Organ Systems Affected by Systemic Lupus Erythematosus (SLE)
Systemic lupus erythematosus (SLE) is a complex multisystemic autoimmune disease that can affect virtually any organ system in the body, with manifestations ranging from mild to severe and life-threatening.
Major Organ Systems Affected
Musculoskeletal System
- Joint pain, swelling, and arthritis (one of the most common manifestations)
- Myalgia and myositis
- Avascular necrosis of bone 1
Mucocutaneous System
- Lupus-specific rashes (acute, subacute, chronic cutaneous lupus)
- Photosensitivity
- Oral/nasal ulcers
- Alopecia
- Discoid lesions 1, 2
Renal System
- Lupus nephritis (affects approximately 40% of patients)
- Proteinuria, hematuria, and impaired kidney function
- Can progress to end-stage kidney disease in about 10% of patients after 10 years 3, 4
Hematologic System
- Anemia (often hemolytic)
- Leukopenia and lymphopenia
- Thrombocytopenia
- Increased risk of thrombosis (especially with antiphospholipid antibodies) 1, 5
Cardiovascular System
- Pericarditis
- Myocarditis
- Libman-Sacks endocarditis
- Accelerated atherosclerosis
- Increased risk of coronary artery disease 1, 2
Pulmonary System
- Pleuritis and pleural effusions
- Pneumonitis
- Pulmonary hypertension
- Interstitial lung disease
- Shrinking lung syndrome 5, 4
Neuropsychiatric System
Gastrointestinal System
Monitoring and Assessment
Laboratory Monitoring
- Anti-dsDNA antibodies and complement levels (C3, C4) correlate with disease activity
- Complete blood count to monitor for cytopenias
- Renal function tests (creatinine, urinalysis, protein/creatinine ratio)
- Antiphospholipid antibodies for thrombotic risk assessment 1, 3
Clinical Assessment
- Regular monitoring every 1-3 months during active disease
- Assessment every 6-12 months for stable patients
- Specific organ system monitoring based on involvement 1
Treatment Considerations
Treatment should be tailored to the specific organ systems involved:
- All patients should receive antimalarials (hydroxychloroquine) unless contraindicated 1
- Musculoskeletal and mucocutaneous manifestations: Antimalarials, low-dose glucocorticoids, and sometimes immunosuppressants
- Renal involvement: Higher intensity immunosuppression with mycophenolate mofetil or cyclophosphamide plus glucocorticoids
- Neuropsychiatric manifestations: High-dose glucocorticoids and cyclophosphamide for severe manifestations
- Hematologic involvement: Glucocorticoids, immunosuppressants, and sometimes rituximab for severe cases 3, 4
Prevention of Comorbidities
- Cardiovascular risk reduction (blood pressure control, lipid management)
- Osteoporosis prevention (calcium, vitamin D)
- Infection prevention (vaccinations, monitoring during immunosuppression)
- Sun protection (UV avoidance) 1, 3
The multisystemic nature of SLE requires a comprehensive approach to monitoring and treatment, with the primary goals of achieving remission or low disease activity, preventing organ damage, and optimizing quality of life 1, 4.