We are exposed to an enormous number of microorganisms and foreign agents all the time. Our immune system safeguards us against these foreigners as they may be detrimental to our body’s health. The immune system is empowered with the capacity to discriminate between self and non-self. Non-self substances may be toxins, microbes, etc. and the term self refers to our own body cells tissues and organs, etc. immune system is an intricate multi-component system that has the capacity to retaliate and hit back on any foreign substance that maybe cause harm to the human body.
Imagine if the custodian of the body’s health perpetrates, repels, and runs a riot and starts killing the body’s self-tissues, organs, and cells, leading to serious complications. Yes! It happens and is termed “auto-immune disease”. Lupus erythematosus, commonly known as Lupus is a chronic and lifelong auto-immune disease in which the immune system runs wild destroying cells and tissues, and organs if left untreated. This results in inflammation of the site where the immune system exerts its deleterious effects. Lupus is a lifelong disease and does not subside with time unlike most diseases which are acute and symptoms resolve after some time. Inflammation is not site restricted but generalized and seen in multiple locations, for example, joints blood, lungs, skin, heart, brain, and kidneys and it can be anywhere in the body.
Most people develop the mild disease but serious symptoms and complications have been seen in large proportions of Lupus cases. The whole gamut of anomalies prevails including an increase in body temperatures, fatigue, joint and mussels pain, body aches, chest pain, headache, shortness of breath, chronic dry eyes, skin lesion, confusion, loss of memory, and rashes including a butterfly on the face.
Great work has been done and is still underway to investigate the cause of the disease, the factors that influence the chances of getting the auto-immune disease are environmental, genetic, hormones, infections, and medications. Thus, Lupus is a multifactorial disorder. Among the environmental factors, ultraviolet rays certain medications traumas, viruses, and physical and mental stem have been reported to be important as facilitators of lupus or any other auto-immune disease.
Lupus of four types has been identified, cuteanous lupus (only confined to the skin), systemic lupus (SLE is the most common type of lupus), erythematosus, DIL (drug-induced), and neonatal (is rare and seen in neonates bone to diseased mothers) . In this essay, we’ll focus on SLE, as it happened to be the most common type of Lupus.
As mentioned earlier, SLE is a chronic disease and it affects various organ systems, it happens primarily due to the deposition and formation of autoantibodies and the complexities of the immune system that leads to ultimate organ damage. The production of hyperactive B cells that results from T-cells and antigen stimulation is increased by the antibodies against antigens which are uncovered on the surface of apoptotic cells. The antigens triggering T-cell and B-cell stimulation in patients with SLE can be accredited to the improper disposal of apoptotic skin cells. Along the way of cellular death, bits of material form on the surface of the perishing cell. Antigens which were absent on the cellular surface are now present on the surface, they are normally embedded within the cellular material. Anionic and Nucleosome phospholipids are common examples of antigens that potentially trigger an immune response and have been recognized in patients with SLE.
The impaired functioning of phagocytic cells compromises the removal of these apoptotic cells and consequently resulting in the disposal of antigen recognition in patients with SLE. The development of SLE is thought to be associated with T-lymphocyte when it is introduced to an antigen-presenting cell (APC). The main histocompatibility complex (MHC) portion of the APC hemmed in with the T-cell receptor leads to cytokine release, B-cell stimulation, and inflammation. The tissue damage in SLE is caused by the stimulation of B-cell division and the production of immunoglobulin G (IgG) autoantibodies. Autoantigen-specific T cells and B cells interact and produce injurious autoantibodies in unhealthy individuals. Antinuclear antibodies (ANAs) are among the many autoantibodies identified in SLE that directly attack the nuclear components of the cells. In the process of diagnosis, the detection of antinuclear antibodies is an essential element. There might be positive results in patients for more than one ANA.
The most extensively tested ANAs are the anti-double-stranded DNA antibodies in SLE. SLE-induced kidney and skin diseases are linked with these antibodies present in a significant number of patients. Among other examples of ANAs are the anti-La antibodies and anti-Ro antibodies, these antibodies are commonly detected during pregnancy and are linked with fatal heart damage. Others are anti-Smith antibodies which are marked with kidney disease. There is another group of autoantibodies that attacks the phospholipid moiety of the prothrombin activator complex and also the cardioplin that can lead to the loss of pregnancy and abnormal clotting (Maidhof and Olga, 2012). In summing up, the production of autoantibodies is due to the presence of hyperactive B cells along with the impaired removal of apoptotic cellular material that results in the formation of immune complexes.
The diagnosis of SLE is made on symptoms and observed signs, diagnostic testing, and laboratory testing adapted to each patient. According to The 1997 Update of the 1982 American College of Rheumatology (ACR) Revised Criteria for Classification of Systemic Lupus Erythematosus (ACR) if the patient exhibit four or more of the 11 criteria, the diagnosis can be made with % sensitivity and 95% specificity (Hochberg, 1997). Nevertheless, according to a study conducted in 2003, higher sensitivity in favor of the weighted criteria has been seen as compared to the ACR criteria referred to above (Sanchez et al, 2003). Therefore, diagnostic testing varies depending on symptoms and signs affecting each patient. For instance, radiography, renal ultrasound, chest radiography, and electrocardiography are used to assess different pains in the body.
As far as the treatment is concerned, the approaches vary depending on the type and severity of the disease. Recommendation for all patients includes proper diet, nutrition, sun protection, appropriate immunization, exercise, cessation of smoking, and stability of comorbid conditions. NSAIDs, antimalarial medications, steroids, immunosuppressive agents, monoclonal antibodies, and rituximab are among the medications applied in different situations depending on the symptoms and signs (Bertsias et al, 2008). Researchers have been interested in the use of stem-cell transplantation to rebuild the immune system by introducing healthy cells into the body. It has been studied that rituximab decreases the number of B cells while DHEA is believed to help in regulating sex hormones (Thatayatikom and Andrew, 2006).
Although scientific research had been done on Lupus for many decades, it continues to present questions that cannot be answered. There is no cure that has been discovered for this disease, the medications listed above are only to control the flares, manage symptoms, and maintain remission. However, health care professionals and Pharmacists can play a crucial role in treatment by educating people. In order to improve the quality of life for all and the increased rate of survival current research is underway to kindle hope for many patients affected by SLE every year.
Works Cited
Hochberg, Marc C. “Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus.” Arthritis & Rheumatology 40.9 (1997): 1725-1725.
Sanchez, M. L., et al. “Can the weighted criteria improve our ability to capture a larger number of lupus patients into observational and interventional studies? A comparison with the American College of Rheumatology criteria.” Lupus 12.6 (2003): 468-470.
Bertsias, G. K., et al. “EULAR recommendations for the management of systemic lupus erythematosus. Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics.” Annals of the rheumatic diseases 67.2 (2008): 195-205.
Thatayatikom, Akaluck, and Andrew J. White. “Rituximab: a promising therapy in systemic lupus erythematosus.” Autoimmunity reviews 5.1 (2006): 18-24.
Maidhof, William, and Olga Hilas. “Lupus: an overview of the disease and management options.” Pharmacy and Therapeutics 37.4 (2012): 240.
