Systemic lupus erythematosus is a systemic disease of unknown etiology and pathogenesis of the very complex.There are two forms of the disease: chronic discoid lupus erythematosus or related to clinical benign form and second acute or systemic lupus erythematosus, difficult runs.Both forms occur with the defeat of the red border of the lips and oral mucosa.Some lesions on the oral mucosa are rare, so sick to the dentist for help are often treated in rare cases.Age of the cases within 20-40 years.Among women, lupus is more common than in men.Currently lupus relates to rheumatic and autoimmune diseases.
history of the disease lupus
The name systemic lupus erythematosus received from the Latin word "lupus" - Wolf and "eritematozus" - red.This name was given because of the similarity with the signs of skin injuries after being bitten by a hungry wolf.
history of lupus disease got its start in 1828.It happened after the French dermatologist Biett first described skin symp
in 1890.It was discovered by the English physician Osler, that systemic lupus erythematosus may occur without cutaneous manifestations.Description of the phenomenon LE- (LE) cells - a discovery of fragments of cells in the blood, in 1948.allowed the identification of patients.
in 1954.They have been found in certain diseased blood protein - antibody acting against its own cells.This finding has been used in the development of sensitive tests for the diagnosis of systemic lupus erythematosus.
Cause of the disease lupus is Sensitization to various infectious and non-infectious factors.One of the contributing factors are the - are allergic to the sun, allergic to the cold, or centers of a chronic infection.There are proven studies on the genetic predisposition to the disease.Today it is generally accepted that lupus has a genetic predisposition, manifested unevenly dominant type.The appearance of the disease and its aggravation occurs after taking the drugs: sulfonamides, antibiotics, vaccines, procainamide, serum, under the influence of ultraviolet irradiation, hypothermia, endocrine disorders, neuro-conflict situations.The adverse effect on the course of the disease on the basis of the trigger mechanism is carried out pockets of sulfonamides, intercurrent diseases, chronic infections.
specific role for neuroendocrine functional disorders that alter the ratio of androgens and estrogens.Changes go towards hyperestrogenism, as well as a decrease in activity of the pituitary-adrenal axis, leading to atrophy of the adrenal cortex.
Dependence allergic activity and lupus photosensitivity of most estrogen saturation.Therefore it is easy to explain the emergence of the disease in girls and young women, the ratio - eight women for one man.For the development of complex disease processes meet the autoimmune pathological reactions.
accumulation of large number of antibodies leads to the formation of pathological immune complexes, which are directed against self-proteins in the cells of the body, which in turn leads to the development of pathological processes.Therefore lupus erythematosus has been included in a group of diseases of immune complexes.In suffering from any disease exhibit various humoral and cellular antibodies: anticardiolipin, LE-factor anticoagulant antibodies to erythrocytes, leukocytes, cellular components antibody as denatured double-stranded DNA and RNA, rheumatoid factor, histone nucleoprotein soluble nuclear components.
In 1948 was discovered a kind nukleofagoditoz, located in the bone marrow of patients and established that the presence of particularly aggressive protein, known as antinuclear factor.This protein acts as an antibody against the nucleoprotein cell substances and IgG class is a constant sedimentation 19S.Cells lupus erythematosus, as well as anti-nuclear factor fixed in diseased form of the system, but from the chronic form is much rarer.Pathognomonic cells relative, becauseThey were found in patients with dermatitis herpetiformis Duhring, toxicoderma, scleroderma and rheumatism.
classification of lupus include systemic and integumentnuyu form is acute, subacute, and chronic.
Systemic lupus erythematosus
disease, being a violation of the immune system, known as an autoimmune disease.In this current body is capable of producing foreign proteins to personal cells and their components, thus causing damage to healthy tissues and cells.An autoimmune disease is manifested in the perception of its own tissues like alien.This leads to inflammation and damage to various body tissues.It manifests itself in several forms, lupus able to provoke the inflammation of muscles, joints, and other parts of the body.As severe acute, systemic disease, manifested by the following symptoms: high fever, weakness, muscle pain, and joint pain.It is characterized by the addition of disease - endocarditis, polyserositis, glomerulonephritis, polyarthritis.Blood tests show the following: elevated erythrocyte sedimentation rate, leukopenia, anemia.Systemic lupus erythematosus is an acute, subacute, and chronic forms.During an exacerbation, and depending on the pathology diagnosed skin-articular, neurological, renal, gastrointestinal, cardiovascular, hematological, hepatic clinical variants of the disease.
Systemic lupus erythematosus shows the changes of the mucous membrane in 60% of patients.The mucous membrane of the sky, gums, cheeks, bloodshot with swollen spots, sometimes with bloody character, as well as different sized bubbles passing in erosion with purulent bloody raid.Skin patches are hyperemia, in rare cases, swelling and blisters appear.Skin lesions are the earliest, common symptoms of systemic lupus erythematosus.A typical location of the area of the face, trunk, neck and limbs.
sometimes seen in patients rozhistopodobnaya form or a typical "Butterfly", which is characterized by sudden swelling, rich red color, the presence of bubbles and multiple erosions, which are covered with hemorrhagic or purulent crusts, serous.The skin of the trunk and limbs may have similar lesions.
Systemic lupus erythematosus and it is characterized by the progression of symptoms, as well as a gradual process of accession to the various tissues and organs.
discoid lupus erythematosus
consider symptoms of discoid lupus erythematosus.The disease usually begins with symptoms of erythema, which are expressed in the spread of the rash on the face (nose, forehead, cheeks), ears, red border of lips, scalp, and other areas of the body.Ability to develop an isolated inflammation of the red border.This oral mucosa is rarely affected.Skin lesions are characterized by a triad of symptoms: hyperkeratosis, erythema and atrophy.The whole process becomes phasic flow.
first (erythematous) stage appears to change in size of the two upward swollen, pink, contoured spots.The center has telangiectasia.Slowly increasing, as well as merging, visually reminiscent of a butterfly rash.At the same time the wings are arranged on the cheeks and back on his nose.Accompanied by the appearance of spots in parallel tingling and burning in the affected area.
second stage (hyperkeratotic-infiltrative), in which the lesions infiltrate and become discoid, dense plaques on the surface of which appear grayish-white, small and tightly fitting scales.Further plaque passes keratinization and becomes greyish white color.Plaque itself is surrounded by a rim of hyperemia.
third stage - atrophic, where there is a plaque in the center portion of the white scar atrophy.Form plaque becomes saucer, with clear boundaries hyperkeratosis and multiple telangiectasias.At the same time it is closely soldered to surrounding tissues, and on the periphery there is infiltration, as well as hyperpigmentation.Sometimes scar atrophy plot resembles a tree form, expressed as a straight, white stripes, without the clutter.Rarely center hyperkeratosis close similarity with rays of flame.This process is characteristic pathological progression and the emergence of new elements of defeat.The occurrence of chronic
(discoid) lupus delayed for long years with exacerbations in warm weather.Erosive and ulcerative form of the disease, located on the red border of lips, capable ozlokachestvlyatsya, so this kind of attribute to the optional precancer.With regard to the histological lesions in the mucous membranes of the mouth and lips, it is characterized by the presence of parakeratosis, alternating with hyperkeratosis, atrophy and akantoezom.Erosive and ulcerative form is characterized by defects in the epithelium, pronounced swelling and inflammation.
discoid lupus erythematosus are often characterized by lesions of the mucous membranes of the mouth.Lesions contain a kind of whitish or bluish-demarcated red plaques in the center with erosions.
lupus erythematosus with lesions of the mucous membranes in the mouth, as well as the red border flows with pain and burning, which increases the time eating and talking.
red border marks the four types of the disease: erosive and ulcerative typical, with the absence of atrophy;deep.
This is the same systemic lupus erythematosus, or simply "lupus" and an abridged version of SLE.In SLE affects many organs of the body.This joints, heart, skin, kidney, lungs, brain, blood vessels.It manifests itself in several forms, lupus able to provoke the inflammation of muscles, joints, and other parts of the body.SLE belongs to the rheumatic diseases.People with this condition have many different symptoms.The most common include arthritis (swollen joints), excessive fatigue, skin rashes, unexplained fever, and kidney problems.Currently, systemic lupus erythematosus credited to an incurable disease, but symptoms can be controlled by medication, so many people with the disease lead a healthy and active life.Exacerbation of SLE are characterized by deterioration and the occurrence of inflammation of various organs.Russian classification distinguishes three stages: the first minimum, moderate second and third terms.Currently, intensive research in understanding the development and treatment of diseases, which should lead to a cure.
As a systemic disease, systemic lupus erythematosus is characterized by the following symptoms:
- swelling and tenderness of the joints and muscle pain;
- chronic fatigue syndrome;
- chest pain when breathing deeply;
- unexplained fever;
- red skin rash on the face or discoloration of the skin;
- increased hair loss;
- blue or whitening of the fingers on the hands, legs, staying in the cold or in the moment of stress (Raynaud's syndrome);
- sensitivity to the sun;
- edema, swelling of the feet, the eyes;
- swollen lymph nodes.
Some people experience headaches, cramps, dizziness, depression.
new symptoms can appear years later and after diagnosis.In some patients suffering from one system of the body (joints and skin, organs of hematopoiesis), in other cases symptoms can affect many organs and carry multiorgan character.The very severity and depth of the lesion body systems at all different.Often affects muscles and joints, while causing arthritis and myalgia (muscle aches).Skin rashes are similarities between patients.
If the patient has multiple organ manifestations, the following pathological changes occur:
- kidney inflammation (lupus nephritis);
- brain damage or central nervous system, and it provokes: psychosis (change in behavior), a headache, dizziness, paralysis, impaired memory, problems with vision, convulsions;
- inflammation of blood vessels (vasculitis);
- blood disorders: leukopenia, anemia, thrombocytopenia, risk of blood clots;
- heart disease: coronary vasculitis, myocarditis and endocarditis, pericarditis;
- pneumonia: pleurisy, pneumonia.
lupus erythematosus diagnosis
possible to diagnose the disease in the presence of foci of lupus of the skin.Upon detection of isolated lesions, such as oral mucosa, or just a red border, can be difficult to diagnose.To avoid this, use additional methods of research (Immunomorphological, histology, fluorescent diagnostics).Wood rays aimed at the areas of hyperkeratosis, focusing on the border of lips, gleaming snow and snow-blue or white light, and the mucous membrane of the mouth gives a white glow like strips or dots.
Chronic lupus erythematosus should be allocated for the following diseases: lichen planus, lupus, and leukoplakia.When the concentration of lesions on the lips of lupus is differentiated from prekantseroznogo cheilitis actinic cheilitis and Manganotti.
acute (systemic) lupus is diagnosed after examination of internal organs and determine the blood and bone marrow LEkletok - cells of lupus.In most cases lupus erythematosus there is a secondary immunodeficiency.
lupus lupus treatment
First of all, the treatment involves a thorough examination and settlement of any existing chronic infection.Drug treatment starts with the administration of drugs quinoline series (delagil, Plaquenil, Plakvenol).Recommend minor doses of corticosteroids: Triamcinolone (8-12 mg), prednisolone (10-15 mg), dexamethasone (1.5-2.0 mg).
efficiency in the use of vitamins B2, B6, B12, niacin and ascorbic.When available immunocompromised appointed Immunocorrecting drugs: Dekaris (levamisole) Timalin, Taktivin.Marked hyperkeratosis treated intradermal injecting 5-10% solution Rezohina, hingamin solution or hydrocortisone.Topical treatments include corticosteroid ointment: Lorinden, flutsinar, Sinalar, prednisolone ointment.
How else to treat lupus?
treatment of erosive and ulcerative forms produced corticosteroid ointments containing antibiotics as well as antimicrobial agents (lokakortena, Oksikort).
Systemic lupus erythematosus and its treatment includes inpatient hospital stay, and the treatment must be continuous and sustained.At the beginning of the treatment shown the adoption of high doses of corticosteroids (prednisolone 60 mg, increasing to 35 mg for 3 months at 15 mg after 6 months).Then the dose prednisolone reduced by switching to a maintenance dose of 5-10 mg of prednisolone.Prevention in violation of mineral metabolism include potassium supplements (Panangin, potassium chloride, 15% potassium acetate solution).
liquidated acute occurrence of systemic lupus erythematosus, for combined treatment with corticosteroids and drugs aminohinolinovogo (Plaquenil delagil or at night).