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.

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 disease, like pericarditis, vasculitis, Raynaud’s disease, and blood clotting; kidney manifestations, especially lupus 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 stroke; hematologic (blood) abnormalities, like leukopenia and anemia; and eye conditions, mainly dry eye.^[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

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.

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 food. 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.