Internal illnesses. Systemic lupus erythematosus (lecture notes)

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Internal illnesses. Systemic lupus erythematosus (lecture notes)

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LECTURE No. 41. Systemic lupus erythematosus

Systemic lupus erythematosus is a chronic polysyndromic disease predominantly of young women and girls predisposed to it.

Classification (according to V. A. Nasonova). When making a diagnosis, it is necessary to separate:

1) according to the form of the course: acute, subacute, chronic, with a continuously relapsing course (malignant);

2) according to the degree of activity (see Table 6);

Table 6. Levels of activity of systemic lupus erythematosus

3) by stages: I - initial, II - generalized, III - terminal.

Clinic. When acute course characterized by an acute onset, the development of polysyndromicity over the next 3-6 months (lupus nephritis or CNS damage).

RџSЂRё subacute course the onset is gradual, arthralgia, nonspecific skin lesions are pronounced. The wave-like course is characteristic, the development of polysyndromicity within 2-3 years.

RџSЂRё chronic course for a long time there are relapses of individual syndromes, the development of polysyndromicity at the 5-10th year, the development of deforming polyarthritis at the 10-15th year.

Lupus crises- manifestations of the activity of the lupus process. Characterized by pronounced clinical polysymptomatics, changes in laboratory parameters, general trophic disorders.

Criteria for making a diagnosis (American Rheumatological Association, 1982) are rashes in the zygomatic region ("butterfly"), discoid rash, photosensitivity, ulcers in the oral cavity - mild or painless, arthritis without destruction of cartilage, two or more peripheral joints, serositis (pleurisy, pericarditis), kidney damage (persistent proteinuria, 0,5 g / day or more), neurological disorders (convulsions), hematological disorders, immune disorders, the appearance of antinuclear antibodies with an increase in their titer.

If four or more signs are present, the diagnosis is considered reliable.

Additional diagnostic study. A complete blood count is being studied (anemia, hemoglobin less than 100 g / l, normo- or hypochromic leukopenia, thrombocytopenia, an increase in ESR during exacerbations), a biochemical blood test (dysproteinemia, hypoalbuminemia, an increase in α₂-globulins in the acute period of the disease, γ-globulins in the chronic). Mandatory immunological examination of blood (LE-cells, antibodies to DNA, to native DNA, ribonucleoprotein, other nuclear substances, the study of the level of activity of the immune system: cellular, humoral, non-specific links). A general urine test is also performed (specific gravity, protein, enzyme elements, epithelium, salts), skin biopsy (morphological changes, fixed immune complexes, IgJ and IgM, complement).

Complications. Complications of the disease are chronic renal failure, pulmonary heart failure, acute adrenal insufficiency, cytopenia.

Differential diagnostics. Should be carried out with systemic scleroderma, dermatomyositis, periarteritis nodosa, rheumatic heart disease, bacterial endocarditis, rheumatoid arthritis, hemoblastosis, drug disease.

Treatment. Patients are prescribed glucocorticoids (prednisolone 50-60 mg followed by a decrease of 2,5-5 mg per week) - for many years, immunosuppressants (azathioprine 100-150 mg, 6-mercaptopurine 150-200 mg, leukeran 10-15 mg) - several months, then a maintenance dose of 50-100 mg for many months, complications may develop - leukopenia, thrombocytopenia, infectious complications (pneumonia), dyspepsia. It is possible to use pulse therapy: 1000 mg of methylprednisolone 3 days in a row or 3 times every other day in 100 ml of isotonic sodium chloride solution or 500 mg for 2 times with the addition of 5000 IU of heparin and suprastin; adjunct to conventional hormone therapy. Drugs of the 4-aminoquinoline series (chloroquine, delagil, plaquenil) are used at 0,75 g each, followed by a decrease to 0,25 g - for several years, non-steroidal anti-inflammatory drugs (butadione, indomethacin, etc.) - for several years, anticoagulants (heparin 10 -000 IU under the skin of the abdomen) - several months, antiplatelet agents (chimes 20-000 mg) - several months, plasmapheresis, hemosorption - up to 150-200 sessions.

Forecast. The prognosis of the disease is unfavorable.

Author: Myshkina A.A.

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