Course and evolution
With the use of appropriate therapy, the average survival of Systemic Lupus Erythematosus patients is currently around 8-10 years from the time of diagnosis.
In some cases the course is benign, especially when vital organs are spared, in other cases it is very serious. It is often characterized by exacerbations and remission of symptoms. Serious renal and nervous systems are involved. The most common causes of death are: renal failure, heart failure, bleeding, infections, injury to the central nervous system.
Therapy
In patients in whom the disease does not appear aggressive and in which the involvement is limited to joints, skin and serosa (pleura, pericardium and peritoneum), treatment can be started with non-steroidal anti-inflammatory drugs ( aspirin ) and antimalarials ( chloroquine or hydroxychloroquine ). Although this therapy is generally well tolerated, it has the risk of being toxic on the retina, so it is necessary to carry out periodic eye exams. At the slightest sign of impaired vision it is necessary to stop therapy immediately.
In cases that do not resolve with these drugs, it is necessary to use steroids (cortisone derivatives, such as prednisone ).
In severe forms, however, immediate and aggressive therapy with steroids is required. If possible, alternate-day therapy can be used, which is able to reduce some of the numerous side effects of steroids used for long periods, and which are: cataract, glaucoma, hypertension, peptic ulcer, acne, weight gain with fat localized especially to the face, stomach and hips, water retention, osteoporosis, rupture of the femoral head, convulsions, psychosis, increased susceptibility to infections.
Continuation of treatment with steroids at high doses for very long periods is not recommended; in these cases it is worthwhile to associate an immunosuppressive drug with cortisone, that is to say that it controls the activation of the immune system, such as azathioprine . If this were not enough, and in any case from the beginning in the forms with severe and rapid renal damage, it is necessary to associate cortisone with the most powerful immunodepressor which is cyclophosphamide, which, however, can cause, in the long run, sterility in young women, tumors bladder, lymphomas and leukemias. Finally, another therapy that has found a sure indication in some particular cases of systemic Lupus erythematosus, is represented by plasma transfusions (the liquid part of the blood), which has the purpose of removing the antigen-antibody complexes that circulate therein in large quantities.
