Hospital pediatrics. Systemic lupus erythematosus (most important)

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Hospital pediatrics. Systemic lupus erythematosus (most important)

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25. Systemic lupus erythematosus

Systemic lupus erythematosus - This is a chronic polysyndromic disease of connective tissue and blood vessels, which develops due to a genetically determined imperfection of immunoregulatory processes.

Etiology- The significance of a viral infection against the background of genetically determined immunity disorders is assumed.

Family genetic predisposition, girls and women get sick more often. Provocative factors: insolation, pregnancy, abortion, childbirth, the onset of menstrual function, infections (especially in adolescents), drug or post-vaccination reactions.

Clinic. The disease begins gradually, with recurrent polyarthritis and asthenia. Less common is an acute onset (high fever, dermatitis, acute polyarthritis). Subsequently, a relapsing course is observed. Polyarthritis, polyarthralgia are an early symptom of the disease. Damage to small joints of the hands, wrists, ankles, and less commonly, knee joints. Erythematous rashes on the skin of the face in the form of a “butterfly”, in the upper half of the chest in the form of a décolleté, and on the extremities are also a characteristic sign of systemic lupus erythematosus. Polyserositis, dermatitis, polyarthritis - diagnostic triad. Characterized by damage to the cardiovascular system with the development of pericarditis, which is accompanied by myocarditis. Lung damage may be associated with the underlying disease in the form of lupus pneumonitis, manifested by cough, shortness of breath, and moist rales on auscultation in the lower parts of the lungs. When examining the gastrointestinal tract, aphthous stomatitis is revealed, dyspeptic syndrome and anorexia develop. Damage to the reticuloendothelial system manifests itself in the form of enlargement of all groups of lymph nodes, enlargement of the liver, and spleen.

Every fifth patient with nephrotic syndrome may have systemic lupus erythematosus and damage to the neuropsychic sphere in patients may develop in all phases of the disease.

In the initial stage, asthenovegetative syndrome is diagnosed, then characteristic signs of damage to the central and peripheral nervous system appear in the form of encephalitis, polyneuritis, myelitis. Very rarely, epileptiform seizures can develop. Diagnosis based on clinical and laboratory data, which are of particular diagnostic value, determines a large number of LE cells, high titers of antibodies to DNA, especially to native DNA, to deoxyribonucleoprotein, Sm antigen.

Treatment- Non-steroidal anti-inflammatory drugs and aminoquinoline derivatives are indicated. Nonsteroidal anti-inflammatory drugs are prescribed for articular syndrome. Immunosuppressants, B vitamins, ascorbic acid during the spring-autumn course. Patients are prescribed treatment in local sanatoriums (cardiological, rheumatological). Climatic-balneological, physiotherapeutic treatment is contraindicated, since ultraviolet irradiation, insolation and hydrotherapy can cause an exacerbation of the disease.

Author: Pavlova N.V.

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