Systemic Lupus Erythematosus
Systemic Lupus Erythematosus (SLE or just Lupus) is an autoimmune disorder associated with outbreaks on skin tissue (and other immunological side-effects). Some supplements are thought to improve quality of life in persons with lupus.
Systemic Lupus Erythematosus falls under theAutoimmune Diseasecategory.
Systemic lupus erythematosus (SLE) is the most common form of lupus, an autoimmune disease characterized by widespread inflammation that can affect nearly any part of the body. In SLE and other autoimmune diseases, the body inappropriately targets and creates antibodies against its own tissues (called autoantibodies). With SLE, the autoantibodies present tend to target molecules originating from the nucleus of cells. This autoantibody-driven self-attack results in acute (occurring suddenly) and/or chronic (long-lasting) damage to organs and organ systems. Other forms of lupus include cutaneous lupus, drug-induced lupus, and neonatal lupus.
The signs and symptoms of SLE vary widely depending on the affected tissues, and can come and go or change over time. When SLE symptoms are active, it is often called a “disease flare”; and when symptoms are inactive, SLE is “in remission”. Disease flares can be very different both within and across people with SLE.
Common systemic symptoms include extreme fatigue, fever, body weight changes, and body aches/pain (including headaches). Most other symptoms are specific to the involved organ system. These include joint pain and arthritis; skin and hair conditions, such as sensitivity to sunlight, rashes (e.g., the facial “butterfly rash”), hair loss, oral/nasal ulcers, and lesions; cardiovascular diseases, like pericarditis, vasculitis, Raynaud’s disease, and blood clots; kidney manifestations, especially nephritis; gastrointestinal issues, such as heartburn/regurgitation, nausea, pancreatitis, and peptic ulcer disease; pulmonary conditions, like pleuritis; neuropsychiatric involvement, ranging from cognitive dysfunction and psychosis to seizures and strokes; hematologic (blood) abnormalities, like leukopenia and anemia; and eye conditions, mainly dry eyes.
There is no single test to diagnose SLE. Instead, SLE is diagnosed with a combination of subjective and objective findings in conjunction with the exclusion of other diagnoses. The subjective findings include a thorough history and physical exam performed by a qualified medical provider (often a rheumatologist). The objective findings include blood tests (e.g., complete blood count, creatinine, antibody testing, complement testing, blood clotting tests); urine tests (which help to detect kidney issues); and, when indicated, imaging tests and biopsies to check for specific tissue damage/injuries.
Once all diagnostic tests are completed, medical providers may use a validated set of criteria to determine if someone has SLE
Medical treatments for SLE are highly individualized and depend on factors like a person’s age, lifestyle, disease symptoms/severity, specific organ involvement, previous responses to treatments, reproductive plans, concurrent disease(s), and personal preferences. Some common medications used to treat SLE include anti-inflammatory agents, antimalarials, immune modulators, immunosuppressants, and steroids. Antimalarials (specifically hydroxychloroquine) are often the primary medical treatment, as they reduce SLE symptoms and rarely cause serious adverse events.
The goal with treatment is to achieve remission of symptoms, minimize tissue damage, and improve quality of life. To this end, medications can be used alone or in combination, and dosages are increased or decreased depending on disease severity and personal tolerance. Disease activity is monitored regularly to guide the treatment plan.
Fish oil, curcumin, probiotics, green tea extract, nicotinamide adenine dinucleotide (NAD+), melatonin, and a variety of antioxidants and vitamins have been studied for their effects on SLE. While some of these supplements show promise in alleviating SLE symptoms, they are generally not recommended as primary or stand-alone treatments for SLE. Human trials reporting the efficacy of these supplements can be found here.
There is no one diet to prevent or treat SLE. Instead, people with SLE should aim to follow the basic principles of a healthy diet, such as eating well-balanced meals, consuming a variety of fruits and vegetables, having a serving or two of fatty fish per week, and limiting the consumption of ultraprocessed foods. As for specific diets, one study found that following a Mediterranean diet reduced SLE disease activity. However, more robust data are needed to support these findings. There are also data suggesting a high consumption of fiber and/or nuts and legumes may benefit people with SLE, but there are no human randomized controlled trials to support these findings.
People with SLE who have certain co-occuring conditions (e.g., cardiovascular disease, diabetes) and/or SLE-related organ damage should speak to their medical provider about potential dietary restrictions. For example, people with kidney damage from SLE may need to be extra mindful of their salt and protein intake.
Exercise is very beneficial for people with SLE. In addition to reducing fatigue and depression, exercise attenuates the increased risk for cardiovascular disease and osteoporosis that accompanies an SLE diagnosis. There is no exercise protocol specific to SLE, so finding a fitness routine that is manageable and enjoyable is important.
Photoprotection (protection from ultraviolet light) is another important treatment for SLE, as sun exposure often exacerbates symptoms. While some people with SLE may choose to avoid sun exposure as much as possible, proper use of sunscreen and protective clothing when outdoors can reduce sun-related SLE symptoms.
There are limited data to support the efficacy of acupuncture, yoga, deep breathing, meditation, and other mind-body therapies for the treatment of SLE. This does not mean people with SLE do not benefit from mind-body therapies; there is simply a need for more research in this area. In fact, since stress may precipitate SLE flares, finding a practice that reduces stress is likely to be beneficial.
SLE and other autoimmune diseases are driven by loss of immune tolerance to “self” molecules in the body. This triggers the immune system to target parts of the body, leading to inflammation and tissue injury. There is no single, known cause for this loss of self-tolerance in SLE. Instead, a combination of internal and external factors play a role in SLE etiology, including genetic, hormonal, immunologic, and environmental determinants. For example, over 100 genetic abnormalities are associated with lupus, but unless these genes are coupled with environmental triggers (e.g., viral or bacterial illness, ultraviolet light exposure) or epigenetic changes, it is rare for SLE to occur due to genes alone.
Yes, but it is important to work closely with a medical provider when considering hormonal contraceptives, as the estrogen exposure from birth control pills can be too risky for certain people with SLE — specifically those with antiphospholipid antibodies and/or high SLE disease activity. In such cases, alternative methods of contraception, like long-acting reversible contraceptives (e.g., intrauterine devices), may be a safer option.
SLE does not usually cause infertility, but it can make becoming and being pregnant more difficult. Most studies find pregnant women with SLE have a two- to fourfold increased rate of complications, both during pregnancy and during/after delivery. Pregnancy complications include preeclampsia, eclampsia (pregnancy-related seizures), blood clots, fetal growth restriction, premature rupture of membranes (“water” breaks early), and preterm labor; complications during/after delivery include unplanned cesarean delivery, postpartum hemorrhage, and increased maternal mortality rate. People with SLE who also have active lupus nephritis, antiphospholipid antibodies, and/or anti-Ro and anti-La antibodies are at an even higher risk for pregnancy and fetal complications.
Despite these risks, people with SLE can and do have successful pregnancies that end in the delivery of a healthy baby. This is often achieved through careful family planning (i.e., trying to conceive when symptoms are in remission) and working alongside a multidisciplinary team for ongoing support and monitoring.
- ^Kiriakidou M, Ching CLSystemic Lupus Erythematosus.Ann Intern Med.(2020-06-02)
- ^Yu H, Nagafuchi Y, Fujio KClinical and Immunological Biomarkers for Systemic Lupus Erythematosus.Biomolecules.(2021-06-22)
- ^Ruiz-Irastorza G, Ramos-Casals M, Brito-Zeron P, Khamashta MAClinical efficacy and side effects of antimalarials in systemic lupus erythematosus: a systematic review.Ann Rheum Dis.(2010-Jan)
- ^Spinelli FR, Moscarelli E, Ceccarelli F, Miranda F, Perricone C, Truglia S, Garufi C, Massaro L, Morello F, Alessandri C, Valesini G, Conti FTreating lupus patients with antimalarials: analysis of safety profile in a single-center cohort.Lupus.(2018-Sep)
- ^Ruiz-Irastorza G, Martín-Iglesias D, Soto-Peleteiro AUpdate on antimalarials and systemic lupus erythematosus.Curr Opin Rheumatol.(2020-11)
- ^Alí Duarte-García, Elena Myasoedova, Paras Karmacharya, Mehmet Hocaoğlu, M Hassan Murad, Kenneth J Warrington, Cynthia S CrowsonEffect of omega-3 fatty acids on systemic lupus erythematosus disease activity: A systematic review and meta-analysisAutoimmun Rev.(2020 Dec)
- ^Khajehdehi P, Zanjaninejad B, Aflaki E, Nazarinia M, Azad F, Malekmakan L, Dehghanzadeh GROral supplementation of turmeric decreases proteinuria, hematuria, and systolic blood pressure in patients suffering from relapsing or refractory lupus nephritis: a randomized and placebo-controlled studyJ Ren Nutr.(2012 Jan)
- ^de Oliveira GLV, Leite AZ, Higuchi BS, Gonzaga MI, Mariano VSIntestinal dysbiosis and probiotic applications in autoimmune diseases.Immunology.(2017-09)
- ^Shamekhi Z, Amani R, Habibagahi Z, Namjoyan F, Ghadiri A, Saki Malehi AA Randomized, Double-blind, Placebo-controlled Clinical Trial Examining the Effects of Green Tea Extract on Systemic Lupus Erythematosus Disease Activity and Quality of Life.Phytother Res.(2017-Jul)
- ^Wu J, Singh K, Lin A, Meadows AM, Wu K, Shing V, Bley M, Hassanzadeh S, Huffstutler RD, Schmidt MS, Blanco LP, Tian R, Brenner C, Pirooznia M, Kaplan MJ, Sack MNBoosting NAD+ blunts TLR4-induced type I IFN in control and systemic lupus erythematosus monocytes.J Clin Invest.(2022-03-01)
- ^Mohammadmahdi Nabatian-Asl, Amir Ghorbanihaghjo, Aida Malek Mahdavi, Alireza Khabbazi, Mehrzad Hajialilo, Morteza GhojazadehEffects of melatonin supplementation on serum oxidative stress markers and disease activity in systemic lupus erythematosus patients: A randomised, double-blind, placebo-controlled trialInt J Clin Pract.(2021 Apr 20)
- ^Pocovi-Gerardino G, Correa-Rodríguez M, Callejas-Rubio JL, Ríos-Fernández R, Martín-Amada M, Cruz-Caparros MG, Rueda-Medina B, Ortego-Centeno NBeneficial effect of Mediterranean diet on disease activity and cardiovascular risk in systemic lupus erythematosus patients: a cross-sectional study.Rheumatology (Oxford).(2021-01-05)
- ^Md Asiful Islam, Shahad Saif Khandker, Przemysław J Kotyla, Rosline HassanImmunomodulatory Effects of Diet and Nutrients in Systemic Lupus Erythematosus (SLE): A Systematic ReviewFront Immunol.(2020 Jul 22)
- ^Barbhaiya M, Tedeschi S, Sparks JA, Leatherwood C, Karlson EW, Willett WC, Lu B, Costenbader KHAssociation of Dietary Quality With Risk of Incident Systemic Lupus Erythematosus in the Nurses' Health Study and Nurses' Health Study II.Arthritis Care Res (Hoboken).(2021-09)
- ^O'Dwyer T, Durcan L, Wilson FExercise and physical activity in systemic lupus erythematosus: A systematic review with meta-analyses.Semin Arthritis Rheum.(2017-10)
- ^Fava A, Petri MSystemic lupus erythematosus: Diagnosis and clinical management.J Autoimmun.(2019-01)
- ^Kuhn A, Gensch K, Haust M, Meuth AM, Boyer F, Dupuy P, Lehmann P, Metze D, Ruzicka TPhotoprotective effects of a broad-spectrum sunscreen in ultraviolet-induced cutaneous lupus erythematosus: a randomized, vehicle-controlled, double-blind study.J Am Acad Dermatol.(2011-Jan)
- ^Greco CM, Nakajima C, Manzi SUpdated review of complementary and alternative medicine treatments for systemic lupus erythematosus.Curr Rheumatol Rep.(2013-Nov)
- ^Rovsing C, Rovsing H, Liboriussen CH, Jensen MK, Andersen SS, Andersen SS, Kristensen S, Jochumsen MDeep Breathing Increases Heart Rate Variability in Patients With Rheumatoid Arthritis and Systemic Lupus Erythematosus.J Clin Rheumatol.(2021-Oct-01)
- ^Bantornwan S, Watanapa WB, Hussarin P, Chatsiricharoenkul S, Larpparisuth N, Teerapornlertratt T, Vareesangthip J, Vareesangthip KRole of meditation in reducing sympathetic hyperactivity and improving quality of life in lupus nephritis patients with chronic kidney disease.J Med Assoc Thai.(2014-Mar)
- ^Pawlak CR, Witte T, Heiken H, Hundt M, Schubert J, Wiese B, Bischoff-Renken A, Gerber K, Licht B, Goebel MU, Heijnen CJ, Schmidt RE, Schedlowski MFlares in patients with systemic lupus erythematosus are associated with daily psychological stress.Psychother Psychosom.(2003)
- ^Levy DM, Kamphuis SSystemic lupus erythematosus in children and adolescents.Pediatr Clin North Am.(2012-Apr)
- ^Gergianaki I, Bortoluzzi A, Bertsias GUpdate on the epidemiology, risk factors, and disease outcomes of systemic lupus erythematosus.Best Pract Res Clin Rheumatol.(2018-04)
- ^Jung JY, Nam JY, Kim HA, Suh CHElevated Salivary Alpha-Amylase Level, Association Between Depression and Disease Activity, and Stress as a Predictor of Disease Flare in Systemic Lupus Erythematosus: A Prospective Case-Control Study.Medicine (Baltimore).(2015-Jul)
- ^Yelin E, Trupin L, Bunde J, Yazdany JPoverty, Neighborhoods, Persistent Stress, and Systemic Lupus Erythematosus Outcomes: A Qualitative Study of the Patients' Perspective.Arthritis Care Res (Hoboken).(2019-03)
- ^Abe N, Tarumi M, Fujieda Y, Takahashi N, Karino K, Uchida M, Kono M, Tanaka Y, Hasebe R, Kato M, Amengual O, Arinuma Y, Oku K, Sato W, Tha KK, Yamasaki M, Watanabe M, Atsumi T, Murakami MPathogenic neuropsychiatric effect of stress-induced microglial interleukin 12/23 axis in systemic lupus erythematosus.Ann Rheum Dis.(2022-Nov)
- ^Roberts AL, Malspeis S, Kubzansky LD, Feldman CH, Chang SC, Koenen KC, Costenbader KHAssociation of Trauma and Posttraumatic Stress Disorder With Incident Systemic Lupus Erythematosus in a Longitudinal Cohort of Women.Arthritis Rheumatol.(2017-11)
- ^Aqel SI, Hampton JM, Bruss M, Jones KT, Valiente GR, Wu LC, Young MC, Willis WL, Ardoin S, Agarwal S, Bolon B, Powell N, Sheridan J, Schlesinger N, Jarjour WN, Young NADaily Moderate Exercise Is Beneficial and Social Stress Is Detrimental to Disease Pathology in Murine Lupus Nephritis.Front Physiol.(2017)
- ^Taub R, Horesh D, Rubin N, Glick I, Reem O, Shriqui G, Agmon-Levin NMindfulness-Based Stress Reduction for Systemic Lupus Erythematosus: A Mixed-Methods Pilot Randomized Controlled Trial of an Adapted Protocol.J Clin Med.(2021-Sep-28)
- ^Mazzoni D, Cicognani EPositive and problematic support, stress and quality of life in patients with systemic lupus erythematosus.Anxiety Stress Coping.(2016-09)
- ^Chang A, Winquist NW, Wescott AB, Lattie EG, Graham AKSystematic review of digital and non-digital non-pharmacological interventions that target quality of life and psychological outcomes in adults with systemic lupus erythematosus.Lupus.(2021-Jun)
- ^Navarrete-Navarrete N, Peralta-Ramírez MI, Sabio-Sánchez JM, Coín MA, Robles-Ortega H, Hidalgo-Tenorio C, Ortego-Centeno N, Callejas-Rubio JL, Jiménez-Alonso JEfficacy of cognitive behavioural therapy for the treatment of chronic stress in patients with lupus erythematosus: a randomized controlled trial.Psychother Psychosom.(2010)
- ^Zhang L, Qing P, Yang H, Wu Y, Liu Y, Luo YGut Microbiome and Metabolites in Systemic Lupus Erythematosus: Link, Mechanisms and Intervention.Front Immunol.(2021)
- ^Xiang S, Qu Y, Qian S, Wang R, Wang Y, Jin Y, Li J, Ding XAssociation between systemic lupus erythematosus and disruption of gut microbiota: a meta-analysis.Lupus Sci Med.(2022-03)
- ^Bax CE, Chakka S, Concha JSS, Zeidi M, Werth VPThe effects of immunostimulatory herbal supplements on autoimmune skin diseases.J Am Acad Dermatol.(2021-Apr)
- ^Akaogi J, Barker T, Kuroda Y, Nacionales DC, Yamasaki Y, Stevens BR, Reeves WH, Satoh MRole of non-protein amino acid L-canavanine in autoimmunity.Autoimmun Rev.(2006-Jul)
- ^Rand A Nashi, Robert H ShmerlingAntinuclear Antibody Testing for the Diagnosis of Systemic Lupus ErythematosusMed Clin North Am.(2021 Mar)
- ^Guan SY, Cai HY, Wang P, Lv TT, Liu LN, Mao YM, Zhao CN, Wu Q, Dan YL, Sam NB, Wang DG, Pan HFAssociation between circulating 25-hydroxyvitamin D and systemic lupus erythematosus: A systematic review and meta-analysis.Int J Rheum Dis.(2019-Oct)
- ^Ronghao Zheng, Alex Gonzalez, Jing Yue, Xiaolin Wu, Ming Qiu, Lin Gui, Songbai Zhu, Li HuangEfficacy and Safety of Vitamin D Supplementation in Patients With Systemic Lupus Erythematosus: A Meta-analysis of Randomized Controlled TrialsAm J Med Sci.(2019 Aug)
- ^Hayashi K, Sada KE, Asano Y, Katayama Y, Ohashi K, Morishita M, Miyawaki Y, Watanabe H, Katsuyama T, Narazaki M, Matsumoto Y, Yajima N, Yoshimi R, Shimojima Y, Ohno S, Kajiyama H, Ichinose K, Sato S, Fujiwara M, Wada JReal-world data on vitamin D supplementation and its impacts in systemic lupus erythematosus: Cross-sectional analysis of a lupus registry of nationwide institutions (LUNA).PLoS One.(2022)
- ^Petri M, Kim MY, Kalunian KC, Grossman J, Hahn BH, Sammaritano LR, Lockshin M, Merrill JT, Belmont HM, Askanase AD, McCune WJ, Hearth-Holmes M, Dooley MA, Von Feldt J, Friedman A, Tan M, Davis J, Cronin M, Diamond B, Mackay M, Sigler L, Fillius M, Rupel A, Licciardi F, Buyon JP,Combined oral contraceptives in women with systemic lupus erythematosus.N Engl J Med.(2005-Dec-15)
- ^Andreoli L, Bertsias GK, Agmon-Levin N, Brown S, Cervera R, Costedoat-Chalumeau N, Doria A, Fischer-Betz R, Forger F, Moraes-Fontes MF, Khamashta M, King J, Lojacono A, Marchiori F, Meroni PL, Mosca M, Motta M, Ostensen M, Pamfil C, Raio L, Schneider M, Svenungsson E, Tektonidou M, Yavuz S, Boumpas D, Tincani AEULAR recommendations for women's health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome.Ann Rheum Dis.(2017-Mar)
- ^Zhang S, Han X, Liu W, Wen Q, Wang JPregnancy in patients with systemic lupus erythematosus: a systematic review.Arch Gynecol Obstet.(2022-Aug-01)
- ^Chen D, Lao M, Zhang J, Zhan Y, Li W, Cai X, Zhan ZFetal and Maternal Outcomes of Planned Pregnancy in Patients with Systemic Lupus Erythematosus: A Retrospective Multicenter Study.J Immunol Res.(2018)
- ^Kwok LW, Tam LS, Zhu T, Leung YY, Li EPredictors of maternal and fetal outcomes in pregnancies of patients with systemic lupus erythematosus.Lupus.(2011-Jul)
- Systemic Lupus Erythematosus Symptoms - Walton AJ, Snaith ML, Locniskar M, Cumberland AG, Morrow WJ, Isenberg DADietary fish oil and the severity of symptoms in patients with systemic lupus erythematosusAnn Rheum Dis.(1991 Jul)
- Systemic Lupus Erythematosus Symptoms - Clark WF, Parbtani A, Naylor CD, Levinton CM, Muirhead N, Spanner E, Huff MW, Philbrick DJ, Holub BJFish oil in lupus nephritis: clinical findings and methodological implicationsKidney Int.(1993 Jul)
- Systemic Lupus Erythematosus Symptoms - U N DasBeneficial effect of eicosapentaenoic and docosahexaenoic acids in the management of systemic lupus erythematosus and its relationship to the cytokine networkProstaglandins Leukot Essent Fatty Acids.(1994 Sep)
- Systemic Lupus Erythematosus Symptoms - Wright SA, O'Prey FM, McHenry MT, Leahey WJ, Devine AB, Duffy EM, Johnston DG, Finch MB, Bell AL, McVeigh GEA randomised interventional trial of omega-3-polyunsaturated fatty acids on endothelial function and disease activity in systemic lupus erythematosusAnn Rheum Dis.(2008 Jun)
- Systemic Lupus Erythematosus Symptoms - Westberg G, Tarkowski AEffect of MaxEPA in patients with SLE. A double-blind, crossover studyScand J Rheumatol.(1990)
- Systemic Lupus Erythematosus Symptoms - Duffy EM, Meenagh GK, McMillan SA, Strain JJ, Hannigan BM, Bell ALThe clinical effect of dietary supplementation with omega-3 fish oils and/or copper in systemic lupus erythematosusJ Rheumatol.(2004 Aug)
- Low-density lipoprotein (LDL) - Ilowite NT, Copperman N, Leicht T, Kwong T, Jacobson MSEffects of dietary modification and fish oil supplementation on dyslipoproteinemia in pediatric systemic lupus erythematosusJ Rheumatol.(1995 Jul)
- Proteinuria - Khajehdehi P, Zanjaninejad B, Aflaki E, Nazarinia M, Azad F, Malekmakan L, Dehghanzadeh GROral supplementation of turmeric decreases proteinuria, hematuria, and systolic blood pressure in patients suffering from relapsing or refractory lupus nephritis: a randomized and placebo-controlled studyJ Ren Nutr.(2012 Jan)