What is systemic lupus erythematosus?
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).[1] 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.
What are the main signs and symptoms of systemic lupus erythematosus?
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.[1]
How is systemic lupus erythematosus diagnosed?
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.[2]
Once all diagnostic tests are completed, medical providers may use a validated set of criteria to determine if someone has SLE
What are some of the main medical treatments for systemic lupus erythematosus?
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.[3][4][5]
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.
Have any supplements been studied for systemic lupus erythematosus?
Fish oil,[6] curcumin,[7] probiotics,[8] green tea extract,[9] nicotinamide adenine dinucleotide (NAD+),[10] melatonin,[11] 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.
How could diet affect systemic lupus erythematosus?
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.[12] However, more robust data are needed to support these findings. There are also data suggesting a high consumption of fiber[13] and/or nuts and legumes[14] may benefit people with SLE,[13] 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.
Are there any other treatments for systemic lupus erythematosus?
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.[15] 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.[16][17]
There are limited data to support the efficacy of acupuncture, yoga, deep breathing, meditation, and other mind-body therapies for the treatment of SLE.[18][19][20] 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,[21] finding a practice that reduces stress is likely to be beneficial.
What causes systemic lupus erythematosus?
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.
Examine Database: Systemic Lupus Erythematosus
Research FeedRead all studies
Frequently asked questions
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).[1] 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.
No. Children can be diagnosed with SLE, but childhood-onset SLE is rare. While SLE manifests similarly in children and adults, the disease course in children tends to be more severe.[22]
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.[1]
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.[2]
Once all diagnostic tests are completed, medical providers may use a validated set of criteria to determine if someone has SLE
The most common blood test for SLE is the antinuclear antibodies (ANA) test, which is positive in the majority of people with SLE. However, this test can be positive for a number of reasons outside of SLE, such as when someone has a different autoimmune disease (like rheumatoid arthritis) or even when someone is completely healthy and has no disease at all (considered a false positive). This is one reason why it is important to work with a trusted medical provider for an SLE diagnosis.[37] Other antibody blood tests that are often used in the diagnosis of lupus include anti-dsDNA (anti-double-stranded DNA), anti-Sm (anti-Smith), and antiphospholipid antibodies.
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.[3][4][5]
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,[6] curcumin,[7] probiotics,[8] green tea extract,[9] nicotinamide adenine dinucleotide (NAD+),[10] melatonin,[11] 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.
It is possible that supplements aimed at stimulating the immune system could worsen SLE symptoms in some people. For this reason, people with SLE are often advised to avoid supplements like alfalfa, echinacea, and spirulina.[35] There is a case report of a study volunteer developing lupus-like symptoms after ingesting an alfalfa supplement for a hypercholesterolemia study.[36]
Maybe. Vitamin D is an important supplement to consider in the context of SLE. Many people with SLE suffer from photosensitivity and consequently get little to no sun exposure. This increases their risk for vitamin D deficiency, which is associated with increased disease severity.[38] Some studies find that vitamin D supplementation reduces fatigue in SLE patients[39], while others find no difference in SLE disease activity.[40] However, given the risks associated with vitamin D deficiency, people with SLE should talk to their medical provider about checking their vitamin D levels and supplementing if appropriate.
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.[12] However, more robust data are needed to support these findings. There are also data suggesting a high consumption of fiber[13] and/or nuts and legumes[14] may benefit people with SLE,[13] 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.[15] 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.[16][17]
There are limited data to support the efficacy of acupuncture, yoga, deep breathing, meditation, and other mind-body therapies for the treatment of SLE.[18][19][20] 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,[21] 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.
Demographic (nonmodifiable) risk factors for SLE include female sex (possibly due to an estrogen effect); being of African, Asian, Hispanic/Latino, Native American, Native Hawaiian, or Pacific Island descent; family history of SLE; and age (disease onset is often between the ages of 16 and 55 years). Environmental risk factors for SLE include smoking and alcohol intake; exposure to air pollution or silica dust; obesity; allergic reactions to medications; viral or bacterial illnesses, particularly Epstein-Barr virus; severe mental and/or physical stress; and, potentially, certain dietary patterns and microbiome changes (although more research is needed in this area).[23]
Multiple observational studies in people with SLE report an association between perceived stress and disease severity, such that increased stress exacerbates SLE symptoms.[21][24][25] While the mechanisms behind this connection are complex, stress induces changes in the central nervous system that may ultimately lead to immune system activation.[26] In people with SLE, this immune system activation is problematic, as it can spark the autoantibody “self-attack” that causes SLE symptoms. A stressful event, like exposure to trauma, may even be the environmental trigger that first provokes an SLE diagnosis.[27]
Considering the relationship between stress and SLE, it is important for people with SLE to find positive ways to manage their stress. This could include an exercise program,[15][28] a mindfulness practice,[29] social support,[30] behavioral therapy,[31][32] or another individualized approach.
Maybe. Some studies report a connection between the gut microbiome and SLE.[33] While research in this area is still emerging, it is possible that dysbiosis (an imbalance in gut bacteria associated with disease) may provoke the immune system dysfunction that contributes to SLE symptoms.[8] Case-control studies that compare the gut microbiome of healthy people to those with SLE do, in fact, find some differences in the balance of bacterial species present, potentially due to SLE itself and/or the medications used to treat SLE.[34] However, more research is needed to discern whether or not interventions aimed at modulating the gut microbiome (e.g., specific probiotics, fermented foods, certain diets) can effectively treat SLE symptoms.
Yes,[41] 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.[42]
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.[43]
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.[44][45]
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