Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. Some cases are mild, but others can be life-threatening. Although the underlying cause is not yet known, it is clear that various abnormalities of the immune system are responsible for the disorder.

The disease follows an irregular course with multiple flare-ups and remissions. Virtually any part of the body can be involved, most notably the skin, joints, kidneys, heart, lungs, and brain. The most common symptoms are skin rash, arthritis, fever, fatigue, and weight loss.

Risk Factors

• Female gender: Nearly 90 percent of cases occur in women, particularly during the childbearing years.
• Ethnicity: African-Americans are most commonly affected and are three times more likely to have SLE than Caucasians. Hispanic-, Asian-, and Native Americans also have an increased risk compared with Caucasians.
• Geography: The risk varies by geography. For example, SLE is rare in West Africa, more common in Central and Southern Africa, and most common in America and Europe. It is unclear whether these differences are related to environmental or genetic factors.
• Age: The highest risk occurs between 20 and 50 years of age.
• Genetics: There is an increased risk in close relatives and identical twins of SLE patients, but specific genes that may be responsible have yet to be determined.
• Medications: Development of SLE has been associated with use of hydralazine, isoniazid, methyldopa, and procainamide. However, the disease may be reversible when these medications are stopped.

Systemic Lupus Erythematosus: Diagnosis and Treatment

Diagnosis

A medical history and physical examination and blood testing are used to diagnose the disease.

Treatment

• Dietary changes, physical activity, smoking cessation, and avoidance of sun exposure are helpful nonmedical measures for managing SLE. Pregnancy should be avoided during flare-ups, due to a high risk of miscarriage and maternal complications.
• Measures to protect against direct and indirect sunlight exposure are important, including daily using high-SPF sunscreen, wearing long-sleeved shirts and wide-brimmed hats, and avoiding midday sun.
• Low-impact, weight-bearing exercise is important for maintaining cardiovascular and bone health in SLE patients.
• Nonsteroidal anti-inflammatory drugs (e.g., ibuprofen) are used in patients with arthritis or fever. However, there have been some reports of meningitis related to ibuprofen use. Further, sulfa-containing drugs (e.g., celecoxib capsules (Celebrex)) should be used with caution, as they may worsen the disease. It is important to ask your physician before beginning any drug, including over-the-counter medications and herbal therapies.
• Steroids are frequently used during flare-ups. However, long-term steroid use can negatively affect the bones. For this reason, dual energy X-ray absorptiometry (DEXA) scanning may be helpful to monitor bone health.
• Disease-modifying antirheumatic drugs (e.g., azathioprine, hydroxychloroquine, and cyclophosphamide) may be useful in advanced cases.
• Experimental therapies under investigation include stem cell transplantation, antibodies, immunoglobulin, and thalidomide.
• Some evidence suggests that patients may benefit from dehydroepiandrosterone (DHEA). At doses of 200 mg/day, DHEA has been found to improve the disease and reduce flare-ups. Some studies have also found that use of DHEA decreases the need for steroids. However, the potential adverse effects of DHEA on health are not fully known.

Systemic Lupus Erythematosus: Nutritional Considerations

The following nutritional measures are under study for possible roles in SLE management:

• Omega-3 fatty acids: Omega-3 fatty acids reduce inflammation, which is a central component of SLE. In one study that evaluated individuals with kidney disease due to SLE, taking 30 to 45 grams per day of flax seed (a rich source of omega-3 fatty acids) reduced the kidney disease. Similarly, supplementation with fish oils (another source of omega-3 fatty acids) has been reported to improve the disease. However, these studies were small and the findings require further assessment in future studies.
• Antioxidants: Preliminary evidence suggests that antioxidant supplementation may reduce disease activity. However, these findings need to be tested in larger controlled trials. 
• A low-fat, low-cholesterol diet: Individuals with SLE frequently have increased low-density lipoprotein (LDL or "bad" cholesterol) and decreased high-density lipoprotein (HDL or "good" cholesterol) and are at risk for heart disease. A diet low in saturated fat and cholesterol produces significant reduction in LDL cholesterol in patients with SLE (See Hyperlipidemia).
• Calcium and vitamin D supplementation for prevention of osteoporosis: Individuals with SLE who use steroids for long periods of time are at risk for osteoporosis and fractures. Limited evidence shows that bone density may improve with calcium and vitamin D supplementation.