. The duration of the crisis can be from one day to two weeks.

Symptoms of lupus erythematosus

In adults, systemic lupus erythematosus manifests itself in a large number of symptoms, which is due to damage to the tissues of almost all organs and systems. In some cases, the manifestations of the disease are limited exclusively to skin symptoms, and then the disease is called discoid lupus erythematosus, but in most cases there are multiple lesions of the internal organs, and then they talk about the systemic nature of the disease.

In the initial stages of the disease, lupus erythematosus is characterized by a continuous course with periodic remissions, but almost always goes into a systemic form. More often there is erythematous dermatitis on the face like a butterfly - erythema on the cheeks, cheekbones and always on the back of the nose. Hypersensitivity to solar radiation appears - photodermatoses are usually round in shape, are of a multiple nature.

Joint damage occurs in 90% of patients with SLE. The pathological process involves small joints, usually fingers. The lesion is symmetrical, patients are concerned about pain and stiffness. Joint deformity rarely develops. Aseptic (without an inflammatory component) bone necrosis is common. The head of the femur and the knee joint are affected. The clinic is dominated by symptoms of functional insufficiency of the lower limb. When the ligamentous apparatus is involved in the pathological process, non-permanent contractures develop, in severe cases, dislocations and subluxations.

Common symptoms of SLE:

• Soreness and swelling of the joints, muscle pain;
• unexplained fever;
• chronic fatigue syndrome;
• Rashes on the skin of the face of red color or a change in the color of the skin;
• Pain in the chest with deep breathing;
• Increased hair loss;
• Whitening or blueness of the skin of the fingers or feet in the cold or under stress (Raynaud's syndrome);
• Increased sensitivity to the sun;
• Swelling (swelling) of the legs and/or around the eyes;
• Enlarged lymph nodes.

For dermatological signs diseases include:

• Classic rash on the bridge of the nose and cheeks;
• Spots on limbs, trunk;
• Baldness;
• Brittle nails;
• Trophic ulcers.

Mucous membranes:

• Redness and ulceration (appearance of ulcers) of the red border of the lips.
• Erosions (surface defects - "corrosion" of the mucous membrane) and ulcers on the oral mucosa.
• Lupus-cheilitis is a pronounced dense swelling of the lips, with grayish scales tightly adjacent to each other.

Damage to the cardiovascular system:

• Lupus myocarditis.
• Pericarditis.
• Libman-Sachs endocarditis.
• Damage to the coronary arteries and the development of myocardial infarction.
• Vasculitis.

With damage to the nervous system The most common manifestation is asthenic syndrome:

• Weakness, insomnia, irritability, depression, headaches.

With further progression, the development of epileptic seizures, impaired memory and intelligence, psychosis is possible. Some patients develop serous meningitis, optic neuritis, intracranial hypertension.

Nephrological manifestations of SLE:

• Lupus nephritis is an inflammatory disease of the kidneys, in which the glomerular membrane thickens, fibrin is deposited, and hyaline blood clots form. In the absence of adequate treatment, the patient may develop a persistent decrease in kidney function.
• Hematuria or proteinuria, which is not accompanied by pain and does not bother the person. Often this is the only manifestation of lupus from the urinary system. Since SLE is diagnosed in a timely manner and effective treatment begins, acute renal failure develops in only 5% of cases.

Gastrointestinal tract:

• Erosive and ulcerative lesions - patients are concerned about lack of appetite, nausea, vomiting, heartburn, pain in various parts of the abdomen.
• Intestinal infarction due to inflammation of the blood vessels supplying the intestines - a picture of an "acute abdomen" develops with high-intensity pains, localized more often around the navel and in the lower abdomen.
• Lupus hepatitis - jaundice, enlarged liver.

Lung damage:

• Pleurisy.
• Acute lupus pneumonitis.
• The defeat of the connective tissue of the lungs with the formation of multiple foci of necrosis.
• Pulmonary hypertension.
• Pulmonary embolism.
• Bronchitis and pneumonia.

It is almost impossible to assume that you have lupus before a visit to the doctor. Seek advice if you develop an unusual rash, fever, joint pain, fatigue.

Systemic lupus erythematosus: photos in adults

What systemic lupus erythematosus looks like, we offer detailed photos for viewing.

Diagnostics

If systemic lupus erythematosus is suspected, the patient is referred for a consultation with a rheumatologist and dermatologist. Several systems of diagnostic signs have been developed for the diagnosis of systemic lupus erythematosus.
At present, the system developed by the American Rheumatic Association is preferred as more modern.

The system includes the following criteria:

• butterfly sign:
• discoid rash;
• the formation of ulcers on the mucous membranes;
• kidney damage - protein in the urine, casts in the urine;
• brain damage, convulsions, psychosis;
• increased sensitivity of the skin to light - the appearance of a rash after exposure to the sun;
• arthritis - damage to two or more joints;
• polyserositis;
• a decrease in the number of erythrocytes, leukocytes and platelets in a clinical blood test;
• detection of antinuclear antibodies (ANA) in the blood.
• the appearance of specific antibodies in the blood: anti-DNA antibodies, anti-Sm antibodies, false-positive Wassermann reaction, anticardiolipin antibodies, lupus anticoagulant, positive test for LE cells.

The main goal of treating systemic lupus erythematosus is to suppress the body's autoimmune reaction, which underlies all symptoms. Patients are prescribed various types of drugs.

Treatment of systemic lupus erythematosus

Unfortunately, there is no complete cure for lupus. Therefore, therapy is selected in such a way as to reduce the manifestations of symptoms, stop the inflammatory, as well as autoimmune processes.

The treatment of SLE is strictly individual and may change with the course of the disease. Diagnosis and treatment of lupus is often a joint effort between the patient and physicians of various specialties.

Modern drugs for the treatment of lupus:

1. Glucocorticosteroids (prednisolone or others) are powerful drugs that fight inflammation in lupus.
2. Cytostatic immunosuppressants (azathioprine, cyclophosphamide, etc.) are drugs that suppress the immune system and can be very helpful in lupus and other autoimmune diseases.
3. TNF-α blockers (Infliximab, Adalimumab, Etanercept).
4. Extracorporeal detoxification (plasmapheresis, hemosorption, cryoplasmosorption).
5. Pulse therapy with high doses of glucocorticosteroids and / or cytostatics.
6. Non-steroidal anti-inflammatory drugs - may be used to treat the inflammation, swelling, and pain caused by lupus.
7. symptomatic treatment.

If you suffer from lupus, there are several steps you can take to help yourself. Simple measures can make flare-ups less frequent and improve your quality of life:

1. Quit smoking.
2. Exercise regularly.
3. Stick to a healthy diet.
4. Watch out for the sun.
5. Adequate rest.

The prognosis for life in systemic lupus is unfavorable, but recent advances in medicine and the use of modern drugs give a chance to prolong life. Already more than 70% of patients live more than 20 years after the initial manifestations of the disease.

At the same time, doctors warn that the course of the disease is individual, and if in some patients SLE develops slowly, then in other cases, the rapid development of the disease is possible. Another feature of systemic lupus erythematosus is the unpredictability of exacerbations, which can occur suddenly and spontaneously, which threatens with serious consequences.

Lupus erythematosus is a systemic disease of unknown etiology and very complex pathogenesis. There are two forms of the disease: chronic lupus erythematosus or discoid, related to a benign clinical form, and the second acute or systemic lupus erythematosus, which is severe. Both forms occur with damage to the red border of the lips, as well as the oral mucosa. Separate lesions on the mucous membranes of the mouth are rare, so those who are sick often turn to the dentist for help in rare cases. The age of the diseased is within 20-40 years. Lupus erythematosus is more common among women than among men. Currently, lupus erythematosus refers to rheumatic as well as autoimmune diseases.

Case history of lupus erythematosus

Lupus erythematosus got its name from the Latin words "lupus" - wolf and "erythematosus" - red. This name was given because of the similarity of skin signs with lesions after being bitten by a hungry wolf.

The history of lupus erythematosus began in 1828. This happened after the French dermatologist Biett first described skin symptoms. Much later, after 45 years, the dermatologist Kaposhi noticed that some of the sick, along with skin symptoms, have diseases of the internal organs.

In 1890 It was discovered by the English physician Osler that systemic lupus erythematosus can occur without skin manifestations. The description of the phenomenon of LE- (LE) cells is the detection of cell fragments in the blood, in 1948. made it possible to identify patients.

In 1954 certain proteins were found in the blood of the diseased - antibodies that act against their own cells. This detection has been used in the development of sensitive tests for diagnosing systemic lupus erythematosus.

Lupus erythematosus causes

The causes of lupus erythematosus disease are sensitization to various infectious as well as non-infectious factors. One of the predisposing factors are -, or foci of chronic infection. There are confirmed studies on the genetic predisposition to this disease. To date, it is generally accepted that lupus erythematosus has a genetic predisposition that manifests itself unevenly in the dominant type. The onset of the disease and its exacerbation occurs after taking medications: sulfonamides, antibiotics, vaccines, procainamide, serums, under the influence of ultraviolet radiation, hypothermia, endocrine disorders, neuro-conflict situations. An adverse effect on the course of the disease according to the principle of a trigger mechanism is carried out by foci of sulfonamides, intercurrent diseases, and chronic infections.

A special role is assigned to neuroendocrine functional disorders that change the ratio of the level of androgens, as well as estrogens. Changes are in the direction of hyperestrogenism, as well as a decrease in the activity of the pituitary-adrenal system, leading to atrophy of the adrenal cortex.

The dependence of allergic activity and photosensitization by lupus erythematosus on the estrogenic saturation itself was revealed. Therefore, it is easy to explain the occurrence of the disease in girls, as well as young women, the ratio is eight women per man. Autoimmune pathological reactions are responsible for the development of complex disease processes.

The accumulation of a huge amount of antibodies leads to the formation of pathological immune complexes that are directed against their own proteins in the cells of the body, which in turn leads to the development of pathological processes. Therefore, lupus erythematosus has been included in the group of immune complex diseases. Various humoral and cellular antibodies are found in those suffering from any form of the disease: anticardiolipin, LE-factor, anticoagulants, antibodies to erythrocytes, leukocytes, antibodies of cellular components, such as denatured and double-stranded DNA and RNA, rheumatoid factor, histone, nucleoprotein, soluble nuclear components.

In 1948, a peculiar nucleophagoditosis was discovered, which is located in the bone marrow of patients, and the presence of a special aggressive protein, called the antinuclear factor, was established. This protein acts as an antibody to the nucleoproteins of cellular substances and is an IgG class with a 19S precipitation constant. Lupus erythematosus cells, as well as the antinuclear factor, are fixed in patients with the systemic form, but in the chronic form it is much less common. Cell pathognomonicity is relative, because they were found in patients with herpetiformis, toxicoderma, scleroderma and rheumatism.

The classification of lupus erythematosus includes systemic and integumentary forms, occurring acutely, subacutely, and chronically.

Systemic lupus erythematosus

The disease, being a disorder of the immune system, is known as an autoimmune disease. With such a flow, the body is able to produce foreign proteins to personal cells, as well as their components, while causing damage to healthy tissues and cells. Autoimmune disease is manifested in the perception of one's own tissues as foreign. This leads to inflammation, as well as damage to various tissues of the body. Manifesting in several forms, lupus erythematosus can provoke inflammation of the muscles, joints, and other parts of the body. Being a severe acute, systemic disease, it manifests itself with the following symptoms: high body temperature, adynamia, muscle and joint pain. It is characterized by the addition of diseases - endocarditis, polyserositis, glomerulonephritis, polyarthritis. Blood tests show the following: increased ESR, leukopenia, anemia. Systemic lupus erythematosus is acute, subacute, and chronic. During the period of exacerbation and depending on the pathology, skin-articular, neurological, renal, gastrointestinal, cardiovascular, hematological, hepatic clinical varieties of the disease are diagnosed.

Systemic lupus erythematosus shows mucosal changes in 60% of patients. The mucous membrane of the palate, gums, cheeks are hyperemic with edematous spots, sometimes having a hemorrhagic character, as well as blisters of various sizes, turning into erosion with a purulent-bloody coating. The skin has spots of hyperemia, in rare cases blisters and swelling appear. Skin lesions are the earliest, most common symptoms of systemic lupus erythematosus. A typical location is the face, torso, neck, limbs.

photo of lupus erythematosus on the face

Sometimes an erysipelas-like form or a typical "butterfly" is observed in a patient, which is characterized by sharp swelling, saturated red skin color, the presence of blisters and multiple erosions, which are covered with hemorrhagic or serous-purulent crusts. The skin of the trunk, as well as the extremities, may have similar lesions.

Systemic lupus erythematosus and its symptoms are characterized by progression, as well as the gradual attachment of various tissues and organs to the process.

Discoid lupus erythematosus

Consider the symptoms of discoid lupus erythematosus. The disease usually begins with symptoms of the disease, which are expressed in the spread of a rash on the skin of the face (nose, forehead, cheeks), auricles, red border of the lips, scalp, and other parts of the body. Able to develop isolated inflammation of the red border of the lips. In this case, the oral mucosa is rarely affected. Skin lesions are characterized by a triad of signs:, erythema and. The whole process takes on a staged course.

The first (erythematous) stage manifests itself in up to two edematous, pink, contoured spots that change in size towards an increase. There are telangiectasias in the center. Slowly increasing and also merging, the rash visually resembles a butterfly. In this case, the wings are located on the cheeks, and the back on the nose. The appearance of spots in parallel is accompanied by tingling and burning in the affected area.

The second stage (hyperkeratotic-infiltrative), in which the lesions infiltrate and turn into a discoid, dense plaque, on the surface of which grayish-white, small and tightly seated scales protrude. Further, the plaque undergoes keratinization and becomes a grayish-white hue. The plaque itself is surrounded by a rim of hyperemia.

The third stage is atrophic, in which an area of ​​cicatricial white atrophy is observed in the center of the plaque. The plaque takes the form of a saucer, with clear boundaries of hyperkeratosis and multiple telangiectasias. At the same time, it is closely soldered to nearby tissues, and there is infiltration along the periphery, as well as hyperpigmentation. Sometimes the site of cicatricial atrophy resembles a tree-like form, expressed as straight, white stripes, without interweaving. Rarely, the focus of hyperkeratosis approaches in resemblance to the rays of a flame. This process is characterized by pathological progression and the appearance of new elements of the lesion.

The course of chronic (discoid) lupus erythematosus drags on for long years with exacerbations in warm weather. The erosive-ulcerative form of the disease, located on the red border of the lips, is capable of becoming malignant, therefore this variety is referred to as an optional precancer. As for the histological picture of the lesion on the mucous membranes of the mouth, as well as the lips, it is characterized by the presence of parakeratosis, alternating with hyperkeratosis, atrophy and acanthosis. The erosive-ulcerative form is characterized by epithelial defects, severe edema and inflammation.

Discoid lupus erythematosus is often characterized by damage to the oral mucosa. Lesions contain the appearance of whitish or delimited bluish-red plaques in the center with erosions.

Lupus erythematosus with lesions of the mucous membranes of the mouth, as well as the red border of the lips, proceeds with pain and burning, which intensifies at the time of eating and talking.

The red border of the lips marks four varieties of the disease: erosive-ulcerative, typical, with the absence of severe atrophy; deep.

photo of discoid lupus erythematosus

What is SLE

This is the same systemic lupus erythematosus or simply "lupus", but an abbreviated version of SLE. SLE affects many organs in the body. These are joints, heart, skin, kidneys, lungs, brain, blood vessels. Manifesting in several forms, lupus erythematosus can provoke inflammation of the muscles, joints, and other parts of the body. SLE is classified as a rheumatic disease. People with this disease have a wide variety of symptoms. The most common include (swollen joints), excessive fatigue, skin rashes, unexplained fever, and kidney problems. Currently, systemic lupus erythematosus is listed as an incurable disease, but the symptoms of the disease can be controlled by treatment, so many people with this disease lead a healthy and active life. Exacerbations of SLE are characterized by deterioration, as well as the occurrence of inflammation of various organs. The Russian classification identifies three stages: the first is minimal, the second is moderate, and the third is pronounced. At present, intensive research is being carried out in understanding the development and treatment of the disease, which should lead to a cure.

Lupus erythematosus symptoms

As a systemic disease, lupus erythematosus is characterized by the following symptoms:

- swelling and soreness of the joints, as well as muscle pain;

- Chest pain with deep breathing;

- unexplained fever;

- red, skin rashes on the face or discoloration of the skin;

- increased hair loss;

- blue or whitening of the fingers, on the legs, being in the cold or at the time of stress ();

- sensitivity to the sun;

- swelling, swelling of the legs, eyes;

- swollen lymph nodes.

New symptoms may appear years later and after diagnosis. In some patients, one system of the body suffers (joints or skin, hematopoietic organs), in other patients, manifestations can affect many organs and be multi-organ in nature. The very severity and depth of damage to body systems is different for everyone. The muscles and joints are often affected, causing arthritis and myalgia (muscle pain). Skin rashes are similar in different patients.

If the patient has multiple organ manifestations, then the following pathological changes occur:

- inflammation in the kidneys (lupus nephritis);

- damage to the brain or central nervous system, and this provokes: (change in behavior), dizziness, paralysis, memory impairment, vision problems, convulsions;

- inflammation of the blood vessels (vasculitis);

- blood diseases: leukopenia, anemia, thrombocytopenia, risk of blood clots;

- heart disease: coronary vasculitis, myocarditis or endocarditis, pericarditis;

- inflammation of the lungs: pleurisy, pneumonitis.

Lupus erythematosus diagnosis

It is possible to diagnose the disease in the presence of foci of lupus erythematosus on the skin. If isolated lesions are found, for example, on the oral mucosa, or only on the red border of the lips, diagnostic difficulties can arise. To prevent this from happening, additional research methods are used (immunomorphological, histological, luminescent diagnostics). Wood's rays, directed at areas of hyperkeratosis, focused on the border of the lips, shine with a snow-blue or snow-white light, and the mucous membrane of the mouth gives off a white glow, like stripes or dots.

Chronic lupus erythematosus should be distinguished from the following diseases:, tuberculous lupus, and also. When the lesions are concentrated on the lips, lupus erythematosus is differentiated from Manganotti's precancerous cheilitis and actinic cheilitis.

Acute (systemic) lupus erythematosus is diagnosed after examination of the internal organs and determination of LE cells in the blood and bone marrow - lupus erythematosus cells. Most patients with lupus erythematosus have a secondary immunodeficiency.

Lupus erythematosus treatment

First of all, treatment includes a thorough examination and elimination of any existing chronic infection. Drug treatment starts with the introduction of drugs of the quinoline series (Delagil, Plaquenil, Plaquenol). Small doses of corticosteroids are recommended: Triamcinolone (8-12 mg), Prednisolone (10-15 mg), Dexamethasone (1.5-2.0 mg).

Effective in the use of vitamins B2, B6, B12, ascorbic and nicotinic acid. With existing immunity disorders, immunocorrective drugs are prescribed: Decaris (levamisole), Timalin, Taktivin. The expressed phenomena of hyperkeratosis are treated with intradermal injections of 5-10% solution of Rezokhin, Hingamine or Hydrocortisone solution. Local treatment includes corticosteroid ointments: Lorinden, Flucinar, Sinalar, Prednisolone ointment.

How else to treat lupus erythematosus?

Treatment of the erosive-ulcerative form is carried out with corticosteroid ointments containing antibiotics, as well as antimicrobial agents (Locacorten, Oxycort).

Systemic lupus erythematosus and its treatment includes a hospital stay, while the course of treatment must be continuous and long. At the beginning of treatment, high doses of glucocorticoids are indicated (60 mg of Prednisolone, increasing to 35 mg in 3 months, by 15 mg after 6 months). Then the dose of Prednisolone is reduced, switching to a maintenance dose of Prednisolone up to 5-10 mg. Prevention in violation of mineral metabolism includes potassium preparations (Panangin, Potassium Chloride, 15% Potassium Acetate solution).

Having eliminated the acute course of systemic lupus erythematosus, combined treatment with corticosteroids, as well as aminoquinoline drugs (Delagil or Plaquenil at night), is carried out.

Lupus erythematosus and systemic lupus erythematosus are different names for the same disease.

The term "systemic lupus erythematosus" is a corruption of the commonly used variant of the name "systemic lupus erythematosus".

Doctors and scientists prefer the fuller term "systemic lupus erythematosus" to refer to a systemic autoimmune disease, since the reduced form "lupus erythematosus" can be misleading. This preference is due to the fact that the name "lupus erythematosus" is traditionally used to refer to tuberculosis of the skin, which is manifested by the formation of red-brown bumps on the skin. Therefore, the use of the term "lupus erythematosus" to refer to a systemic autoimmune disease requires clarification that this is not about skin tuberculosis.

Describing an autoimmune disease, we will use the terms "systemic lupus erythematosus" and simply "lupus erythematosus" in the following text to designate it. In this case, it must be remembered that lupus erythematosus refers to systemic autoimmune pathology, and not skin tuberculosis.

Autoimmune lupus erythematosus

Lupus erythematosus - what is this disease?

Connective tissue is important for all organs, since it is in it that blood vessels pass. After all, the vessels do not pass directly between the cells of the organs, but in special small, as it were, "cases" formed precisely by the connective tissue. Such layers of connective tissue pass between areas of various organs, dividing them into small lobes. At the same time, each such lobule receives a supply of oxygen and nutrients from those blood vessels that pass along its perimeter in "cases" of connective tissue. Therefore, damage to the connective tissue leads to disruption of the blood supply to areas of various organs, as well as to a violation of the integrity of the blood vessels in them.

With regard to lupus erythematosus, it is obvious that damage by antibodies to connective tissue leads to hemorrhages and destruction of the tissue structure of various organs, which causes a variety of clinical symptoms.

Lupus erythematosus is more common in women, and according to various sources, the ratio of sick men and women is 1:9 or 1:11. This means that for one man with systemic lupus erythematosus, there are 9-11 women who also suffer from this pathology. In addition, it is known that lupus is more common in representatives of the Negroid race than in Caucasians and Mongoloids. People of all ages, including children, get sick with systemic lupus erythematosus, but most often the pathology first manifests itself at the age of 15-45. Lupus is extremely rare in children under 15 years of age and adults over 45 years of age.

There are also known cases neonatal lupus erythematosus when a newborn child is born already with this pathology. In such cases, the child fell ill with lupus in the womb, which itself suffers from this disease. However, the presence of such cases of transmission of the disease from mother to fetus does not mean that women suffering from lupus erythematosus necessarily have sick children. On the contrary, usually women with lupus carry and give birth to normal healthy children, since this disease is not infectious and cannot be transmitted through the placenta. And the cases of the birth of children with lupus erythematosus, mothers who also suffer from this pathology, indicate that the predisposition to the disease is due to genetic factors. And therefore, if the baby receives such a predisposition, then he, while still in the womb, suffering from lupus, falls ill and is born already with a pathology.

The causes of systemic lupus erythematosus are currently not reliably established. Doctors and scientists suggest that the disease is polyetiological, that is, it is caused not by any one reason, but by a combination of several factors acting on the human body in the same period of time. Moreover, probable causative factors can provoke the development of lupus erythematosus only in people who have a genetic predisposition to the disease. In other words, systemic lupus erythematosus develops only in the presence of a genetic predisposition and under the influence of several provoking factors at the same time. Among the most likely factors that can provoke the development of systemic lupus erythematosus in people who have a genetic predisposition to the disease, doctors highlight stress, long-term viral infections (for example, herpes infection, infection caused by the Epstein-Barr virus, etc.), periods of hormonal restructuring of the body, prolonged exposure to ultraviolet radiation, taking certain medications (sulfonamides, antiepileptic drugs, antibiotics, drugs for the treatment of malignant tumors, etc.).

Although chronic infections can contribute to the development of lupus erythematosus, the disease is not contagious and does not belong to tumor. Systemic lupus erythematosus cannot be contracted from another person, it can only develop on an individual basis if there is a genetic predisposition.

Systemic lupus erythematosus occurs in the form of a chronic inflammatory process that can affect both almost all organs and only some individual tissues of the body. Most often, lupus erythematosus occurs as a systemic disease or in an isolated skin form. In the systemic form of lupus, almost all organs are affected, but the joints, lungs, kidneys, heart, and brain are most affected. Cutaneous lupus erythematosus usually affects the skin and joints.

Due to the fact that the chronic inflammatory process leads to damage to the structure of various organs, the clinical symptoms of lupus erythematosus are very diverse. However any form and variety of lupus erythematosus is characterized by the following general symptoms:

• Soreness and swelling of the joints (especially large ones);
• Prolonged unexplained fever;
• Rashes on the skin (on the face, on the neck, on the trunk);
• Chest pain that occurs when you take a deep breath or exhale;
• Sharp and severe blanching or blueness of the skin of the fingers and toes in the cold or in a stressful situation (Raynaud's syndrome);
• swelling of the legs and around the eyes;
• Enlargement and soreness of the lymph nodes;
• Sensitivity to solar radiation.

For lupus the presence of not all symptoms at once is characteristic, but their gradual appearance over time. That is, at the beginning of the disease, only some symptoms appear in a person, and then, as lupus progresses and more and more organs are affected, new clinical signs join. So, some symptoms may appear years after the development of the disease.

Women with lupus erythematosus can have a normal sex life. Moreover, depending on the goals and plans, you can both use contraceptives, and vice versa, try to get pregnant. If a woman wants to endure pregnancy and give birth to a child, then she should register as early as possible, since lupus erythematosus increases the risk of miscarriage and premature birth. But in general, pregnancy with lupus erythematosus proceeds quite normally, albeit with a high risk of complications, and in the vast majority of cases, women give birth to healthy children.

Currently systemic lupus erythematosus is not completely curable. Therefore, the main task of treating the disease, which doctors set for themselves, is to suppress the active inflammatory process, achieve stable remission and prevent severe relapses. For this, a wide range of drugs are used. Depending on which organ is most affected, various drugs are selected for the treatment of lupus erythematosus.

The main drugs for the treatment of systemic lupus erythematosus are glucocorticoid hormones (for example, Prednisolone, Methylprednisolone and Dexamethasone), which effectively suppress the inflammatory process in various organs and tissues, thereby minimizing the degree of their damage. If the disease has led to damage to the kidneys and the central nervous system, or the functioning of many organs and systems is disrupted at once, then in combination with glucocorticoids, immunosuppressants are used to treat lupus - drugs that suppress the activity of the immune system (for example, Azathioprine, Cyclophosphamide and Methotrexate).

In addition, sometimes in the treatment of lupus erythematosus, in addition to glucocorticoids, antimalarial drugs are used (Plaquenil, Aralen, Delagil, Atabrine), which also effectively suppress the inflammatory process and maintain remission, preventing exacerbations. The mechanism of the positive action of antimalarial drugs in lupus is unknown, but in practice it is well established that these drugs are effective.

If a person with lupus erythematosus develops secondary infections, they are given immunoglobulin. If there is severe pain and swelling of the joints, then, in addition to the main treatment, it is necessary to take drugs from the NSAID group (Indomethacin, Diclofenac, Ibuprofen, Nimesulide, etc.).

A person suffering from systemic lupus erythematosus must remember that This disease is lifelong., it cannot be cured completely, as a result of which you will have to constantly take any medications in order to maintain a state of remission, prevent relapses and be able to lead a normal life.

Causes of lupus erythematosus

Thus, doctors and scientists came to the conclusion that lupus develops only in people who have a genetic predisposition to the disease. Thus, the main causative factor is conditionally considered the genetic characteristics of a person, since without a predisposition, lupus erythematosus never develops.

However, in order for lupus erythematosus to develop, one genetic predisposition is not enough; additional long-term exposure to certain factors that can trigger the pathological process is also necessary.

That is, it is obvious that there are a number of provoking factors that lead to the development of lupus in people who have a genetic predisposition to it. It is these factors that can be conditionally attributed to the causes of systemic lupus erythematosus.

Currently, doctors and scientists to the provoking factors of lupus erythematosus include the following:

• The presence of chronic viral infections (herpetic infection, infection caused by the Epstein-Barr virus);
• Frequent bacterial infections;
• stress;
• The period of hormonal changes in the body (puberty, pregnancy, childbirth, menopause);
• Exposure to ultraviolet radiation of high intensity or for a long time (the sun's rays can both provoke a primary episode of lupus erythematosus, and lead to an exacerbation during remission, since under the influence of ultraviolet it is possible to start the process of producing antibodies to skin cells);
• Skin exposure to low temperatures (frost) and wind;
• Taking certain medications (antibiotics, sulfonamides, antiepileptic drugs and drugs for the treatment of malignant tumors).

Drugs, which are one of the causative factors of lupus, can cause both the disease itself and the so-called lupus syndrome. At the same time, in practice, it is the lupus syndrome that is most often recorded, which in its clinical manifestations is similar to lupus erythematosus, but is not a disease, and disappears after the drug that caused it is discontinued. But in rare cases, drugs can also provoke the development of their own lupus erythematosus in people who have a genetic predisposition to this disease. Moreover, the list of drugs that can provoke lupus syndrome and lupus itself is exactly the same. So, among the drugs used in modern medical practice, the following can lead to the development of systemic lupus erythematosus or lupus syndrome:

• amiodarone;
• Atorvastatin;
• Bupropion;
• Valproic acid;
• voriconazole;
• Gemfibrozil;
• Hydantoin;
• Hydralazine;
• Hydrochlorothiazide;
• Glyburide;
• Griseofulvin;
• Guinidin;
• Diltiazem;