Systemic Lupus Erythematosus (SLE)

Systemic Lupus Erythematosus (SLE)

Systemic Lupus Erythematosus, abbreviated
as SLE. This is a systemic disease, which means that
it can affect the whole body systemically. The brain, skin, heart, lungs, kidneys, joints,
the immune system, the vascular system, and the list goes on. Lupus means Wolf. Erythematosus means reddening of the skin. Why did I show a red butterfly? Because a very typical sign of SLE is a butterfly
shaped reddening of the skin. The way I remember this disease, is to imagine
a wolf that attacks a woman, and why a woman? Because 9 out 10 patients are women. So the wolf bites the face of the woman causing
a butterfly shaped erythema on her face. Then the wolf continues to bite all her organs
one by one, because this disease is a systemic disease, which means that it can affect all
the organs systemically. Of course this disease has nothing to do with
a wolf. But SLE is an autoimmune disease, which means
that this woman called Emma have an immune system that attacks her own body, instead
of only attacking bacterias, viruses and parasites. So Emma have an immune system that acts as
a wolf inside her. I will show you how we can find out if Emma
really has SLE by diagnosing her. And then we will look at what type of medications
we can give her. I want you to remember at least one thing
from this presentation. That is Systemic Lupus International Collaborating
Clinics, abbreviated as SLICC. SLICC is a criterion that can help in the
diagnosis of SLE. SLICC contains clinical criteria, immunologic
criteria and biopsy criteria. We need more than 4 criteria with at least
1 clinical and 1 immunologic. Or we need 1 biopsy criteria and 1 immunologic
criteria. So what does these 3 words mean? Clinical, Immunologic and Biopsy? The synonym for clinic, is hospital. So clinical criteria stand for the symptoms,
signs and lab values of a patient in the hospital. Immunology deals with the immune system that
protects you from bacterias, viruses, and parasites. Immunologic criteria are usually lab tests
that detect any problem with the immune system. Biopsy means that a doctor cuts out a piece
of an organ. For example, a small piece of kidney can be
cut out, and then the doctor puts this piece of kidney in a microscope and looks for diseases. Clinical criteria can be divided into Alopecia,
which means hairloss. Skin problems
Ulcers Heart diseases
Lung diseases Kidney problems
Joint pain Problems with the nervous system
And blood diseases. Skin problems can be grouped under the name
Cutaneous Lupus Erythematosus. We can divide these skin diseases into acute
Subacute And chronic, based on the timing of the diseases. Acute diseases are usually those that happen
suddenly with a short duration. Chronic diseases are ongoing for a long time. Whereas subacute means those diseases that
are not yet chronic but has passed the acute phase. A way to remember these timing are to memorize
2 numbers. 1 and 3. Why? Because the duration of acute diseases are
usually less than 1 month, subacute are 1 to 3 months, and chronic are more than 3 months
in duration. So which are the acute type of skin problems? Butterfly erythema, which is a reddening of
the face in a butterfly shape. It usually affects the cheeks or also called
malar region, and therefore it is sometimes called malar erythema. It does not affect the nasolabial region. There can also be bullous lesions which are
blisters that can be a mix of small grouped vesicles to large tense bullae. Bullae are elevating the skin and are filled
with fluid. Toxic Epidermal Necrolysis-like SLE, is a
detachment of the epidermis, the upperlayer of the skin, resulting in exfoliation, meaning
that the upperlayer just falls off. This is very dangerous, because the skin is
the organ that protects against infections. So if you loose a large part of your skin,
then Sepsis can happen, which means that bacterias easily invade your vascular system, since
there is no skin to protect you. This can lead to something called septic shock,
which can lead to death. Maculopapular rash is another acute sign. Macules are flat spots up to 1 cm, and papules
are bumps up to 1 cm. Maculopapular is a combination between macules
and papules. Photosensitivity can also be seen which means
that the skin is much more sensitive to sunlight than normally. This can cause cause solar urticaria, which
is a vascular reaction of the skin that cause pathches. Patches are flat lesions like macules, but
they are bigger than 1 cm. So one difference between macules and patches
is the size. Macules are less than 1 cm, whereas patches
are more than 1 cm. So the acute cutaneous lupus erythematosus
can be divided into 5 lesions: Butterfly shaped erythema, bullous lesions, toxic epidermal
necrolysis, maculopapular rashes, and photosensitive solar urticarias. Subacute cutaneous lupus erythematosus can
be divided into 2 types. One is Annular polycyclic lesions. The word polycyclic refers to more than 1
ring structures that can be seen in chemistry for example. The word annular also refers to a ring-shaped
structure. So annular polycyclic lesions are ring-shaped
skin lesions that usually occur on sun-exposed areas of the skin. Nonindurated psoriaform is the other type
of subacute skin lesions. Psoriaform means that it looks like psoriasis. Nonindurated means that it is not hard
as psoriasis. Subacute can be divided into annular polycyclic
and nonindurated psoriaform lesions Chronic skin lesions are Chilblain lupus,
that affects toes, fingers, nose, and ears during cold weather. These are painful, bright red nodules. Nodules means a swelling of the skin that
is up to 1 cm diameter. Discoid rash can also be seen. Discoid refers to the disc shape of these
lesions. We can divide discoid into classical type. Discoid lesions can be divided into localized,
which means that discoid lesions appear above the neck,
and generalized, which means that discoid lesions can appear both above and below the
neck. Lichen planus is an inflammatory disease that
can affect the skin and oral mucosa. Here we see a picture of whitish lichen planus
on the oral mucosa. The word lichen means tree-moss as you can
see here on the picture. So this disease is looking like a tree moss
but with a whitish color. In SLE patients this happen, that a discoid
lesion is seen together with lichen planus. Verrucous lesions or also called Hypertrophic
lesions are skin that hypertrophies, which means that the skin cells increase in number
and cause these hard wartlike lesions, especially on extensor arms. Mucosal lesions can affect the mucosal membrane
around the teeth, the tongue, and hardpalate for example. Panniculitis or also called Profundus, is
an inflammation and destruction of the subcutaneous fat. Tumidus lesions are pinkish urticarial non-scarring
plaques usually in sun-exposed areas. Plaques are elevation of the skin similar
to papule, but they differ in size. So plaques are more than 1 cm in diameter,
whereas papules are less than 1 cm. The chronic skin lesion are chilblain, discoid,
discoid with lichen planus, hypertrophic, mucosal, panniculitis, and tumidus. Ulcers can appear on the mucosal membrane,
on for example the hardpalate, buccal region, on the tongue, and on the nasal septum. Inflammation can affect the heart causing
pericarditis. Here we see a normal normal heart on the upper
picture, and a reddish heart on the lower picture. Inflammation is causing redness, pain, heat,
swelling and loss of function. The heart wall rub against each other causing
a typical pericardial rub sound that one can hear with a stethoscope. Here we see a man having a painful pericarditis
Pericardial effusion can also happen, which means that fluid accumulates around the heart
causing a typical waterbottle-shaped heart on x-ray. As I mentioned, pericardial rub sounds can
be heard with a stethoscope. Inflammation can also affect the lungs. So similar to the heart, there will be inflammation,
pain, pleural friction rub sounds, and pleural effusion
Here we can see the pleural effusion that have accumulated between the 2 layers of the
lungs. This is how pleural friction rub sounds like. Imagine walking on snow when you hear this
sound. We need to collect urine to find kidney problems. More than 500 mg of protein in the urine during
a 24 hour period can be seen in SLE patients. This is called Proteinuria, meaning protein
in the urine, which is not normal. We can also find red blood cell casts in the
urine by analyzing the urine in a microscope. These casts are formed by red blood cells
that stick together. Blood in the urine is not normal. It suggest that something is wrong with the
kidney. Synovitis is inflammation of the synovial
membrane of the joints. Polyarthritis can be seen in SLE. Poly stands for that more than 1 joint is
affected. Arthritis is inflammation of joint. So more than 1 joint will be inflamed causing
pain. The nervous system can also be affected by
SLE. Seizures can happen, which are hyperexcitation
of neurons in the brain, sometimes leading to muscle contractions. Psychosis and Acute confusional state, also
called Delirium can happen. Psychosis and Delirium patients usually suffer
from hallucinations. Neuropathies can be seen in SLE. Neuropathy means neurons that are diseased. The neurons can be in the cranial part, peripheral
part, in the spinal cord which is then called myelitis, or single nerves can be damaged
which is then called mononeuropathy, mono standing for single. Or Multiple single nerves in different areas
of the body can be damaged, which is then called Multiple Mononeuropathy. What can we see in the blood? With a microscope we can distinguish different
blood cells. Here is a picture showing the blood cells. The blood cells originate from one cell called
multipotential hematopoetic stem cell. This cell can produce myeloid cells, and lymphoid
cells. The myeloid cells can produce erythrocytes,
also called red blood cells. But in SLE hemolytic anemia can be seen, which
means that the erythrocytes can damaged and therefore anemia will happen, which means
that not enough oxygen is transported to the tissues. The myeloid cells can also produce Megakaryocytes,
that can further produce thrombocytes, also called platelets. But in SLE the number of thrombocytes can
be reduced, and we call this thrombocytopenia. penia stands for less of something, in
this case we have a penia of thrombocytes, so thrombocytopenia. The symptom of thrombocytopenia is usually
petechiae which are small purplish spots on the skin. Leukopenia can happen in SLE which is a reduced
number of leukocytes, which are white blood cells, with neutrophils being the most common
white blood cell. Lymphopenia can also be seen, which are reduced
number of lymphocytes. So the clinical criteria were alopecia, skin
lesions, ulcers, diseases of the heart, lungs, kidneys, joints, nervous system and the blood. The immunologic criteria are related to autoantibodies,
meaning that the antibodies of the immune system attacks itself, instead of only attacking
bacterias etc. Here we have a cell, with its nucleus, containing
chromosomes that contain DNA. In SLE, the antibodies attack your own nuclear
proteins, for example your own DNA, or RNA binding proteins called Smith proteins. So in SLE we check for antinuclear antibody
levels, abbreviated as ANA. We also check anti-Smith and anti-double stranded
DNA. Another immunologic criteria is direct Coombs
test. Here we mix the patients blood together with
a Coombs reagent, and if red blood cells agglutinate, meaning they stick together, then we have
a positive test result. The complement system helps or complements
the antibodies to fight infections. In SLE we can see a low number of these complement
proteins. The complement proteins are numbered C1 to
C9, and it is the C3 and C4 complement proteins that are low in SLE. CH50 stands for the total complement activity,
which is also low in SLE. An increased number of antiphospholipid antibodies
can be measured in SLE. These antibodies bind to proteins like Beta
2 glycoprotein 1 on the phospholipid cell membrane. The function of the Beta 2 glycoprotein 1
is to prevent phospholipid membrane to activate the thrombosis cascade. We know that thrombosis can cause death. So therefore it is very important to check
the antiphospolipid antibody level. It is especially important in pregnant women,
because these antibodies can cause spontaneous abortion and late fetal death. Except antiphospholipid antibodies, SLE flares
can also cause fetal death. SLE fluctuate between Flares and remissions. A Flare is a very active disease with many
symptoms, whereas a remission is an inactive state with few symptoms. During pregnancy, the mother should be monitored
for any SLE flares since these can lead to fetal death. So if a woman wants a child, then pregnancy
should be timed for when SLE is in remission for at least 6 months. Furthermore, anti-Ro antibodies should be
measured, because if anti-Ro is detected, then Doctors should warn Mothers that there
are risks of the fetus getting a neonatal lupus or even a severe congenital heart block
which means the death of the fetus. So it is very important to monitor the fetal
heart in this case, with for example an echocardiograph and a 24-hour Holter monitor. Lets turn now to the biopsy criteria. Here we need a biopsy of the kidney, which
will show that there is inflammation, called nephritis. But it is not enough with a biopsy, we need
an immunologic criteria as well, for example antinuclear antibodies, or anti-double-stranded
DNA. Now lets see how we can treat SLE patients. The first thing that we have to do is to remove
any type of medication that can cause SLE-like symptoms. These are for example Hydralazine, Procainamide,
and Isoniazid. Non-Steroidal Anti-Inflammatory Drugs are
very useful in SLE patients, especially in controling arthralgias, which means painful
joints. Here we can use Naproxen, Ibuprofen, and Diclofenac. Antimalarial medications also help joints
problems, but also skin problems, and they reduces the SLE flares. The typical SLE medication is Hydroxychloroquine,
but there are alternative like Chloroquine and Quinacrine. Hydroxychloroquine can in rare cases cause
retinal problems, skeletal muscle problems and cardiac problems. So it is important that the eyes are examined
yearly. Corticosteroids are usually the first line
treatment in acute severe SLE. We typically begin by giving intravenous methylprednisolone
for 3 days and then we maintain the therapy with prednisone. Disease-Modifying Antirheumatic Drugs are
also very important. We can use Azathioprine, methotrexate, mycophenolate
mofetil, cyclophosphamide together with Mesna, and in very severe cases intravenous immunoglobulin. It is well known that corticosteroid use for
a long time can cause osteoporosis, which means bone weakening. Therefore it is important to consider giving
calcium, vitamin D, and bisphosphonate. So to conclude, we can say that Emma has SLE,
which is a systemic autoimmune disease, that affects her whole body systemically. The brain, skin, heart, lungs, kidneys, joints,
the immune system, and the vascular system. Lupus means Wolf. Erythematosus means reddening of the skin. The typical butterfly-shaped erythema can
be seen in SLE patients. Thank you very much for listening!


  • Cristi Marjee Sutton says:

    where can I find a Doctor like you? Very enlightening. I have been diagnosed with lupus because I had impressive blood work and so many clinical markers 15 years ago. Eventually the dx was changed to UTDD, bc ANA was neg. I had developed seizures at age 37, PN, neurological symptoms, head ache, exstensive teeth problem (I now need detures at 50) pericardidis, chronic inflammation, joint pain, ridiculously sudden fatigue, malar rash, photosensitivity, eye problems, protein in urine, blood in urine, (I have had full hysorectomy at 37) rynoids sydrome, …. However.. my blood work is typically not very inpressive. I often have a very elevated sed rate, but sometimes my blood work is "fine" I went through a year and a half of remission, my current rheumatologist stated she must diagnosis me with fibromyalgia bc, despite my history, I had one lab that was good. still she is willing to give me plaqunil and possibly a biologic. she also told me no one with lupus has remissions. does this make sense to anyone???

  • Precious Chinomso says:

    I dont pay you but I pay my teachers but I must tell you ,you are really good and impact great knowledge , God bless you for making it easy for me to understand

  • Precious Chinomso says:

    I just subscribed ,anyone who dislikes your video is a total failure

  • Delia Malone says:

    Amazing!! Thank you! Really direct, simple. I'm going to watch it many times before my Optometry Boards in March!!

  • Mehr maa says:

    hello dr ! Excellent in our language zabardast! m a finl yr student lovely videos!

  • sunandakambhampati says:

    great video sir..very helpful to students and fresher doctors
    keep posting more
    thank you ๐Ÿ™‚

  • Poedji Laksono says:

    Thank You, doctor Fazakas. God Blessing You

  • Masood Ahmed says:

    v good

  • Christina Martinez says:

    thank you dr. all this information has been helpful i was diagnose with lupus at the age of 16 iam 32 now but i do have to ask i recently got sick and found out that the lupus has already has done damage to my kidneys and i have high blood pressure the dr. put me on 4 different blood pressure pills ,i was just wondering what causes high blood

  • Christina Martinez says:

    thank you

  • Kofi Mensah says:

    Doc, you're simply awesome. Keep it up!

  • Linda Nickell says:

    Thank you!!

  • Linda Nickell says:

    Does anyone out there ever have bouts of excruciating painful burning itching on the skin but no rash and seemingly nothing to biopsy. The bouts start on above the knee and travels both sides. Can last for up to three hours. There is no remedy. my Docs don't know what to do about this.

  • Chrissy Velasco says:

    In 2010, I was diagnosed as having lupus because I ache everywhere. My hands, my wrists, ankles, toes, were all swollen. I was prescribed various medications and one of them was steroid which I took every day. Two years later, my Rheumatologists said, my condition turned into rheumatoid arthritis. I was in pain, no medications helped. I was so fed up, I started doing my own research, trials, and errors and used myself as a guinea pig.

    Anyway, to cut the story short, over the following years I had put together what I had learned and practice it myself religiously. Amazingly, my condition improved each day until one day, most of my pains were disappearing. I was extremely excited that I had finally discovered a regime that not only put my arthritis into remission but also as a potential healing method that anybody with chronic illness or disease can follow to help them heal their conditions effectively.

    Not only that it put my arthritis into remission, I am now completely free from all medications. My recovery had completely transformed me in a very short period of time. Without medications and free from all kinds of inflammations, I now look 20 years younger.

    Anyone who wishes to find out more, visit links below.

  • Jacqui Armando says:

    I wish I would have seen your videos 9 yrs ago. I was diagnosed with sjogren's and SLE lupus. Then a whole lot more of health issues popped over the years. When I got diagnosed with sjogren's there wasn't that much info out there. You get diagnosed and no one really explains what you're going to face.

  • Carrie Kieler says:

    I was never biopsied, told I had, then that I didn't, my skin changed, hair color, pain everywhere (joints,muscles, nerves.),I have extreme dizziness,lost of movement in limbs, locking joints,iron deficiency, b12 deficiency, itching, hard time getting rid of a cold etc. break out in rash and gives in the sun. stutter when over stressed or do to much. whatever I have is taking over my life.

  • Carrie Kieler says:

    they took my blood it did stick together they told me I had sticky blood.

  • Akash Gupta says:

    thank you so so much. I really appreciate your efforts. it's a great video. it's really helpful. one of my close one is suffering from SLE. She is on medication and had to go for check-ups in every 2 months.

  • christina paul says:

    my mother had a systemic lupus erythematosus . so . How can i make sure that i have a genetic defect which can cause this disease or not ?

  • nj a says:

    thank you

  • Hans Timmek says:

    Well done, great video. Thank you very much.

  • Hans Timmek says:

    It is especailly great how you miss your presentation with the pictures and the "mindmap tree". Because iur brain learns in picutres! the combiation is great!

  • Alicia Lopez says:

    disculpen alguien save el link en spanish

  • pia sabekun says:

    my sister have a rear desieas which call c1q nephritis , we are living in bangladesh. we are help less and hope less. is that any possiblelity to cure?

  • naresh kumar kumar says:

    Nice sir

  • naresh kumar kumar says:

    Ultimate sirjee

  • medical ocean says:

    cool video.check out my channel
    it is a new one

  • Carolina Gonzalez S. says:

    Michael Jackson had lupus or not?.

  • Shael Singh says:

    A perfect representation of a disease! Thank you so much sir ๐Ÿ˜Š

  • Jeanette blessed says:

    Very informative thank you

  • ConwayTruckload says:

    Men get this too. I am a guy and I have SLE

  • Naza Naza says:

    hi dr i have mild plural effusion < which drug is used to remove this ? my doctor couldn't remove it for me by an injection thanks

  • My Makeup Tackle Box says:

    Very informative Dr. I need to get tested, I donโ€™t know where to start.

  • Lakhwinder Kaur says:

    Respected sir my sister suffered from sle please have any treatment possible.

  • Irildi Grazhdani says:

    Thank you doctor for the lecture.

  • Nk Gupta says:

    Thank you so much ….this is the very educational video

  • Nabeel iq says:


  • Linda Nickell says:

    When I flare it feels like a pack of wolves roaming and chewing on my body.
    Too bad the majority of doctors are working off an ancient diagnosis protocol and assumptions that a person who doesnโ€™t look sick isnโ€™t ill. Ugh. Lupus sucks!

  • Mustajab Alam says:

    Great knowledge …full of energy ….Plz upload more video's on autoimmunity

  • Misa Misa says:

    Green veggies like kale are great for us
    Dr Brooke Goldner, dr Eric Berg, Dr Bergman

  • Tracy lyn Jirak says:

    What can we do to help ourselves

  • Shabeena Shaik says:

    Sir I suffering with lupus ..wt is the treatment fr this

  • Ali Elgohary says:

    what are the programs used in this video ?you are great by the way ๐Ÿ˜€

  • Adilson Silva says:

    I love your lessons!. Thank you Dr Andras!


    Best video

  • zaki ABBAS says:

    Hey kindly can u tell me that u r belong to which country and hospital?????

  • Nour Jamil says:

    Thank you, very informative ๐Ÿ‘๐Ÿป

  • Fatimah Hasan says:

    Thank you Doctor sooo much you have amazing explanation

  • Kimberley says:

    I can't use prednisone it made me gain 120 plus pounds.

  • brb says:

    Great teaching video for patients and students! Awesome, thank you!

  • Hasan Hanifa says:

    you are soooo good

  • Madhukar Deshpande says:

    Thanks very nice information

  • Gods Soilder says:

    I have SLE Lupus….I take Prednisone for mine….I be in so much pain….my joints be hurting…. SMH…..

  • karen willis says:

    Wow this is a good way to teach this.

  • Ruyita Monzon says:

    Omg this video is just amazing! Thank you!๐Ÿ˜ญ๐Ÿ˜ญ

  • Dr.ABDUS SHAHID says:

    Excellent lecture!
    Thank you:-)

  • azhagarasan azhagarasan says:

    My sister also attack this disease.what I do

  • ansar mahmood says:

    Is this is recoverable.Maximum Treatment time .

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