Rheumatology
Systemic Lupus Erythematosus
전신홍반루푸스
Multi-system autoimmune disease with diverse manifestations
- How common
- 0.05–0.1% (9:1 female)
- Typical age
- Childbearing age 15–45
What is it?
Genetic predisposition and environmental triggers (UV, estrogen, EBV) activate autoimmunity to nuclear antigens; immune complexes deposit in multiple organs causing inflammation.
Commonly affected: Skin, joints, kidney, blood, CNS, heart, lungs (multi-organ)
How it develops
- Defective apoptosis clearanceIncreased self-antigen exposure stimulates immune system
- Autoantibody productionAnti-dsDNA, anti-Sm, anti-Ro/La produced
- Immune complex depositionDeposits in glomeruli, skin, joints, lung, heart
- Complement & multi-organ damageC3/C4 consumption, systemic inflammation and organ damage
Symptoms
- Lupus nephritisProteinuria, hematuria, renal failure
- Malar (butterfly) rashPhotosensitive erythema across malar areas, sparing nasolabial folds
- ArthritisNon-erosive symmetric polyarthritis
- HematologicHemolytic anemia, leukopenia, thrombocytopenia
- Oral ulcers/alopeciaPainless oral/nasal ulcers, hair loss
How it is examined
- ACR/EULAR 2019 criteriaANA entry, weighted scoring across domains ≥10
- Autoantibody panelANA (96%), anti-dsDNA, anti-Sm, anti-Ro/La, antiphospholipid
- Renal evaluationUA, quantitative proteinuria, biopsy (class I–VI)
Imaging
Joint X-rays show non-erosive changes (Jaccoud: reversible deformity).
- Non-erosive joint changes
- Jaccoud arthropathy
Brain MRI for neuro-lupus, echo for pericardial effusion.
- White matter lesions
- Pericardial effusion
- Synovitis
Non-surgical care
- Hydroxychloroquine (all patients)Foundation therapy; reduces flares and improves survival
- Low–moderate corticosteroidsShort-term for active disease
- ImmunosuppressantsMMF, azathioprine, methotrexate
- Photoprotection/SPFUV triggers rash and systemic flares
- CV risk managementBP, lipids, smoking (accelerated atherosclerosis)
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Severe organ involvement (nephritis, neuro-lupus)
Procedures that may be discussed
- IV cyclophosphamide pulse
- Mycophenolate mofetil
- Belimumab (anti-BLyS)
- Rituximab (anti-CD20)
- Anifrolumab (anti-IFN-α receptor)
Outlook
5-year survival >90%, 10-year 80–85%. Renal, CNS, infection, CV complications drive mortality.