Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. This means that the body's immune system, which behaves abnormally, mistakenly attacks the own healthy tissues of the affected individual and triggers an immune response as it is supposed to mount when an infectious agent invades the body. In Lupus, almost any tissue and organ can be affected. Skin, joints, kidneys, heart and brain are the most often reported affected organs. The Lupus syndrome is said to be polymorphic as symptoms vary from person to person and not all appear in everyone. Thus, some people have only skin symptoms, suffering from the so-called discoid lupus .
Depending on the organs involved, patients must see different specialists, in particular a rheumatologist, nephrologist, dermatologist, hematologist, infectious disease specialist, cardiologist, pulmonologist, high-risk obstetrician, gastroenterologist, neurologist….
Lupus is said to be multifactorial because both genetic and environmental causes (cigarettes, diet, stress, chemicals, sunlight, and certain drugs) are involved in the disease. In fact, the origin of the lupus disease is complex and still poorly understood. Likewise, the reasons for which its presentation and course are so variable are not precisely known, ranging from indolent to fulminant, and the disease follows relapsing and remitting periods that can be highly variable in time.
SLE is much more common in women than men (rate of almost 9 to 1). It may occur at any age, but appears most often in people between the ages of 15 and 45. African Americans, Asians and Hispanics are more often affected than people from other ethnicities.
In the United States, it is estimated that there are as many as 1.5 to 2 million suffering from Lupus and up to 5 million of individuals may be affected worldwide. The average annual incidence of Lupus in the US is estimated in several case studies to be between 1.8 to 7.6 cases per 100,000 people and the prevalence of SLE is estimated to be 53 per 100,000. In Northern Europe the rate is about 40 per 100,000. These figures are on the rise over years, but it is not known whether this is due to better diagnosis or to increasing frequency of the disease. .
Today, Lupus is incurable. Standard therapy given to patients with Lupus varies according to the form and intensity of the disease and can only suppress some symptoms and relieve discomfort. It generally consists of high doses of aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and/or immunosuppressive drugs. Antimalarial drugs (e.g. hydroxychloroquine) are given for pleurisy, mild kidney involvement, and inflammation of the tissue surrounding the heart. NSAIDs are given for fever, arthritis, and headache.
Thus, the main approaches available today to treating the Lupus condition include the use of relatively strong strategies to dampen down the over-stimulated immune system. Unfortunately, these options are a non-specific and can be damaging with many side effects that are well known to patients and their treating specialists.
As a result, one of the challenges is to find novel therapies or combination of therapies that are successful in treating Lupus, but also display a minimum, if any, secondary effects. A number of contrasting pathways are being pursued and current emerging strategies include classical immunosuppression, cell depletion, antigen-specific immunomodulation, and targeting of antigen-nonspecific immune-activating molecules. Multiple susceptibility genes have been recently identified that should help better define a range of newer therapeutic targets that might ultimately be beneficial to patients who are particularly at-risk from the condition.
There is clearly a need for treatments which do not involve general immunosuppression of the immune system. There is also a great deal of attention focused on new drugs that can maintain long-term control of the disease and improve the quality of life of patients with Lupus .
The following list provides a number of links to organisations and information on Lupus.
- Lupus Foundation of America
- Lupus Europe
- The US National Institure of Health National Library of Medicine Medline service
- Lupus UK
- Lupus Information from Wikipedia
- Lupus France
- World Lupus Day
- Lupus Basics from the US Centers for Disease Control and Prevention
- Lupus Erythematodes Selbsthilfegemeinschaft
- Federación Española de Lupus
- Gruppo LES Italiano