Systemic Lupus Erythematosus

Last Updated: November 18, 2022

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.

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.

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References
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Examine Database References
  1. 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)
  2. 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)
  3. 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)
  4. 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)
  5. Systemic Lupus Erythematosus Symptoms - Westberg G, Tarkowski AEffect of MaxEPA in patients with SLE. A double-blind, crossover studyScand J Rheumatol.(1990)
  6. 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)
  7. 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)
  8. 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)