Lupus érythémateux systémique

The systemic lupus is an autoimmune disease characterized by cutaneous-articular, visceral (kidney, nervous system, serous membranes), and haematological lesions. Due to the various groups of symptoms that have been observed, classification criteria have been proposed; these are useful for cohort comparisons, but are not adequate for individual diagnosis. Grouping main clinical manifestations allows to distinguish benign forms – mainly the cutaneous-articular, and the serous (pleuropericarditis) types – from the severe visceral, renal, central neurological, haematological (thrombopenia, haemolytic anaemia), and thrombotic forms. The immunological diagnosis is based on the evidence of high levels of antinuclear antibodies and, less frequently, of native anti-DNA antibodies, or antinucleosome. Other antibodies are useful for the diagnosis, despite their rareness: anti-Sm, and anti-ribosome antibodies. In one case out of three, antiphospholipid antibodies are associated with arterial or venous thrombotic complications, or with obstetrical accidents. The disease evolves spontaneously, by successive attacks, more or less regressive. Prognosis depends on the severity of the visceral sequelae after adequate treatment, with the mortality reduced to 1% per year of disease duration. Therapy is based on symptomatic treatments (aspirin, antihypertensive agents, hypolipidemic agents, anticoagulant drugs), long-acting medications (synthetic antimalarial drugs, methotrexate,…), corticoids dosed according to the severity of clinical manifestations, and immunosuppressive drugs (cyclophosphamide, azathioprin, mycophenolate).