Systemic Lupus Erythematosus
A lifelong multisystem autoimmune disease in which loss of tolerance produces autoantibodies and inflammation across skin, joints, kidneys, blood, serosa and the nervous system.
Definition
Systemic lupus erythematosus is a lifelong multisystem autoimmune disease caused by loss of immune tolerance and characterised by variable inflammatory involvement of the skin, joints, kidneys, blood, serous membranes and nervous system. It commonly follows a relapsing and remitting course.
First principles
SLE is a clinical diagnosis supported by, not replaced by, autoantibodies
SLE arises from loss of immune tolerance with genetic, hormonal and environmental contributions. Clinical features and organ involvement must be interpreted with serology: ANA is a sensitive entry test when there is reasonable clinical suspicion, whereas anti-dsDNA, anti-Smith antibodies and low complement are more supportive in the right clinical context. Classification criteria can help structure thinking but are not diagnostic rules.
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