Systemic Lupus Erythematous (SLE)

 

 

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Introduction

Systemic Lupus Erythematous (SLE) is an Autoimmune disease that can affect any part of the body. Here the immune system attacks the body’s cells & tissues, resulting in inflammation & tissue damage.

It is Chronic, Unpredictable & characterized by exacerbations & remissions.

Incidence- In India 3.2 per 1, 00,000 population. More than 85% are females (Female: Male=9:1)

It commonly occurs in Age group 20-50 yrs.

Etiology: Unknown

Most probable causes:

  • Genetic influence -HLA B8, DR3, DR2 Inherited complement deficiencies
  • Hormones – Oestrogen imbalance
  • Environmental factors – UV light, Physical & emotional stress, Infections
  • Abnormal immune system
  • Certain medications

Pathogenesis:

Important stages of SLE

  • Immune insufficiency stage
  • Hyper activation stage
  • Formation of Auto antibodies & Immune complexes stage
  • Active disease stage
  • Destruction stage

Clinical manifestations:

sle pic

  • Ranges from a relatively mild disorder to rapidly progressing, affecting multiple body systems.
  • Most commonly affects the skin/muscles, joints, lining of lungs, heart, nervous tissue and kidneys.

Constitutional symptoms:

  • Fever
  • Headache
  • Malaise
  • Weight loss

Mucocutaneous manifestations:

  • Classical Malar rash- butterfly rash.
  • Rash in pre-auricular, auricular & post auricular area.
  • Diffuse hyper pigmentation/maculopapular rash.
  • Discoid lesions.
  • Scalp- Alopecia is common

Gastrointestinal manifestations:

  • Oral ulcers
  • Dysphagia
  • Anorexia
  • Nausea
  • Vomiting
  • Abdominal pain

Musculoskeletal manifestations:

  • Polyarthralgia with morning stiffness
  • Arthritis :Commonly affected- Small joints of hands (Phalangeal & Interphalangeal), wrist joint, knee joint Erosive arthritis is rare.

Cardiopulmonary manifestations:

  • Pericarditis: often silent
  • Myocarditis: presents with unexplained tachycardia, heart failure, arrhythmias or heart block.
  • Pleurisy & Pleural effusion: most common
  • Lupus pneumonitis & alveolar hemorrhage: rare

Renal manifestations:

  • Renal involvement may be asymptomatic
  • Lupus nephritis- Ranging from mild proteinuria to glomerulo nephritis.

Neurological manifestations:

  • Generalized/focal seizures
  • Peripheral neuropathy
  • Headache
  • Cognitive dysfunction:-Disorientation, Memory deficits and Psychiatric symptoms.

Haematological manifestations:

  • Anemia is common
  • Formation of antibodies against blood cells
  • Concomitant iron deficiency may be present.
  • Thrombocytopenia
  • Leucopenia

Criteria for diagnosis of SLE  4/11 Criteria  (American College of Rheumatology):

  1. Serositis – heart, lung, peritoneum
  2. Oral ulcers – painless esp palate
  3. Arthritis – non-erosive
  4. Photosensitivity
  5. Blood disorders -Hemolytic anaemia, low WBC count, low platelet count
  6. Renal involvement – proteinuria /± casts
  7. ANA
  8. Immunologic phenomena – LE cells, anti-dsDNA Ab, anti-Sm Ab, antiphospholipid Ab,
  9. Neurological disorders – seizures/ psychosis
  10. Malar rash – cheeks + nasal bridge
  11. Discoid rash

Diagnostic Tests

  • CBC – Hematological problems
  • ESR & CRP – Indicative of Inflammatory activity
  • Urine Analysis – Lupus Nephritis
  • X-rays of affected joints
  • Chest X-ray & CT – Pulmonary problems
  • ECG – Cardiac manifestations
  • CT or MRI of Brain – Neurological changes

Autoantibody tests used in SLE:

  • Antinuclear antibodies (ANA) : Best Screening test,95%
  • Antibodies to double-stranded (anti-dsDNA) : High specificity test,70%
  • Anti-Smith antibodies (anti-Sm) : Best Confirmatory test,30%

Prognosis:

Prognosis is improved with:

  • Earlier diagnosis
  • Earlier and better treatment regimens
  • Careful monitoring for organ involvement

General Principles

  • Sun avoidance & use of high factor sun-blocks
  • Lifestyle modifications

Eg.: Exercise

Smoking avoidance

Stress management etc.

 

Ayurvedic perspective

SLE is a multi system disorder- ‘Vyadhi Sankara’. Few signs and symptoms can be correlated with Vatarakta or amavata.

Management of SLE in Ayurveda:

  • Nidana parivarjana
  • Apatarpana
  • Vataraktavat chikitsa
  • to dhatu
  • Bahirparimarjana chikitsa
  • Shamana aushadhi
  • Rasayana prayoga

Deepana Pachana yogas

  • Amritadi Kashaya
  • Agnikumara Rasa
  • Amrutottara Kashaya
  • Shunthi Jala
  • Chitrakadi vati
  • Ajamodadi Choorna

Vatarakta chikitsa prayoga:

  • Uttana Vatarakta- Alepa, Abhyanga, Parisheka, Upanaha
  • Gambhira vatarakta- Virechana, Niruha basti, Snehapana

Basti:

  • Erandamooladi Niruha Basti
  • Kshara Basti
  • Dashamooladi Niruha Basti
  • Madhuyashtyadi Niruha Basti
  • Balaguduchyadi Niruha Basti
  • Vaitarana basti

Alepa:

  • Eladi Choorna
  • Nimbadi Choorna
  • Patoladi Choorna
  • Manjishtadi Lepa
  • Sarshapadi Lepa

Abhyanga

  • Madhuyashti taila
  • Pinda taila

Swedana

Parisheka Sweda, Pinda sweda and upanaha sweda

Shamana aushadis:

  • Yogaraja Guggulu – Guduchi Kashaya as Anupana
  • Mahayogaraja Guggulu
  • Kaishora Guggulu
  • Gokshuradi Guggulu
  • Maharasnadi Kwatha
  • Rasnapanchaka Kwatha
  • Rasnasaptaka Kwatha
  • Dashamoola Kwatha
  • Guggulu Tiktaka kashaya

Rasayana prayoga:

  • Amrita Bhallataka Rasayana
  • Madhusnuhi Rasayana
  • Vardhamana Pippali Rasayana
  • Swarna Mahayogaraj guggulu
  • Guduchi

Author:

IMG_20170615_234244

 

 

 

 

 

Dr. Keerthi Shetty

Ayurveda Doctor

Panchakarma Expert

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