Systemic Lupus Erythematosus and Multiple Sclerosis

Introduction

Systemic lupus erythematosus and multiple sclerosis are some of the diseases common among young people. Both disorders occur at a relatively young age and present an obstacle to a common lifestyle. There are no cures found for these disorders, but the appropriate behavior of the patients can lower the possibility of developing serious symptoms.

Pathophysiology of the diseases

Systemic lupus erythematosus is a chronic disease. This inflammatory connective tissue disorder is autoimmune and is caused by the breakdown in the functioning of the immune system. The pathophysiology of lupus is not fully investigated by modern medicine, as it has many elusive issues. Modern studies reveal the hereditary nature of the disease and state that susceptibility to it “involves human leucocyte antigen (HLA) class II gene polymorphisms” (Lau & Mok, 2003, p. 481).

The disease is more common among women, as 9 of 10 patients with lupus are female. The female predilection becomes more visible in the reproductive age. The total index of factors, such as sex, hormonal sphere, the HPA axis, and defective immune regulation influence the person’s susceptibility to this disease (Lau & Mok, 2003, p. 488). The development of the disease starts when the immune system begins creating antibodies against LSm proteins. This process is caused by “excess T cell help, defective B cell suppression, and shifting of Th1 to Th2 immune responses” (Lau & Mok, 2003, p. 488). All these abnormal phenomena lead to the damage of the vital organs. While the cause of the disease is not determined, environmental factors are believed to provoke the onset of lupus.

Multiple sclerosis is a disease affecting the nervous system (Alvarez & Wu, 2011, p. 257). It involves the immune-mediated processes in which the immune system presents a threat to the nervous system. The disease is characterized by the formation of scars, known as lesions, in the nervous system. This process is called demyelination. It is a partial destruction of myelin. Myelin is a fatty protective layer that covers nerve fibers (Alvarez & Wu, 2011, p. 258).

It starts inflammatory processes which lead to further worsening of the nervous system functioning. The pathophysiology of multiple sclerosis remains partially unexplored and creates many challenges for modern medicine. A combination of different environmental factors is believed to present a risk of developing the disorder (Alvarez & Wu, 2011, p. 257). The disease is not considered hereditary. The possibility of its autoimmune nature is still a theme of debate.

Lupus is an autoimmune disease while the autoimmune nature of multiple sclerosis is not proved. While the investigations on the nature of lupus proved its hereditary nature, a genetic aspect of multiple sclerosis is still not fully explored. Both diseases are related to unexplained abnormal processes in the organism. Modern medicine leaves numerous questions about these diseases unanswered. However, the pathophysiology of multiple sclerosis remains more elusive than the nature of lupus.

Clinical manifestations

Systemic lupus erythematosus is associated with a wide range of clinical manifestations. The most common constitutional manifestations include fatigue, weight changes, and fever. Musculoskeletal manifestations, mostly joint pain, are extremely common in patients with this disease (Cojocaru, Cojocaru, Silosi, & Vrabie, 2011, p. 331). Dermatological manifestations include malar rash, photosensitivity, discoid rash, and alopecia.

Renal manifestations, such as nephritis, hematuria, and proteinuria, often lead to the development of renal failure and sepsis, which can cause fatal consequences. Neuropsychiatric manifestations can take numerous forms and involve any part of the central nervous system. Pulmonary manifestations include serositis, pulmonary hypertension, and thromboembolic disease. Lupus is protean in its manifestations and follows “a relapsing and remitting course (Cojocaru et al., 2011, p. 335).

Multiple sclerosis is known for numerous clinical manifestations caused by neurological dysfunction. The episodes of occurring symptoms are often followed by partial or complete remissions. General clinic manifestations include fatigue, lack of sleep, sensory loss, heat intolerance. Optic neuritis is a common manifestation of multiple sclerosis. It refers to blurred vision and headaches caused by eye movements. Other clinical manifestations of the disease include Charcot’s triad of dysarthria, trigeminal neuralgia, facial myokymia, depression, and subjective cognitive difficulties.

Clinical manifestations of multiple sclerosis are more limited than the manifestations of systemic lupus erythematosus. It makes the diagnostics of multiple sclerosis easier and more precise. However, both diseases cause distinct manifestations that distinguish them from other disorders.

Medical Management

The severity of systemic lupus erythematosus and its manifestations regulates its management. As the disease has a multisystem nature, its management depends on the consultations with numerous specialists. The choice of specialists is determined by the organ system involved. Dermatological and musculoskeletal manifestations are usually treated with nonsteroidal anti-inflammatory drugs and small amounts of corticosteroids.

Bigger doses of steroids can be needed if the vital organs are involved. The use of steroids is usually kept on the lowest possible level, as they have numerous side effects. Hydroxychloroquine and chloroquine are the cornerstones of lupus medical management. These antimalarials give good results in long-term treatment and do not cause severe side effects.

The medical management of multiple sclerosis is based on the multidisciplinary approach, as the disease produces a spectrum of clinical manifestations. Immunomodulatory therapy is an accepted way of treatment for patients with this disease. This treatment is directed at lowering the frequency of relapses and stopping the progression. Therapy, aimed at modifying the disease, costs a lot of money and relies on every day injections.

The lack of knowledge about the nature of systemic lupus erythematosus and multiple sclerosis leads to the impossibility of finding an effective cure that can beat the disease. Therefore, medical management for these diseases is mostly directed on relieving the symptoms and lowering progression.

Prognosis

Systemic lupus erythematosus is not considered a fatal disease in modern medicine. Though in the past this disease caused high rates of deaths among young people, nowadays people with this disorder can expect a normal lifespan. The patient should lead a healthy lifestyle, follow the instructions of doctors, and take appropriate medications. This results in longer life expectancy and the possibility of living a normal life, without the need for hospitalization. However, the cure for this disease is not found and recovery is not possible.

Multiple sclerosis is not fatal. The length of life among people suffering from this disease is not lower than the common life expectancy. The negative side of prognosis includes prospects of disability and the impossibility of living a usual life. However, this notion is sometimes exaggerated. Nearly a third of patients live without any serious disability and rarely require medical assistance. At the same time, there are no cure or chances of recovering from this disease.

Both multiple sclerosis and systemic lupus erythematosus do not belong to the deadliest diseases. However, the cures for them are yet to be created.

The nature of such diseases as systemic lupus erythematosus and multiple sclerosis is not fully investigated. Though they cannot be cured, a level of severity of manifestations can be lowered by a well-timed appropriate treatment.

References

Alvarez, E., & Wu, G. F. (2011). The immuno-pathophysiology of multiple sclerosis. Neurologic Clinics, 29(2), 257-278.

Cojocaru, I. M., Cojocaru, M., Silosi, I., & Vrabie, C. D. (2011). Manifestations of systemic lupus erythematosus. Maedica: A Journal of Clinical Medicine, 6(4), 330-336.

Lau, C. S., & Mok, C. C. (2003). Pathogenesis of systemic lupus erythematosus. Journal of Clinical Pathology, 56(7), 481-490.