TREATING SYSTEMIC LUPUS ERYTHEMATOSUS.

Systemic lupus erythematosus (SLE), the most serious form of lupus, is a chronic, multi-system, autoimmune disease. SLE can occur in men, but the incidence is 10 times more frequent in adult women. Whereas SLE afflicts people of all races, it is 3 times more common in black women than in white women. [1-3]

Between 500 000 and 1.5 million people in the United States have been diagnosed with SLE, with more than 16 000 new cases each year, according to the Lupus Foundation of America in Rockville, Md. Approximately 1 out of every 250 black women between the ages of 18 and 65 years has SLE. [4] This article will review SLE treatment options and the latest research findings.

Background

The cause of SLE remains unknown. Epidemiological studies have focused on endocrine-metabolic, environmental, and genetic factors. Female gender is the strongest risk factor for SLE development. In a study of persons with juvenile and adult-onset SLE, Masi and Kaslow found that the proportion of females with the disease increased dramatically after puberty. Approximately 1 male was affected for every 3 adolescent females, compared to more than 10 adult women with the disease for every adult man. [5] In another study by Hochberg and Kaslow, 74 women with SLE were interviewed to determine menstrual, sexual, and reproductive history prior to SLE diagnosis. Each group was equally matched according to age, race, and other factors. Study results indicated that a history of pregnancy ending in miscarriage was associated with SLE. Of 45 women diagnosed with SLE, 39 of them had a miscarriage. [6] These results may possibly explain the high prevalence seen in women.

Noninfectious and infectious etiologies have been proposed for SLE. Noninfectious factors include chemicals causing drug-induced lupus. Agents commonly implicated include hydralazine, procainamide, and isoniazid. The possibility that lupus may be caused by a virus has also been suggested by some study findings. However, further documentation is needed.

A hereditary predisposition to SLE has long been suspected. This theory is supported by racial differences in its incidence. Also, major histocompatibility complex antigens have been found in excess in black Patients. [7-9]

Diagnosis