Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder, which is characterized by production of autoantibodies against nuclear antigens, against factors of coagulation system and a wide spectrum of clinical manifestations. The prevalence varies between 12 and 50 cases per 100 000, as it is higher in USA compared with Europe and differs in different ethnic groups. There is a female predominance with female to male ratio 9-10:1 and peak age of onset among young women between late teens and the age of 40. These age-related differences are associated with hormonal changes. No single cause of SLE is identified, but a number of aetiologic factors has been noticed to cause SLE exacerbations such as sun light and drugs. Sunlight is the most obvious environmental factor, that may cause SLE flare not only as a skin lesions at sun-exposed areas, but also immunologic and visceral activation. SLE is a disease of women in child-bearing age and there are data about SLE exacerbation during exogenous oestrogen intake.
SLE is sometimes called the “great imitator” because of its wide variety of symptoms, which may mimick a number of other pathologic conditions. It may present with constitutional symptoms (e. g., fever, hair loss, lymphadenopathy etc.) as well as with organ involvement; skin, joint, kidney, vascular, kidney and central nervous system pathology being the most common. Complications in SLE are caused by the disease itself and also by the treatment. The main complications, which are also main causes of mortality in SLE are infections, premature atherosclerosis, coronary heart disease, corticosteroid induced disorders (diabetes, hypertension, osteoporosis, avascular bone necrosis), malignancies. Proper interpretation of the signs of the disease activity and its complications is still a challenge for practising physicians.
The treatment of SLE is adjusted according to the clinical form of the disease and the disease activity and includes corticosteroids at different dose, including pulse therapy; antimalarial drugs, immunosuppressants, etc. Currently, administration of biologic drugs in SLE patients marks a new era in the modern rheumatology. The monoclonal antibody belimumab, a B-lymphocyte stimulator–specific inhibitor has been found to reduce disease activity and possibly decrease the number of severe flares and steroid use in patients with SLE when used in combination with standard therapy. B-cell depletion with rituximab has been used successfully for rheumatoid arthritis, but studies have shown contradictory results for the treatment of SLE.
Of note, some non-pharmacological treatments such as plasma exchange are still underused due to the insufficient data from controlled studies.
Affecting most commonly women at child-bearing age, the management of SLE during pregnancy poses particular challenge to the rheumatologists.
Based on these data and the personal experience of the authors, the intention of this proposal for a special issue of American Journal of Medicine Studies is to discuss some specific clinical aspects of the disease, to analyse the recent advances in the treatment as well as some more specific issues such as the application of plasma exchange and management of pregnant SLE patients. This up-to-date collection of practical issues will provide summarized knowledge about challenging clinical aspects of SLE and its treatment and will underline topics for further research.