Systemic Lupus Erythematosus
Patient Presentation
In January 2001, C.F., a 21 year-old female, with no prior history of
disease reported “not feeling right” and complained of frequent,
“on-and-off” flu-like symptoms. She reported having “ambiguous” body aches
despite normal blood work. In 2002-2003, C.F.’s symptoms worsened during
her first year of graduate school, forcing her to withdraw at the end of the
academic year. In the Fall of 2003, C.F. reported the appearance of malar
rash . She complained of alopecia -“enough to clog the bath drain”- and of
photosensitivity. Her joints hurt (nonerosive arthritis), especially her
fingers, hands, and wrists. And she had developed a rash with raised edges
(discoid rash) the size of a baseball over her left elbow. She also
reported feeling pain and stiffness throughout her body. In 2004, C.F.
complained of episodes of severe weakness (due to anemia) and of feeling
“very inflamed and hot to the touch.”
Diagnosis
C.F. made an appointment to see a rheumatologist in April 2003 who suspected
systemic lupus erythematosus (SLE). He ordered lab work to test for the
presence of antinuclear antibody (ANA). ANA attacks the nucleus of a
person’s own cells. The results came back positive with an ANA titer of
1:320. (Titers of less than or equal to 1:40 are considered negative.) Her
erythrocyte sedimentation rate was also elevated which indicates the
presence of inflammation although it is non-specific. Also, her C3 and C4
(complement proteins are part of the immune system and are involved in
inflammatory responses) levels were low, which is typically seen in SLE. In
October 2004, C.F.’s ANA was 1:640. In June 2005, the presence of a
circulating lupus anticoagulant was detected and her PTT was prolonged
(>40 seconds) indicating clotting disturbances.
Treatment
C.F.’s rheumatologist recommended she begin treatment with Plaquenil® in
2006. Plaquenil® is a DMARD which is also used to treat malaria. It is
combined with methotrexate for its immunosuppressive capabilities. Her
dosage was 400 mg once a day. C.F. was also prescribed aspirin for its
anti-inflammatory, analgesic, and anti-platelet effects. For her discoid
rash, she was given a corticosteroid cream for topical application. The
goal of treatment is to control symptoms and prevent any further
inflammation that can cause tissue damage.
Outcome/Prognosis
There is no cure for SLE. The prognosis of SLE depends on how well the
individual controls her symptoms, how severe her lupus is, and how many
organs are involved. C.F. took Plaquenil® and baby aspirin until May 2007
when she became pregnant. Since childbirth in February 2008, her symptoms
have remained mild without medication although she reports the recurrence of
alopecia. She also reports that sun exposure causes flare-ups so she is
careful to limit her outdoor activities. For now, she is in a period of
remission.