SLE spectrum of conditions

Anti-phospholipid Syndrome

This disease is identified by repeated episodes of recurrent arterial and venous thromboses, and miscarriages.

It was first described as a complication in about 30% of patients with SLE, however there is another presentation (primary anti-phospholipid syndrome) in which the patients have thrombotic episodes and anti-phospholipid antibodies (aPL).

Around one third of patients with SLE have aPL but not all have the syndrome.

In about 2% of the normal population detectable aPL are present so it is unusual.

The cause is the attachment of antibodies to phospholipids, which are fats which contain phosphorus, and which are the main lipid (fat) component of cell walls in the body.

There is an increased risk of miscarriage in the second and 3rd trimester of pregnancy, an increased risk of pre-eclampsia, early delivery of the baby, and renal complications.

Patients with circulating anti-phospholipid antibodies are advised to take aspirin and heparin in pregnancy.

Discoid Lupus Erythematosus

This type of Lupus affects only the skin, especially on the face and head, where there are raised round bumps [in the shape of discs, hence the name “discoid”], scaling, and frequent scarring and hair loss. This is normally the only manifestation of this condition, but in 10% of people with this condition there may be mild manifestations of systemic disease.

When the manifestations of the disease are confined to the skin, (discoid lupus), topical steroid creams can be used.

Drug- induced Lupus Erythematosus

A large number of drugs can induce a lupus – like reaction, and there is this potential in any drug.

Removal of the offending drug normally leads to a resolution of the disease. Drugs which may induce lupus are: anticonvulsants, hydralazine, procainamide, chlorpromazine, minocycline and isoniazid.

This list is not exclusive, but these are the ones which are reported most.

Amended November 2008