Chemotherapy ver. Chemotherapy in the treatment of cancer

In the first period of the study of systemic lupus erythematosus, skin lesions were thought of as an obligatory attribute of this disease.

The skin lesion itself was characterized mainly by features of persistent exudative erythema, which was therefore called at one time as erythema perstans, with localization on the face, neck, and less often in other parts of the body. Since a febrile state was observed at the same time, the entire disease was designated as lupus acutus erythematodes disseminatus. Another form of systemic (or acute) lupus erythematosus developed, on the contrary, on the basis of a local, often recurrent process that had already existed for years, sometimes decades, with deep skin lesions and the outcome in cicatricial atrophy and pigmentation against the background of discoid or chronic lupus erythematosus.

Often, in the further course of the disease, the skin syndrome can appear only in the form of atrophic cicatricial changes.

At present, the following refinements can be made to this classical scheme.

On the one hand, at first casuistically rare, and by now more and more frequent, even prevailing in frequency, cases of systemic lupus erythematosus with arthritis and visceritis without skin lesions - lupus sine lupo - have become known.

On the other hand, with systemic lupus erythematosus, internists began to note more banal skin manifestations in the form of urticaria, exudative erythema, sometimes persistently recurrent course; in some cases, skin lesions reflect vascular disorders characteristic of lupus visceritis, in the form of purpura, petechial rashes and especially capillaritis, sometimes with micronecrosis (on the pads of the fingers, on the palms).

Now, relatively rarely and usually only for a short time, lupus erythema on the face in the form of a "butterfly" is observed, which at first was the main criterion for the diagnosis of systemic lupus from the standpoint of an internist. But nevertheless, the "butterfly" that appears after insolation remains indicative for an internist, often helping in the diagnosis.

It should be emphasized that with the actual cutaneous form of typical discoid lupus, one or another manifestation of general suffering, general immunological disorders (accelerated ROE, moderate hypergammaglobulinemia, or single lupus cells) are increasingly found.

The issue of skin syndrome is further complicated by the frequency of drug intolerance in patients with systemic lupus erythematosus, when, as, indeed, with a variety of other diseases, it is difficult to decide whether urticaria is a symptom of the underlying disease or an additional, drug.

Consequently, a sort of sharper "watershed" is drawn between the dermatological and internist aspects of considering a single disease - lupus erythematosus, and dermatologists are still interested in more limited, but more pronounced dermatologically skin lesions, while internists are interested in general forms with relatively mild, uncharacteristic skin lesions ...

In this article, we will provide only a brief description of those skin lesions that are especially characteristic of systemic lupus erythematosus. Let us describe discoid lupus and other lesions that are more specific from the dermatological side, which can be observed at one stage or another in patients with systemic lupus erythematosus or remain always in the competence of only dermatologists.

Characteristic skin lesions in systemic lupus erythematosus

Figure 1: Chronic systemic lupus erythematosus. Pigmentation and cicatricial atrophy of the skin of the face and chest after the reverse development of elements of discoid lupus erythematosus; severe baldness.

The primary element of chronic lupus erythematosus is a limited, pink-red spot, often rounded with whitish-gray scales in the central part. Over time, in the central part of the lesion, the skin becomes thinner and cicatricial atrophy occurs, which then captures the entire lesion. Along with the cardinal clinical symptoms - redness, hyperkeratosis and atrophy, less permanent signs are observed, such as telangiectasias, infiltration and pigmentation (Figure 1). Many other clinical varieties of lupus erythematosus are noted, depending on the predominance of one or another sign: fixed, hyperkeratotic, verrucous, etc.

Figure 2: Subacute systemic lupus erythematosus. Elements of discoid lupus on the nose and cheeks in the form of a "butterfly"

Chronic lupus erythematosus is localized mainly on the face, namely on the skin of the nose and cheeks, where the so-called butterfly can be seen, the “body” of which is located on the nose, and “wings” - symmetrically on the cheeks (Figure 2, 3).

The third place in terms of the frequency of localization is occupied by the auricles, followed by the forehead and eyebrows, the skin of the upper lip, chin, and lower lip (Figure 4). In 7-8% of patients, the scalp is affected, and in 2-3% - the open part of the chest, then the neck, shoulders and forearms, hands and fingers, thighs and shins, feet, trunk.

Figure 3: Acute systemic lupus erythematosus. Elements of discoid lupus erythematosus on the face in the form of a "butterfly", hair loss.

From the mucous membranes, the mucous membrane of the eyelids and oral cavity is often captured, and especially often the lips are in the form of a red border, and the lower lip is twice as often. The defeat of the mucous membranes is characterized by the presence of whitish-red, sometimes bright red strip-like, less often radial, reticular infiltrates and trophic foci, where, unlike skin lesions, partial ulceration of individual plaques occurs. Possibly isolated lesion of the red border of the lips.

With the defeat of the red border of the lips, erosive and ulcerative forms often occur, and the phenomena of atrophy are usually mild. In the flowering period, the focus on the red lip is characterized by stagnant hyperemia with sharp boundaries and: the central part of the inflammatory focus is slightly sunken, with dense scales (or bloody purulent crusts) and a narrow, raised rim along the edges of the lips.

Figure 4: Subacute systemic lupus erythematosus. Elements of discoid lupus on the chin, lesions of the red border of the lips.

The defeat of the mucous membranes is common, especially the defeat of the conjunctiva in the form of often recurrent conjunctivitis and the oral cavity.

Skin changes in systemic lupus erythematosus are not dominant in the clinical picture and differ significantly from those in chronic lupus erythematosus. The rash is characterized by polymorphism (Figure 5), and is spread over the entire skin. Along with separate, sometimes merging usual pale red, red and lid-red, flaky spots, there are hemorrhagic spots, nodules and nodes, and all these rashes do not leave atrophic changes.

Figure 5: Acute systemic lupus erythematosus. Exudative erythema on the hands.

Typical lesions of the skin of the face in the form of symmetrical, sharply limited redness and swelling, very reminiscent of erysipelas. On the mucous membrane of the oral cavity, eyelids, less often in other places, there may be ordinary red spots, vesicles and bubbles of erosion, hemorrhages; a picture of stomatitis, conjunctivitis may develop. Spotty eruptions of red or liquid-red color on the palms, soles and pads of the toes are very typical. You can observe at the same time a rash of chronic lupus erythematosus.

Histological changes in the skin with systemic lupus erythematosus depend on the clinical form. Usually, in the dermis, there is significant edema in both the papillary and papillary layers, vasodilatation, focal inflammatory infiltrates from leukocytes, lymphocytes and other cells, in the epidermis - the phenomenon of edema, up to the formation of vesicles and even blisters.

From the foregoing, it can be seen that skin lesions in systemic lupus erythematosus are extremely diverse, polymorphic and variable, but still retain their important diagnostic value, undoubtedly with typical elements ("butterfly", capillaries on the fingertips).

Systemic lupus erythematosus (SLE) is a very severe, progressive pathological condition that manifests itself in many syndromes and mainly affects young women.

The first signs appear at the age of 15 - 25 - the genetically imperfect immune system of the body does not recognize some of its own cells and activates antibodies against them, causing lesions and chronic inflammation of organs.

Systemic lupus erythematosus - prognosis for life

In the past, most patients died 2 to 5 years after the first symptoms of the disease. With the possibilities of modern medicine, the prognosis for surviving to old age is quite high.

The duration and quality of life is associated with the severity of chronic organ damage, since in this form of the disease, drug therapy has a good effect on all types of symptoms. The correct treatment regimen for systemic lupus erythematosus improves the prognosis for a person's life. Doctors say that modern medicines make it possible to live for more than 20 years after an accurate diagnosis is made.

Symptoms and signs of systemic lupus erythematosus appear depending on the form and speed of the disease. Most people with SLE live full lives and continue to work.

In severe acute form, a person often cannot work due to intense joint pain, severe weakness, and neuropsychiatric disorders.

Atherosclerosis of cerebral vessels, symptoms and treatment of the disease:

Symptoms of systemic lupus erythematosus, photo

photos of characteristic manifestations of systemic lupus erythematosus

Since with SLE, damage to any organ can be expected, the symptoms are rather blurred, and the signs are characteristic of many diseases:

• an increase in temperature of unknown origin;
• muscle pain (myalgia), fatigue during physical and mental stress;
• muscle pain, headache attacks, general weakness;
• frequent diarrhea;
• nervousness, irritability, sleep disturbance;
• depression.

Fibromyalgia - what is it? Symptoms and treatment, signs of the disease:

Specific signs

In addition to general symptoms, lupus erythematosus has many specific symptoms, allocated into groups in accordance with the affected organ or system.

Skin manifestations:

• The classic symptom of the disease, which gave it its name, is characteristic erythema - reddening of the skin in the shape of a "butterfly", which occurs when the capillaries expand, and the appearance of a rash in the bridge of the nose and on the cheekbones. It is noted in every second or third patient. Erythema is also observed on the body, limbs in the form of separate or confluent edematous red spots of various shapes.
• Small hemorrhagic rash (due to bursting small vessels) on the skin of the palms and fingertips.
• On the mucous membrane of the genitals, nose, throat, lips, ulcers, dental aphthae appear.
• Trophic ulcers occur in severe disease.
• Nails become brittle, hair dry, focal hair loss is observed.

Joint problems:

The connective tissue present in the area of ​​the joints is severely affected by lupus, so most patients note:

• Pain in the small joints of the wrists, hands, knees;
• The manifestation of polyarthritic inflammations that pass without destruction of bone tissue (in comparison with rheumatoid arthritis), but with frequent deformities of the damaged joints (in every fifth);
• Inflammation and pain in the coccyx and sacrum (mainly in men).

Reaction from the hematopoietic system:

• The detection of lupus LE cells in the blood is a characteristic sign of SLE.
• These cells are altered leukocytes, within which nuclei of other blood cells are found. This phenomenon indicates that the immune system is mistaken, perceiving its own cells as foreign and dangerous, giving a signal to leukocytes to absorb them.
• Anemia, leukopenia, thrombocytopenia (in every second patient), arising from the disease, and because of the drugs taken.

Cardiac activity and vascular system

Many patients have:

• Pericarditis, endocarditis and myocarditis (without revealing signs of infection that provokes such inflammatory diseases).
• Damage to the heart valves with the further development of the disease.
• The development of atherosclerosis.

Nephrology for SLE:

1. The development of lupus nephritis (lupus nephritis) is a pronounced renal inflammation with disruption of the glomeruli and decreased renal function (more likely in the acute form of the disease).
2. Hematuria (an abundance of blood in the urine) or proteinuria (), proceeding without painful manifestations.

With timely diagnosis and initiation of therapy, acute renal pathology occurs in only 1 out of 20 patients.

Neurological and mental disorders

Without effective treatment, the likelihood of occurrence is high:

• Encephalopathy (damage to brain cells).
• Convulsive seizures.
• Cerebrovasculitis (inflammation of the vessels of the brain).
• Decreased sensitivity.
• Visual hallucinations.
• Confusion of perception, violation of the adequacy of thinking.

These deviations in the neuropsychiatric sphere are difficult to correct.

Respiratory system

Symptoms of lupus erythematosus appear in the area of ​​the lung system in the form of shortness of breath, painful sensations in the chest when breathing (often with the development of pleurisy).

Forms of the disease

There are three forms of the disease.

Acute form characterized by:

• abrupt onset, when the patient can name a certain day;
• high fever, chills;
• polyarthritis;
• rash and the appearance of a "lupus butterfly" on the face;
• cyanosis (bluish skin color) on the nose and cheeks.

Within six months, signs of acute serositis (inflammation of the serous membranes of the pericardium, pleura, peritoneum), pneumonitis (inflammation of the lungs with damage to the alveolar walls), neurological and mental disorders, seizures similar to epileptic ones develop.

The course of the disease in acute form is severe. Life expectancy without active therapy is no more than a year or two.

Subacute form begins with manifestations such as:

• general symptoms of lupus erythematosus;
• soreness and swelling of small joints;
• recurrent arthritis;
• cutaneous lesions in the form of lupus erythematosus (ulceration of the skin, scaly, scaly);
• photodermatosis appearing in the neck, chest, forehead, lips, ears.

The undulation of the flow of the subacute form manifests itself quite clearly. For a period of 2 - 3 years, a complete clinical picture is formed.

Noted:

1. Persistent paroxysmal headaches, high degree of fatigue.
2. Severe heart damage in the form of Liebman-Sachs endocarditis and inflammation of the valves - mitral, aortic, tricuspid.
3. Myalgia (muscle pain, even at rest).
4. Inflammation of the muscles and muscles of the skeleton with their atrophy - myositis.
5. Raynaud's syndrome (blue discoloration or whitening of the skin of the fingertips or feet in cold, stressful conditions), often resulting in death of the fingertips.
6. Lymphadenopathy is a pathological enlargement of the lymph nodes.
7. Lupus pneumonitis (inflammation of the lungs with SLE, developing in the form of SARS or atypical pneumonia).
8. Inflammation of the kidneys, not becoming as severe as in the acute form;
9. Anemia, leukopenia (a strong decrease in the number of leukocytes), thrombocytopenia or Welhoff's syndrome (a sharp decrease in blood platelets, accompanied by bruising, bruising on the skin, mucous membranes, bleeding and difficulty stopping bleeding even after minor injuries).
10. Increased concentration of immunoglobulins in the blood.

Chronic form

Disease lupus erythematosus, which proceeds in a chronic form, for a long time is expressed in frequent polyarthritis, manifestations of lupus erythematosus, lesions of small arteries, Welhoff's syndrome.

During 6 - 9 years of the disease, other organic pathologies (nephritis, pneumonitis) join.

The diagnosis is made on the basis of a complex of signs (joint and muscle pain, fever), systemic lupus erythematosus syndromes - Raynaud and Welhoff, and research results.

To make a reliable diagnosis, certain criteria are taken into account that manifested themselves during the patient's illness.

They include:

• Lupus butterfly.
• Photosensitization - increased sensitivity of exposed skin to sunlight.
• Discoid lupus, a coin-sized, edematous, scaly rash that leaves scarring.
• Ulcers on the mucous membranes.
• Arthritis with tenderness and swelling of the joints (often symmetrical).
• Serositis or inflammation of the membranes surrounding the heart, lungs, peritoneum, causing difficulty breathing and pain when changing body position.
• Inflammation of the kidneys develops in almost all patients with SLE in mild or severe form. At first, it is detected only by urine tests, detecting blood and protein in it, and by swelling of the eyes, legs and feet.
• Neurological manifestations, expressed in depressive conditions, acute attacks of headache, impaired memory, concentration, psychosis (severe mental pathology with impaired behavior and perception).
• Pathological changes in blood cells: destruction of red blood cells that carry oxygen (causes anemia), a decrease in the number of leukocytes (leukopenia), platelets with the occurrence of bleeding from the nose, urinary tract, brain, digestive organs and uterus.
• Immunological disorders: the formation of autoantibodies (antibodies to native DNA), which indicates the development of SLE. An increase in their number indicates the active development of the disease.
• The appearance of SM antibodies, which are detected only in systemic lupus erythematosus. This confirms the diagnosis.
• Antiphospholipid antibodies (ANA) in the blood that target the cell nuclei are also found in almost every patient.
• Blood complement levels (proteins that kill bacteria and are responsible for regulating the body's inflammatory and immune responses). A low level indicates the progression of the disease,

Laboratory examinations and tests are needed to:

• clarification of the diagnosis;
• determining the organs involved in the disease process;
• monitoring the progression and severity of SLE;
• determining the effectiveness of drug therapy.

There are many tests that measure the effects of lupus on various organs:

• taking an X-ray of the lungs, heart;
• electrocardiogram, echocardiography of the heart;
• determination of the respiratory function of the lungs;
• for brain examination - electroencephalography EEG, MRI.

The main goals of complex treatment:

• removal of inflammation and regulation of immune pathology;
• prevention of exacerbations and complications;
• treatment of complications provoked by the intake of immunosuppressants, hormonal and antineoplastic agents;
• active treatment of certain syndromes;
• cleansing the blood of antibodies and toxins.

Basic methods:

Pulse therapy, which includes the use of:

• corticosteroids, which are prescribed in the early stages of the disease. All patients are registered with the dispensary, so that hormones are used in a timely manner at the very initial manifestations of exacerbation of SLE.
• the use of increased doses of cytostatics (drugs that suppress the growth and development of cancer cells), which allows you to quickly get rid of severe symptoms of the disease. The course is short.

The method of hemosorption is the removal of toxins, pathological cells of immune complexes and blood cells from the blood, regulation of hematopoiesis using a special apparatus through which blood is passed through a filter with an absorbent.

• If it is impossible to use steroids, drugs are prescribed that suppress some pathological manifestations of the central nervous system.
• Immunosuppressants (drugs that suppress abnormal immune responses).
• Drugs that block the action of enzymes that provoke inflammatory processes and help relieve symptoms.
• Non-steroidal anti-inflammatory drugs.
• Mandatory treatment of diseases that cause lupus - nephritis, arthritis, pulmonary pathologies. It is especially important to monitor the condition of the kidneys, since lupus nephritis is the most common cause of death in patients with SLE.
• All medicines and techniques are used according to strict medical indications in compliance with the dosage regimen and precautions.
• During periods of remission, the dose of steroids is reduced to maintenance therapy.

Existing diseases of the urinary system and ways to combat them:

Complications of SLE

The main complications that SLE provokes:

1. Renal pathologies (nephritis, nephrosis) develop in 25% of patients with SLE. The first symptoms are swelling in the legs, the presence of protein and blood in the urine. Failure of the kidneys to function properly is extremely life-threatening. Treatment includes strong SLE medications, dialysis, and kidney transplants.

2. Heart disease:

• pericarditis - inflammation of the heart bag;
• hardening of the coronary arteries that feed the heart due to the accumulation of thrombotic clots (atherosclerosis);
• endocarditis (infection of damaged heart valves) due to hardening of the heart valves, an accumulation of blood clots. Valve transplants are often performed;
• myocarditis (inflammation of the muscle of the heart), causing severe arrhythmias, diseases of the heart muscle.

3. Diseases of the lungs (30%), pleurisy, inflammation of the muscles of the chest, joints, ligaments. Development of acute tuberculous lupus erythematosus (inflammation of the lung tissue). Pulmonary embolism - blockage of the arteries by emboli (blood clots) due to increased blood viscosity.

4. Diseases of the blood, life-threatening.

• a decrease in erythrocytes (supplying cells with oxygen), leukocytes (suppressing infections and inflammation), platelets (promoting blood clotting);
• hemolytic anemia caused by a lack of red blood cells or platelets;
• pathological changes in the organs of hematopoiesis.

Although pregnancy with lupus has a high likelihood of exacerbations, most women have a successful gestation and delivery period.

But, if we compare with 15% of miscarriages in healthy expectant mothers, then in pregnant patients with SLE, the number increases to 25%.

It is very important that no signs of lupus should be found six months before conception. And in these 6 months, all medications that can cause the drug form of lupus are canceled.

The choice of therapy during pregnancy is important. Some SLE medications are discontinued to avoid miscarriage and harm to the fetus.

Symptoms of SLE during pregnancy:

• exacerbations of mild or moderate;
• with the use of corticosteroids there is a high risk of high blood pressure, diabetes, kidney complications.

One in four babies from lupus pregnancy are born prematurely, but they do not have any defects. In the future, children also do not show either mental or physical retardation.

Very rarely, children born to women with special antibodies in their blood show some signs of lupus in the form of a rash or a low red blood cell count. But these symptoms are recurrent, and most children do not need treatment at all.

Pregnancy that has arisen unplanned - at the time of exacerbation of the disease - has a negative impact on the fetus and the mother, increasing all manifestations of SLE, and creating difficulties with bearing.

The safest method of contraception is the use of diaphragms, caps with contraceptive gels, and uterine spirals. It is not recommended to use contraceptive oral medications, the use of medications with a high content of estrogen is especially dangerous.

Do you know how to recognize the early signs of lupus?

Lupus is a chronic and painful condition. Mayo Clinic describes it as "a chronic inflammatory disease that occurs when the body's immune system destroys its own tissues and organs."

Like psoriasis, lupus is an autoimmune disease in which the body accidentally directs its disease-fighting capabilities to itself. The severity of lupus can vary widely.

Some people have only mild symptoms, while others are more severe and may interfere with their ability to work. There are many different risk factors, many of which are genetic. Scientists still don't fully understand why some people have more signs of lupus than others. Moreover, in 9 out of 10 cases, women suffer from lupus.

Take a look at some of the more common early signs of lupus.

Lupus sign # 1: Butterfly rash

Image: LittleThings

A butterfly rash is one of the most common early signs of lupus.

According to WebMD, it usually spreads through the top of the nose to both cheeks.

In some people, it can spread even further. This rash is usually reddish purple and may be scaly or scaly.

Lupus sign # 2: Blue fingers

Image: LittleThings

Lupus causes circulatory problems that can lead to Raynaud's disease.

In Raynaud's syndrome, small vessel spasms make it more difficult for blood to flow to your fingertips.

Therefore, you may notice that your fingers and fingertips are blue, purple, or white due to the lack of blood flow.

Lupus sign # 3: wasting

Image: LittleThings

We all get tired, but exhaustion is another matter entirely.

When you are exhausted, your body and bones are so tired that you can barely move. This feeling can also be accompanied by a fever.

Lupus researchers do not know why it causes such intense feelings of fatigue, although this may be due to the fact that the body is falsely trying to believe that it is fighting the disease.

Lupus sign # 4: Hair loss

Image: LittleThings

Hair loss is a common symptom of a number of ailments, including stress and malnutrition.

However, if you notice that your hair appears to be falling out in clumps, it could be a sign of lupus.

Typically, lupus balding is temporary and hair will start growing again during remission.

Lupus sign # 5: Swollen legs

Image: LittleThings

For many people with lupus, swollen feet and ankles are the very first symptom.

You may experience swelling that will reshape your lower limbs.

Lupus nephritis, which impairs kidney function, makes it harder for the body to excrete excess water and it starts to build up in your body. Legs swell primarily due to gravity.

If you experience this symptom, you need to get screened for kidney failure.

Lupus sign # 6: Throbbing chest pains

Image: LittleThings

Chest pain is one of the most dangerous early symptoms of lupus, as it can mean your heart is at risk.

Lupus can attack any tissue in the body, including the heart. When this happens, an inflammation called myocarditis sets in. This causes pain and can lead to poor heart rate.

Lupus sign # 7: Ulcers in the nose and mouth

Image: LittleThings

About 50% of people with lupus have sores in their mouth and nose.

These sores are usually not painful, but can make you feel itchy, sore, or dry.

They most often appear in the upper part of the mouth (although they can appear everywhere) and are red in the middle with a whitish "halo" around.

Lupus sign # 8: Swollen joints

Image: LittleThings

When lupus affects the entire body, lupus arthritis may be one of the first symptoms.

Like any other type of arthritis, it causes swelling and pain in the joints.

Lupus affects the tissues and ligaments in the joint, causing them to become inflamed and swollen, leading to arthritis.

Lupus is a serious medical condition that can affect anyone. If you experience any of the listed symptoms, be sure to see your doctor.