What is lupus and what causes it?
Systemic lupus erythematosus is an autoimmune disease. We call autoimmune diseases those in which the defense mechanisms of the body designed to defend against external aggressions, for reasons not well known begin to target and attack the body itself. In the case of systemic lupus erythematosus, we know that there is a hereditary base in the disease, as shown by the familial aggregation of cases and the relationship between this disease and other autoimmune diseases, although we do not know the exact mechanisms by which this alteration is initiated.
What symptoms does it present?
The symptoms of the disease are very varied because these auto-antibodies, which are these products of the defense mechanisms that attack the organism, can be directed to a multitude of organs and systems. In any case, the most common symptoms are skin lesions, especially the photosensitivity of sun reactions, joint pain with arthralgias, arthritis, frequent myalgias, although a multitude of symptoms such as inflammation of the serous, pleura, pericardium may appear. involvement in the kidneys, neurological involvement, although all the more serious forms of the disease are much less frequent. The vast majority of patients have either skin lesions or skin lesions plus joint pain plus biological alterations.
What is the treatment and what's new?
When we diagnose a patient with systemic lupus erythematosus, the first thing to say is whether or not they need treatment. Not all patients need treatment, if all patients should be monitored. There are patients that with an annual follow-up visit is more than enough. Patients who have very mild forms of the disease such as joint or skin lesions can go very well with a very old and widely used drug that is hydroxychloroquine sometimes combined with small doses of corticosteroids or anti-inflammatories at specific times. If the disease affects other organs and the risk of complications is a little higher, corticosteroids can be added to hydroxychloroquine at higher doses and sometimes we use immunosuppressants such as azatriopine.. Currently, in more serious cases that, I repeat, are less frequent, we use corticosteroids at very high doses, sometimes immunosuppressants such as cyclophosphamine and sometimes monoclonal antibodies, as rituximab has recently been used.. Recently, the use of a new monoclonal antibody, belimumab, has been accepted by the Spanish drug agency, which is indicated for patients who have used azatriopine or mycophenolate, have not controlled the disease and have positive anti-DNA antibodies. Small specific group of patients can benefit from the use of monoclonal antibodies.