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Systemic lupus erythematosus

Category: Illness or disabilities

Type

Involuntary

Introduction and description

All the paintings on this page are by Edward Atkinson Hornel
see below for more details
 

Systemic lupus erythematosus (SLE), also known simply as lupus, is classified by the medical profession as an autoimmune disease in which and I quote “the body’s immune system mistakenly attacks healthy tissue in many parts of the body”.

Given that the symptoms may be mild to severe, that life expectancy is lower among people with SLE, and that SLE significantly increases the risk of cardiovascular disease, with this being the most common cause of death, one would have thought this is indeed a silly thing for the immune system to do. 

But of course, this diagnosis is only believed by those who consider the human body to be an accident of Darwinian evolution.  Those who believe the human body is a perfectly designed work of art and engineering, do not for one moment think this is an autoimmune disease.  They think there is a cause – a pathogen – a virus, bacteria, fungus, parasite or toxin of some sort that is attacking the person, and it just hasn’t been identified, because doctors treat symptoms and not causes.

Whatever is attacking the person it can clearly cause heart disease, as such – given that heart disease can be caused by viruses, bacteria and parasites, for example, any of the pathogens above could be a cause.

Rates of disease vary between countries from 20 to 70 per 100,000. Women of childbearing age are affected about nine times more often than men. While it most commonly begins between the ages of 15 and 45 a wide range of ages can be affected. Those of African, Caribbean, and Chinese descent are at higher risk than white people. Rates of disease in the developing world are unclear. Lupus is Latin for wolf as in the 18th century it was thought to be caused by a wolf's bite.  

Symptoms

 

The immune system is having to fight very hard against this pathogen [or pathogens] – it is clearly a formidable adversary - as the symptoms are all the ones one expects from major immune system battles – the swelling of the blood vessels, for example, in order that the immune system’s ‘troops’ can get to the scene of the invasion, visible on the surface of the skin as a red rash, but felt in the joints and muscles too as the blood vessels press against nerves. 

While SLE can occur in both males and females, it is found far more often in women and the symptoms associated with each sex are different [Wikipedia]”. A strange statement – if there are different symptoms why give it the same name? 

  • Females tend to have a greater number of relapses, a low white blood cell count, more arthritis, Raynaud's phenomenon, and psychiatric symptoms.
  • Males tend to have more seizures, kidney disease, serositis (inflammation of tissues lining the lungs and heart), skin problems, and peripheral neuropathy.
 

On the whole we could be dealing with several pathogens here, not just one, which attack the body differently.  This also tells us that the pathogen can get everywhere, including the brain.  One aspect of this disease is severe damage to the epithelial cells of the blood–brain barrier.

  • Joints and lymph system problems - this pathogen appears to like to hide in the joints - common symptoms include painful and swollen joints.  It also appears to be able to get into the lymph system, as another symptom is swollen lymph nodes – a symptom which is indeed not good news.
  • Brain problems - A common neurological disorder people with SLE have is headache.  Other common neuropsychiatric manifestations of SLE include “cognitive dysfunction, mood disorder, cerebrovascular disease, seizures, polyneuropathy, anxiety disorder, and psychosis. Steroid psychosis can also occur as a result of treating the disease”.  The pathogen has entered the brain.
  • Fever - is also a common symptom.  Fever can be used by the immune system to fight certain sorts of viruses but warmth helps the immune system too, as it opens the blood vessels to full capacity and thus makes it easier for the immune system to get to the sites of attack more quickly.
  • Tiredness - The person frequently feels tired.  This is partly due to the effort the body has to make to fight formidable invaders, but tiredness is often a way for the body to tell the person to stop what they are doing and sleep.  Rest and sleep are great healers, as the body has nothing else to do during sleep [a busy brain uses a lot of energy], except defrag your muddled brain and heal you.
  •  
    Heart problems - The person can get chest pain as the pathogen attacks the heart.  A person with SLE may have inflammation of various parts of the heart, such as inflammation of the fibrous sac surrounding the heart, heart muscle, and inner lining of the heart.
  • Breathing problems - The person can have breathing difficulties.  Inflammation of the pleurae known as pleurisy can damage the lungs, reducing its volume.  “Other associated lung conditions include pneumonitis, chronic diffuse interstitial lung disease, pulmonary hypertension, pulmonary emboli, and pulmonary haemorrhage”.  These are known to be caused by pathogens.
  • Kidney problems – there may be passage of blood or protein in the urine. “Acute or chronic renal impairment may develop, leading to acute or end-stage kidney failure, end-stage renal failure occurs most frequently in black people, where the risk is many times higher.
  • Skin problems - And where the pathogen reaches the skin, mouth and the scalp there can be hair loss, mouth ulcers,  and a red rash which is most commonly on the face.
  • Reproductive system problems - SLE causes an increased rate of fetal death in utero and spontaneous abortion (miscarriage). Pregnancy outcome appears to be worse in people with SLE.  Whatever the pathogen is, it can be passed to the infant as ‘Neonatal lupus’ is the occurrence of SLE in an infant born from a mother with SLE, most commonly presenting with a rash and sometimes with systemic abnormalities such as heart block or enlargement of the liver and spleen.  SLE in women can cause vaginal ulcers.
  • Blood circulatory system disorders - Anaemia is common in children with SLE and develops in about 50% of cases, a possible indicator that the pathogen is attacking the kidneys and possibly the liver.  “Low platelet and white blood cell counts may be due to the disease or a side effect of pharmacological treatment [sic]”.

Anaemia … may be the result of impaired erythropoietin production by kidneys involved in the SLE, or gastrointestinal blood loss from anti-inflammatory therapy, increased red cell destruction from hypersplenism or a drug-induced immune phenomenon. We briefly review the important processes that can lead to a low hemoglobin in children with SLE, their clinical features and their treatment.  PMID:  2133750

Often there are periods of illness, called flares, and periods of remission when there are few symptoms.  The flares are likely to be caused by times of stress, cold, lack of sleep and poor nutrition all of which compromise the immune system enabling the pathogen to emerge again and start the attack.

Cause

The following example causes provide you with an indication of the types of pathogen that can cause SLE.  We have given some example bacteria, viruses and so on, but it is clear that this does not provide a complete list, many more could be implicated.  There does appear to be a link with latency – the ability of a pathogen to lie low and then re-emerge later, sometimes much later.  For example a very small child may be able to go through its childhood relatively symptom free, but as adolescence approaches the symptoms emerge, and the pathogen could have been passed on by the mother.

Bacteria - TB

 

One of the possible pathogens may be the bacteria that causes tuberculosis. 

Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis (MTB). Tuberculosis generally affects the lungs, but can also affect other parts of the body.  Prevention of TB has been via vaccination with the bacillus Calmette-Guérin vaccine.  In countries where tuberculosis is common one dose is recommended in healthy babies as close to the time of birth as possible.  Side effects are more common and potentially more severe in those with poor immune function. It is not safe for use during pregnancy. The vaccine was originally developed from Mycobacterium bovis which is commonly found in cows. While it has been weakened, it is still live.  Furthermore, this bacteria is a latent bacteria, it can sit in the body and emerge later.  To this can be added the additional problem that antibiotic resistance is a growing problem with increasing rates of multiple drug-resistant tuberculosis (MDR-TB).  In effect via antibiotics and vaccines, we have introduced completely new strains of the tuberculosis bacteria.

One-third of the world's population is thought to be infected with TB. New infections occur in about 1% of the population each year.  In 2014, there were 9.6 million cases of active TB which resulted in 1.5 million deaths. More than 95% of deaths occurred in developing countries.  About 80% of people in many Asian and African countries test positive while only 5–10% of people in the United States population tests positive.  This may tie in with the finding that those of African, Caribbean, and Chinese descent are at higher risk than white people.

Systemic lupus erythematosus (SLE) patients are at increased risk of developing tuberculosis (TB), particularly extrapulmonary TB (ExP-TB)……. We retrospectively reviewed and compared the frequency of ExP-TB, in particular OA-TB, in patients with SLE at a tertiary hospital in South Africa, ….TB was diagnosed 111 times in 97 (17%) of the 568 SLE patients. …. While the relative frequency of ExP-TB was lower in the SLE group compared to the control group, our findings suggest that SLE patients are at particular risk of developing OA-TB. PMID:  19246552

 

Or another way of looking at it, is that it is one cause.

Bacteria – syphilis

There are case studies on PubMed that show that the symptoms of SLE are often co-morbid with those of syphilis. 

It appears that the tests for syphilis in this form are inadequate, as the following case history shows. 

This may indicate that new strains of syphilis are emerging, or that the symptoms of syphilis are not being correctly diagnosed, or that syphilis is capable of producing SLE like symptoms.  Or all three.

A 47-year-old man presented with fever, a maculopapular rash of the palms and soles, muscular weakness, weight loss, faecal incontinence, urinary retention and mental confusion with 1 month of evolution. Neurological examination revealed paraparesis and tactile hypoesthesia with distal predominance, and no sensory level. Laboratory investigations revealed a venereal disease research laboratory (VDRL) titre of 1/4 and Treponema pallidum haemagluttin antigen (TPHA) of 1/640, positive anti-nuclear antibodies of 1/640 and nephrotic proteinuria (3.6 g/24 h). Lumbar puncture excluded neurosyphilis, due to the absence of TPHA and VDRL. The diagnosis of systemic lupus erythematosus (SLE) was established … A diagnosis of secondary syphilis was also established  PMID:  26045520

Pharmaceuticals

Wikipedia
Drug-induced lupus erythematosus is a (generally) reversible condition that usually occurs in people being treated with pharmaceuticals. … symptoms of drug-induced lupus generally disappear once the medication that triggered the episode is stopped. More than 38 medications can cause this condition, the most common of which are procainamide, isoniazid, hydralazine, quinidine, and phenytoin

If you go to this eHealthme LINK  , you will find, if you scroll down, a section entitled, Drugs that could cause Systemic Lupus Erythematosus.  This provides you with an up-to-date list of all the drugs that have shown themselves capable of causing SLE.  The list is derived from Adverse Drug reports submitted by doctors to the FDA and SEDA in the USA.  Significantly more than 38.

 

Food Allergies

There is a definite link between SLE and food allergy, particularly gluten.  Other food allergens and food additives may also be implicated

Case reports and case series have indicated a possible association between celiac disease (CD) and systemic lupus erythematosus (SLE)…. Our objective was to investigate the association between CD and SLE using a community-based approach in a real-life population database.  The study included 5018 patients with SLE and 25,090 age- and sex-matched controls. The prevalence of CD was significantly higher in patients with SLE than in controls … Also, SLE was associated with CD (OR 3.92, 95% CI 2.55-6.03, p<0.001) in a multivariate logistic regression model.  PMID:  27295421

Viruses

Research has found that Lupus is associated with the viruses parvovirus B19, Epstein-Barr virus, and cytomegalovirus.  There is evidence that infection with these viruses is associated with a higher risk of numerous .. diseases especially dermatomyositis, systemic lupus erythematosus, rheumatoid arthritis, Sjögren's syndrome and multiple sclerosis. EBV is the human herpes virus 4 and is caught by the oral transfer of saliva and ‘genital secretions’.

The hepatitis family of viruses is also implicated in SLE.  The following paper is for hepatitis B, but there are also papers for hepatitis C and others.

The association between hepatitis B and autoimmune disorders has been intriguing for decades. Many reports have speculated on the possible linkage between these two conditions, yet never before data driven from a large national database was utilized in order to investigate this issue. The objective of this study was to investigate the association between SLE and hepatitis B carrier state. In a multivariate logistic regression analysis, SLE was significantly associated with hepatitis B…. Patients with SLE have a greater proportion of hepatitis B carrier state than matched controls.  PMID:  27423436

Other viruses may be implicated. There are papers that implicate the human papillomavirus (HPV).  In this rather intriguing paper, the Varicella zoster virus is implicated.  The person had SLE [cause not investigated] was given immunosuppressants and the VCV emerged in its full glory

Varicella is a typical acute exanthematous viral infection caused by varicella-zoster virus (VZV). In recent years, as far as hepatic dysfunction caused by viruses other than the hepatitis virus is concerned, there …. [is a report of] an immunocompromized adult following treatment for Systemic lupus erythematosis. (SLE) in Japan. PMID:  9621571

 

Toxins

Again, there is evidence that toxins of various sorts can cause SLE.  One toxin may be aluminium.  Here we have a paper that not only supports the fact that toxins are implicated, but adds some hope to the afflicted that treatment may be possible:

We present the case of a 42-year-old woman with lupus nephritis accompanied by periods of exacerbation of SLE, with necrotic-like skin lesions, psoriatic arthritis without skin psoriasis, purpura of the lower limb, petechial rash, joint pain, fever, eyelid edema with bilateral conjunctival hyperemia and itching. The patient underwent a dialytic treatment of hemodiafiltration with endogenous reinfusion. The technique uses the super-high-flux membrane Synclear 02 (SUPRA treatment) coupled with an adsorbent cartridge that has affinity for many toxins and mediators. Fever and joint pain were immediately reduced after treatment and, subsequently, there was a notable reduction of the skin damage.  …. SUPRA coupled with an adsorption may be a promising new technique for the treatment of lupus nephritis.    PMID:  26034748

It is worth noting that this poor woman was also on immunosuppressants and they were stopped. 

Nutritional deprivation

Vitamin deficiency has been associated with SLE, but Vitamin D deficiency in particular because it regulates the immune system.  In one study, serum concentration of 25(OH)D(3) in SLE patients during the warm season was significantly decreased as compared with that of the control group, but the cold season was found to be a real risk factor for vitamin D deficiency  [PMID:  22065093]

and

Systemic lupus erythematosus (SLE) is a disease with multi-organ inflammation, ….. Regulatory T cells have been reported as deficient in number and function in SLE patients. However, some authors also described an enrichment of this cell type. The hypothesis that certain forms of SLE may result from a conversion of Treg cells into a Th17 cell phenotype has been suggested by some studies. In fact, in SLE patients' sera, the IL-17 levels were observed as abnormally high when compared with healthy individuals. Environmental factors, such as vitamin D, that is considered a potential anti-inflammatory agent, … have been associated with the SLE phenotype…We assessed 24 phenotypically well-characterized SLE patients. All patients were screened before vitamin D supplementation and 3 and 6 months after the beginning of this treatment. …. In conclusion, this study demonstrated that vitamin D supplementation provided favourable, immunological and clinical impact on SLE.  PMID:  27423437

Parasites

Parasites have been found in people with SLE, and indeed could be a cause, but what complicates studies is that very often the person with the SLE has been given immunosuppressants.  This means that with a suppressed immune system, the person can catch anything, and the parasite may have entered the body and thrived after the medication was given, not before.

Visceral leishmaniasis is an infection with an insidious and disabling course caused by parasites of the genus Leishmania. ….. A 60 year-old Caucasian woman with Systemic lupus erythematosus presented with a one-year history of fever, malaise, weakness and weight loss.
Full-body CT scan revealed massive hepatosplenomegaly. Microbiology investigation was negative for the most common pathogens, including tuberculosis. There were no signs of hematologic malignancy in the bone marrow smear. PCR for Leishmania infantum was positive both in blood and bone marrow. The patient was treated and immunosuppression was adjusted. She showed rapid clinical improvement and 6 months later had no signs of disease.  PMID:  26793472

‘Adjusted’ means stopped.

Fungal infection

Fungal infection in SLE is a symptom, but it is very unclear as to whether it is also a cause:

Systemic lupus erythematosus (SLE) can manifest with arthralgia and myalgia, and, in severe cases, disorganization of the joints and tendon rupture. Further, Raynaud's phenomenon and other circulatory problems such as vasculitis have been reported, and may be associated with loss of sensation and ulcers. Associated with impaired peripheral neurovascular function there is the potential for changes in tissue viability leading to thinning of the skin or callus formation. ….. resistance to infections may be reduced, such as fungal infection of the skin and nails, bacterial infection associated with wounds and viral infections such as verruca.   PMID:  27264548

In other words, if a person has SLE, they may get treated with an immunosuppressant, this suppresses the immune system and as a consequence they get fungal infections.  They also tend to die.  So the cause is the medication – the immunosuppressant - not the fungal infection:

To study the prevalence, risk factors, and mortality of invasive fungal infections (IFI) in patients with childhood-onset systemic lupus erythematosus (cSLE).  A retrospective multicenter cohort study was performed in 852 patients with cSLE from 10 pediatric rheumatology services.  IFI were observed in 33/852 patients (3.9%) with cSLE. Proven IFI was diagnosed in 22 patients with cSLE, probable IFI in 5, and possible IFI in 6. Types of IFI were candidiasis (20), aspergillosis (9), cryptococcosis (2), and 1 each disseminated histoplasmosis and paracoccidioidomycosis.   To our knowledge, this is the first study to characterize IFI in patients with cSLE. We identified that disease activity and current glucocorticoid use were the main risk factors for these life-threatening infections, mainly in the first years of disease course, with a high rate of fatal outcome.  PMID:  26568586

Treatment

 

Conventional medical treatment

There is no medical cure for SLE, simply because the medical profession do not know or even investigate the cause.  If you don’t know the cause of something you can never cure something, all you can ever provide is palliative treatment.

Unfortunately the palliative treatment being offered by the medical profession is indeed unhelpful.  Treatments may include NSAIDs, and corticosteroids/immunosuppressants.  Immunosuppressants suppress the immune system.  Given that this illness is caused by a pathogen, this might be seen to be a somewhat unwise course of action.  It is more than likely the symptoms will disappear for a while, because the symptoms being experienced are the side effects of the battle between your immune system and the pathogen, but of course without an immune system, the pathogen will spread and depending on the pathogen you will succumb sooner rather than later to another illness which appears to be unrelated to the SLE.  The doctor at this stage will say you have heart disease, for example, and you will not associate it with a pathogen allowed to roam your body at will because of the SLE medication he has given you.

Alternative treatment

FIND THE CAUSE.

In particular get yourself tested for food allergens, not just for the presence of bacteria or viruses. 

Meanwhile keep as warm as possible, as cold compromises the immune system.  Eat fresh organic food and try to boost your immune system with Vitamin C containing food.  Remember the doctor may say you have an ‘autoimmune disease’, but the immune system needs to be helped, not flattened.  Sleep, sleep long hours, rest when tired, relax, let your body help you to heal by allowing it to work unhindered.  Go outside in the sun if you are vitamin D deprived, fresh air, sun and gentle exercise boost the vitamin D levels and also the immune system.  Don’t take supplements, the researchers use supplements so they can measure the result of trials; you have no need to spend your hard earned pennies on them.

 

References and further reading

  • QJM. 2009 May;102(5):321-8. doi: 10.1093/qjmed/hcp015. Epub 2009 Feb 26.  Osteoarticular tuberculosis in patients with systemic lupus erythematosus. - Hodkinson B1, Musenge E, Tikly M.
  • BMJ Case Rep. 2015 Jun 4;2015. pii: bcr2015209824. doi: 10.1136/bcr-2015-209824.  Lupus or syphilis? That is the question!  Duarte JA1, Henriques CC2, Sousa C3, Alves JD1.
  • Autoimmun Rev. 2016 Aug;15(8):848-53. doi: 10.1016/j.autrev.2016.06.003. Epub 2016 Jun 11. All disease begins in the gut: Celiac disease co-existence with SLE. Dahan S1, Shor DB2, Comaneshter D3, Tekes-Manova D4, Shovman O1, Amital H5, Cohen AD6.
  • Immunol Res. 2016 Jul 16. [Epub ahead of print]  Hepatitis B carrier state among SLE patients: case-control study.  Gendelman O1,2, Mahroum N1,2, Comaneshter D3, Rotman-Pikielny P4, Cohen AD3,5, Amital H6,7, Sherf M8,9.
  • Immunol Res. 2016 Jul 16. [Epub ahead of print]  Vitamin D supplementation effects on FoxP3 expression in T cells and FoxP3+/IL-17A ratio and clinical course in systemic lupus erythematosus patients: a study in a Portuguese cohort.Marinho A1,2, Carvalho C3, Boleixa D3, Bettencourt A3, Leal B3, Guimarães J3,4, Neves E4, Oliveira JC5, Almeida I3,6, Farinha F3,6, Costa PP3, Vasconcelos C3,6, Silva BM3.
  • Musculoskeletal Care. 2016 Jun;14(2):110-5. doi: 10.1002/msc.1119. Epub 2015 Sep 7.  An Investigation into the Scale and Impact of Self-Reported Foot Problems Associated with Systemic Lupus Erythematosus: A Study Protocol and Survey Questionnaire Development.  Williams AE1, Cherry L2, Blake A3, Alcacer-Pitarch B4, Edwards C2, Hopkinson N5, Vital E4, Teh LS6.
  • J Rheumatol. 2015 Dec;42(12):2296-303. doi: 10.3899/jrheum.150142.  A Multicenter Study of Invasive Fungal Infections in Patients with Childhood-onset Systemic Lupus Erythematosus.  Silva MF1, Ferriani MP1, Terreri MT1, Pereira RM1, Magalhães CS1, Bonfá E1, Campos LM1, Okuda EM1, Appenzeller S1, Ferriani VP1, Barbosa CM1, Ramos VC1, Lotufo S1, Silva CA2.
  • IDCases. 2015 Sep 30;2(4):102-5. doi: 10.1016/j.idcr.2015.09.006. eCollection 2015.  Visceral leishmaniasis in a patient with systemic lupus erythematosus.  Santos Silva AF1, Figueiredo Dias JP1, Nuak JM1, Rocha Aguiar F2, Araújo Pinto JA2, Sarmento AC1.
  • Case Rep Nephrol Dial. 2015 Apr 22;5(1):106-12. doi: 10.1159/000381395.  Radical improvement of signs and symptoms in systemic lupus erythematosus when treated with hemodiafiltration with endogenous reinfusion dialysis.  Solano FG1, Bellei E2, Cuoghi A2, Caiazzo M3, Bruni F1.
 

 The paintings

The paintings on this page are by Edward Atkinson Hornel (1864–1933), a Scottish painter of landscapes, flowers, and foliage, with children.

He was born in Bacchus Marsh, Victoria Australia, on 17 July 1864 of Scottish parents, and he was brought up and lived practically all his life in Scotland after his family moved back to Kirkcudbright in 1866. 

Something cheering to help ease the gloom of SLE.

 

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