SLE: Symptoms, Diagnosis, and Treatment Options

SLE (Systemic Lupus Erythematosus)

Hello, Director Gao.
I am 33 years old and have been experiencing various illnesses and unexplained pains over the past few years, but no cause has been identified.
I have also consulted a psychiatrist and taken medication without improvement (suspected autonomic nervous system dysfunction).
I am unsure if my condition and blood test results could indicate systemic lupus erythematosus (SLE) and whether I should change my consultation to a different specialty, as I originally consulted dermatology.
Thank you.

I have lost 20% of my body weight this year, am experiencing severe fatigue and hair loss, poor memory, anemia, and intermittent proteinuria.
I have had episodes of diarrhea (sudden onset lasting one to two weeks, then returning to normal multiple times), and I experience joint and muscle pain in different areas at irregular intervals.
My body temperature remains between 37.3-38.0°C.

The current examination reports are as follows:
1.
Anti-Cell Antibody (ANA pattern 2) AC-1: Nuclear homogeneous 1:80
2.
Anti-Cell Antibody Disease Association: AC-1: dsDNA Ab is associated with SLE.
AC-4: Anti-SSA/SSB Ab is associated with SLE and Sjögren's syndrome.
Anti-Mi2, TIF1-gamma, and TIF1-beta Ab are associated with dermatomyositis/polymyositis.
However, a low titer of 1:80 was tested, and follow-up ANA testing is recommended in 3-6 months.
When clinically indicated, we strongly suggest testing for dsDNA Ab, anti-SSA/SSB Ab, and myositis-specific Ab to determine such specificities.
3.
Anti-Cell Antibody Antigen Associations: AC-4: SS-A/Ro, SS-B/La, Mi-2, TIF1γ, TIF1β, Ku; AC-1: dsDNA, nucleosomes, histones
4.
Anti-Cell Antibody: Positive
5.
Anti-Cell Antibody (ANA result): Positive
6.
Anti-Cell Antibody (ANA pattern 1) AC-4: Nuclear fine speckled 1:80
7.
Anti-Cell Antibody (Cytoplasm result): Negative
8.
Anti-Cell Antibody (Mitotic result): Negative
eGFR: 201.13
Eosinophil count: 84

Ting, 30~39 year old female. Ask Date: 2023/12/28

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
A slight fever can still be concerning, and I recommend visiting a rheumatologist.
Based on the information you provided, it is not possible to confirm whether there is an issue with your immune system, so it would be best for a physician to examine you in person.
The Allergy, Immunology, and Rheumatology Department at Changhua Hospital, Ministry of Health and Welfare, is here to support you.

Reply Date: 2023/12/28

More Info

Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease that can manifest with a wide range of symptoms, making diagnosis and management challenging. Your symptoms, including fatigue, weight loss, joint and muscle pain, and the presence of protein in your urine, are indeed concerning and warrant further investigation.

Symptoms of SLE
SLE can present with various symptoms, which may include:
- Fatigue: A common complaint among SLE patients, often debilitating.

- Joint Pain: Arthralgia or arthritis is prevalent, affecting multiple joints.

- Skin Rashes: The classic "butterfly rash" across the cheeks and nose, as well as discoid lesions.

- Fever: Low-grade fevers can occur, often related to disease activity.

- Renal Involvement: Proteinuria or hematuria may indicate lupus nephritis, a serious complication.

- Neurological Symptoms: Cognitive dysfunction, headaches, and mood disorders can occur.

- Hematological Issues: Anemia, leukopenia, and thrombocytopenia are common.

Diagnosis of SLE
The diagnosis of SLE is based on a combination of clinical symptoms and laboratory findings. The American College of Rheumatology (ACR) has established criteria that include:
1. Malar rash
2. Discoid rash
3. Photosensitivity
4. Oral ulcers
5. Arthritis
6. Serositis (pleuritis or pericarditis)
7. Renal disorder (proteinuria or cellular casts)
8. Neurological disorder (seizures or psychosis)
9. Hematological disorder (hemolytic anemia, leukopenia, or thrombocytopenia)
10. Immunological disorder (anti-dsDNA, anti-Smith, or antiphospholipid antibodies)
11. Positive antinuclear antibody (ANA)
You mentioned positive ANA with a homogenous pattern and the presence of anti-dsDNA antibodies, which are strongly associated with SLE. The presence of anti-SSA/SSB antibodies may also indicate a risk for Sjögren's syndrome, which can co-occur with SLE.

Treatment Options
Management of SLE is tailored to the individual, focusing on controlling symptoms and preventing flares. Treatment options may include:
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): For joint pain and inflammation.

- Antimalarials: Hydroxychloroquine is commonly used for skin and joint symptoms.

- Corticosteroids: Used for more severe manifestations or flares.

- Immunosuppressants: Medications like azathioprine or mycophenolate mofetil may be used for significant organ involvement.

- Biologics: Belimumab is a newer option for patients with active SLE.

Follow-Up and Monitoring
Given your symptoms and laboratory findings, it is crucial to follow up with a rheumatologist who specializes in autoimmune diseases. Regular monitoring of kidney function, blood counts, and disease activity is essential to adjust treatment as needed.

Conclusion
Your symptoms and lab results suggest a possible diagnosis of SLE, but a thorough clinical evaluation by a specialist is necessary to confirm this and rule out other conditions. It is important to communicate openly with your healthcare provider about your symptoms and concerns, as this will help guide your treatment plan effectively. If you feel overwhelmed, consider bringing a list of questions to your appointments to ensure all your concerns are addressed.

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