Systemic Lupus Erythematosus - Complications

The most serious CNS disorder is inflammation of the blood vessels in the brain, which occurs in 10% of patients with SLE. Fever, seizures, psychosis, and even coma can occur. Other CNS side effects include:

Irritability
Emotional disorders (anxiety, depression)
Mild impairment of concentration and memory
Migraine and tension headaches
Problems withthe reflex systems, sensation, vision, hearing, and motor control

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Infections

Infections are a common complication and a major cause of death in all stages of SLE. The immune system is indeed overactive in SLE, but it is also abnormal and reduces the ability to fight infections. Patients are not only prone to the ordinary streptococcal and staphylococcal infections, but they are also susceptible to fungal and parasitic infections (called opportunistic infections), which are common in people with weakened immune systems. They also face an increased risk for herpes, salmonella, and yeast infections. Corticosteroid and immunosuppressants, treatments used for SLE, also increase the risk for infections, thereby compounding the problem.

Gastrointestinal Complications

About 45% of patients with SLE suffer gastrointestinal problems, including nausea, weight loss, mild abdominal pain, and diarrhea. Severe inflammation of the intestinal tract occurs in less than 5% of patients and causes acute cramping, vomiting, diarrhea, and, rarely, intestinal perforation, which can be life-threatening. Fluid retention and swelling can cause intestinal obstruction, which is much less serious but causes the same type of severe pain. Inflammation of the pancreas can be caused by the disease and by corticosteroid therapy.

Joint, Muscle, and Bone Complications

Arthritis caused by SLE almost never leads to destruction or deformity of joints. The inflammatory process can, however, damage muscles and cause weakness. patients with SLE also commonly experience reductions in bone mass density (osteoporosis) and have a higher risk for fractures, whether or not they are taking corticosteroids (which are known risk factors for osteoporosis).

Click the icon to see an image of osteoporosis.

Eye Complications

Inflamed blood vessels in the eye can reduce blood supply to the retina, resulting in degeneration of nerve cells and a risk of hemorrhage in the retina. The most common symptoms are cotton-wool-like spots on the retina. In about 5% of patients sudden temporary blindness may occur.

Socioeconomic Consequences

In one study, 40% of patients with SLE quit work within four years of diagnosis, and many had to modify their work conditions. Significant factors that predicted job loss included high physical demands from the work itself, a more severe condition at the time of diagnosis, and lower educational levels. People with lower income jobs were at particular risk for leaving them.

Pregnancy and Systemic Lupus Erythematosus

In some studies 6 - 15% of women report fewer flares during pregnancy. Most flares occur during the first or second trimester and2 months after delivery. Women who conceive after at least 6 months of remission have a lower risk for flares.

Effect of SLE During and After Pregnancy

All lupus pregnancies are regarded as high risk. Evidence has suggested that 75% of pregnancies are carried to term, although 25% of the babies may be premature. (Newer treatments help improve these rates.) A mother?s lupus can harm the fetus even before her symptoms appear. A 2005 study reported that the risk of still births was 10 times greater for women who had not yet been diagnosed with lupus, and four times greater for women with diagnosed lupus, compared with healthy women. This study suggests that lupus may have a predisease state. Women with lupus and predisease lupus also had more preterm births and low weight babies.

Miscarriage. About 25% of SLE pregnancies result in miscarriage. The risk for miscarriage is highest in patients with one or more of the following conditions:

Women who have antiphospholipid antibodies that cause blood clotting problems
Women who have active kidney disease
Women with high blood pressure

Bleeding in Pregnant Woman. There is an increased risk for bleeding problems after the birth, due to either anti-SLE drugs or SLE itself.

Preeclampsia. Preeclampsia, a dangerous condition associated with high blood pressure that occurs during pregnancy, develops in 20% of pregnant SLE women.

Pulmonary Hypertension. In this condition, blood pressure in the lungs increases, which can be life-threatening. It is not common in SLE pregnancies but some cases have been reported.

Managing SLE During Pregnancy

Many drugs used to treat SLE are safe to take during pregnancy. Caution is advised with antimalarial and immunosuppressant drugs, and cyclophosphamide should always be avoided.

Women with antiphospholipid syndrome (APS) are usually treated with prednisone and aspirin Investigators have studied a combination of aspirin and standard heparin (a blood-thinning drug). A 2002 study suggested, however, that low-dose aspirin worked just as well as the combination or heparin alone. Experts reviewing the study recommended avoiding heparin if possible. A newer form of heparin called low-molecular-weight heparin (LMWH), which includes enoxaparin (Lovenox), dalteparin (Fragmin), and tinzaparin (Innohep), is proving to be beneficial and safer than standard heparin. Investigators are also testing intravenous immunoglobulin, which is showing excellent results. The optimal treatment is still in question, although a 2003 study suggested that LMWH plus aspirin, which achieved an 84% life-birth rate, may be the best option at this time for many women.

One study indicated that any pregnant women with SLE should be treated with heparin. In the study, when all pregnant SLE women were treated with heparin, the infant survival rate was 93% compared to only 77% when heparin was given only to women with APS.

Dangers to the Newborn

Thrombocytopenia. During pregnancy anti-phospholipid antibodies may also cross the placenta and cause thrombocytopenia (drop in platelets) in the fetus, although babies with low-platelet counts are nearly always delivered safely.

Neonatal Lupus. Another known risk to the baby is neonatal lupus, which occurs in 3% of SLE pregnancies and usually resolves within6 months.