Systemic Lupus Erythematosus (SLE)

What is Systemic Lupus Erythematosus (SLE)?

Systemic lupus erythematosus (lupus) is a chronic autoimmune disease in Singapore that occurs when your body’s immune system targets its own tissues and organs. It is a complex condition that can affect multiple organs, such as the skin, joints, kidneys, blood cells, heart, lungs, brain and intestines.

The condition follows a pattern of relapses and remissions, where individuals may experience active phases of the disease known as flares, followed by symptom-free periods referred to as quiescent or inactive states of disease. As a result, long-term care and regular medical follow-ups with a rheumatologist are crucial to monitor disease activity and ensure timely treatment to prevent organ damage.

What causes Systemic Lupus Erythematosus?

The exact cause of systemic lupus erythematosus is not fully understood. A common theory for the cause of lupus relates to apoptosis or cell death. Usually, when a cell dies, it is removed by the body. However, in individuals with autoimmune disorders, these dead cells may not be cleared as efficiently– believed to result from a combination of genetic, environmental, and hormonal factors. These dead cells trigger the immune system to produce autoantibodies, which attack healthy cells and tissues of the body, resulting in multiorgan involvement in lupus.

While these factors are associated with an increased risk of developing lupus, not everyone exposed to them will develop the disease. Lupus is a complex condition with variations from person to person, and research is ongoing to understand its causes and how to manage it effectively.

What are the common symptoms of Systemic Lupus Erythematosus in Singapore?

Each case of lupus is unique, and no two cases are identical. Symptoms of systemic lupus erythematosus can manifest suddenly (acute) or develop gradually, ranging from mild to severe and life-threatening. Many individuals with lupus have periods of worsening symptoms, known as flares, which can improve or even completely resolve with treatment. The course of the disease is unpredictable, underscoring the importance of long-term treatment and follow-up care. Here are some common symptoms of lupus:

• Fatigue: lupus-related fatigue can be extreme and persistent.
• Fever: lupus can cause recurrent low-grade fevers.
• Weight loss: unintended weight loss may occur as a lupus-related symptom.
• Joint pain: you may find yourself experiencing stiffness, pain and swelling in multiple joints, often on both sides of your body.
• Skin rashes: butterfly-shaped facial rash on the face that covers the cheeks and bridge of the nose (malar rash) worsens upon sun exposure are common.
• Sensitivity to sunlight (photosensitivity): exposure to UV light can trigger or worsen skin rashes and other symptoms you experience.
• Hair loss: you may experience hair thinning and hair loss.
• Mouth and nose ulcers: painful sores may develop inside your mouth or on the nasal passages.
• Raynaud’s phenomenon: some individuals with lupus may also develop Raynaud’s phenomenon, where your fingers and toes turn white or blue when exposed to cold or stress.
• Chest pain: inflammation of the lining of the heart or lungs can cause pain during deep breathing, resulting in shallow breathing and breathlessness.
• Kidney problems: lupus can lead to inflammation in your kidneys, resulting in swelling around the eyelids, swelling of the feet and legs and reduction in urine output
• Blood disorders: anaemia (low red blood cell count), low white blood cell count, or low platelet count are possible.
• Neurological symptoms: lupus rarely affects the nervous system. You may experience headaches, behavioural changes, psychosis, strokes, and even seizures.
• Gastrointestinal issues: lupus can cause inflammation of the gut, liver and pancreas, resulting in non-specific symptoms such as abdominal pain, nausea, and diarrhoea.

If you suspect you have systemic lupus erythematosus or are experiencing any of the symptoms mentioned above, make an appointment with Asia Arthritis Rheumatology Clinic today.

Is Systemic Lupus Erythematosus painful?

Systemic lupus erythematosus can be painful. Pain is a variable and distressing aspect of this autoimmune disease.

The pain in lupus typically stems from inflammation and can affect various parts of the body. Joint pain is a common complaint, often described as achy, stiff, swollen, and tender. This pain can move from one joint to another.

Individuals with lupus may also experience muscle pain, chest pain, abdominal pain or headaches, depending on the organ involved. Lupus-related pain can range from mild to severe and often fluctuates.

Who is at risk of Systemic Lupus Erythematosus in Singapore?

Genetic, environmental, and hormonal factors influence the risk of developing systemic lupus erythematosus. In Singapore, lupus can affect anyone, but several risk factors are associated with the condition. Risk factors for systemic lupus erythematosus include:

• Gender: women are nine to ten times more likely to have lupus than men.
• Age: lupus can occur at any age, but most are diagnosed in their 20s to 30s.
• Ethnicity: Asians are at a higher risk of developing lupus and commonly exhibit more severe disease symptoms compared to Caucasians.
• Family history: relatives of people with lupus have a greater chance of developing lupus. First-degree relatives (mother, father, brother, sister) of people with lupus have an eightfold to ninefold risk of having lupus compared to the general public.
• Genetics: certain genes are associated with an increased risk of developing lupus.
• Environmental factors: exposure to certain environmental triggers such as ultraviolet light (sunlight), infections, certain medications, and stress, can contribute to the development of lupus.
• Hormonal influence: lupus is more common in women of childbearing age, suggesting a hormonal link. Oestrogen, a female hormone, might be associated with lupus development.
• Immune system dysfunction: the immune system loses its ability to differentiate between foreign invaders (like bacteria or viruses) and the body's healthy tissues. This results in the immune system attacking various organs and tissues, causing inflammation and damage.

How is Systemic Lupus Erythematosus diagnosed?

Diagnosing systemic lupus erythematosus can be complex and typically requires the expertise of a rheumatologist. To reach a diagnosis, your rheumatologist will conduct the following:

• Medical history: your rheumatologist will discuss your medical history and ask you about the symptoms you are experiencing. This can include joint pain, skin rashes, fatigue, fever, and other manifestations of systemic lupus erythematosus. This detailed history-taking is crucial in making a diagnosis of lupus.
• Physical examination: a physical exam is conducted to look for specific clinical signs such as skin rashes, oral ulcers, joint swelling and other physical signs that can suggest systemic lupus erythematosus or any other underlying medical condition.
• Laboratory tests (blood and urine tests) include:
  • Full blood count - to measure your red blood cells, white blood cells and platelet levels, as a low level often occurs in lupus.
  • Erythrocyte Sedimentation Rate (ESR) – a non-specific inflammatory marker, which is raised in many diseases, including lupus. It is a good measure of disease activity, and as your condition improves, your ESR drops.
  • Kidney function test – to assess kidney function
  • Urine examination – an examination of urine may show an increase in red blood cells or protein levels. This can occur if lupus has affected your kidneys.
  • Antinuclear antibody (ANA) – a general antibody marker in the blood which is present in lupus or other autoimmune diseases. About 5-8% of normal people can have a slightly raised ANA antibody test. These ANA levels also increase with age, thereby increasing the rate of an incorrectly positive test as a person gets older. Therefore, the ANA test is most useful when the result is negative, which essentially rules out the diagnosis of lupus.
  • Anti-ds DNA antibody – this test is often done together with the ANA test. Patients with lupus and kidney involvement often have raised anti-dsDNA antibody levels.
• Imaging tests: in some cases, imaging tests such as X-rays or ultrasounds, CT or MRI scans may be used to assess potential organ damage caused by systemic lupus erythematosus, especially in the case of joint or organ involvement.
• Biopsy: if your rheumatologist suspects organ involvement (such as your kidney or skin), a biopsy may be recommended to confirm lupus involvement.

Diagnosing systemic lupus erythematosus may take time, as symptoms vary widely and can mimic other conditions. Early detection and management are crucial in effectively treating lupus and preventing organ damage.

What are the treatment options for Systemic Lupus Erythematosus in Singapore?

Treating systemic lupus erythematosus involves a multidisciplinary approach to manage symptoms, prevent flares, and minimise organ damage. Treatment is often tailored according to your signs, symptoms and organ involvement. Choosing the appropriate medications involves a thorough discussion of the pros and cons with a rheumatologist. To effectively manage lupus, your rheumatologist might suggest more potent medications at higher doses in the beginning, but as the disease flare diminishes, the dosage can typically and gradually and cautiously be reduced. Some common treatment options include:

• Medications:
  • Nonsteroidal Anti-inflammatory Drugs (NSAIDs) to manage fever, muscle aches, joint pain and swelling
  • Antimalarial drugs like hydroxychloroquine to control symptoms and prevent flares.
  • Corticosteroids to reduce inflammation during flares.
  • Immunosuppressive drugs to suppress overactive immune response. Some of these drugs include mycophenolate mofetil, azathioprine or cyclophosphamide.
  • Biologics and monoclonal antibodies in some cases, such as rituximab or belimumab.
• Lifestyle modifications: Maintaining a healthy lifestyle, which includes regular exercise, a balanced diet, and stress management and adequate rest, can help to reduce the risk of lupus flares and overall well-being. Additionally, avoid triggers like sun exposure by wearing sunscreen and UV-protected clothing.
• Regular monitoring: close follow-up with your rheumatologist is essential for ongoing care and medication adjustments.
• Preventive measures: vaccinations and preventive medications may be recommended to reduce the risk of infections, as individuals with systemic lupus erythematosus are more susceptible.

Treatment plans are highly individualised and tailored to each patient's specific needs. Regular appointments with your rheumatologist are crucial to managing systemic lupus erythematosus effectively.

If you suspect you have systemic lupus erythematosus or are experiencing related symptoms, you can consult Dr Annie Law, a Senior Consultant Rheumatologist with a subspeciality in systemic lupus erythematosus for a proper diagnosis and tailored treatment plan.

Frequently Asked Questions