Advances in systemic lupus erythematosus

Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with a heterogeneous course and systemic involvement. It is the result of a complex pathogenic pathway that culminates in autoantibody formation. The interaction between environmental triggers and genetic susceptibility is key in this process. Genome-Wide Association Study (GWAS) technology has allowed the recognition of over 80 loci associated with SLE that lead to the formation of key proteins, each of which contributes a small increase to the risk. Advances in the management of the disease include new validated standardized tools to capture disease activity, damage and quality of life, for clinical and research purposes. The prognosis of SLE has much improved in the last 50 years due to better general management and specific treatment, including better use of immunosuppressives and development of a new group of drugsbiologic therapy.

Systemic lupus erythematosus: causes and manifestations

“…The improvement in patient survival – 50% four year survival in 1950; 85% 15 year survival in 2019 – is probably due to multiple factors, including earlier disease recognition with more sensitive diagnostic tests and improved treatment …”

“…One of the chromosome regions having the strongest association with SLE is the human leucocyte antigen (HLA) locus, especially the class region containing HLA‐DRB1,‐DQA1 and ‐DQB1. There are also associations of some of these loci with specific clinical and serological features …”

“…There is a higher prevalence of SLE in the African‐Caribbean population living in Europe and North America, compared with the Caucasian population (approximately 5:1) …”

“…Other reported environmental triggers are ultraviolet light, smoking and silica. Medications implicated in drug‐induced lupus include hydralazine, d‐penicillamine, minocycline, lithium and TNF alpha‐blocking agents …”

Increased MLKL mRNA level in the PBMCs is correlated with autoantibody production, renal involvement and SLE disease activity

“…SLE is a complex, heterogeneous systemic autoimmune disease that attacks various cells and tissues, resulting in chronic in ammation and persistent tissue damage [1]. A notable characteristic of SLE is the production of pathogenic autoantibodies recognizing nucleic acids or proteins binding to nucleic acids [2].…”