Systemic lupus erythematosus (SLE)

SLE affects 36 per 100,000 UK caucasian females, but that is increased to 206 per 100,000 of black females.  The disease usually starts between the ages of 15 and 64, with peak onset at 15 to 25 years of age.  SLE is much lower in men.

SLE is an auto-immune disorder that can start with symptoms in almost any part of the body.  The cause is “multifactorial”, including genetic, hormonal and environmental factors, even a viral infection has been questioned.  In addition, a “lupus-like” disease is associated with a variety of drugs.

Joint pain is the commonest symptom in SLE (90% of cases), often combined with fatigue.  There is often excess fluid in the joint causing swelling.  Hand problems are seen, especially related to tendons, ligaments, and the hand may develop an abnormal posture, similar to that seen in rheumatoid arthritis.

Constitutional symptoms include fatigue, low-grade fever, weight loss and swollen lymph glands.  Other common features include rash (especially a “butterfly” pattern on the face), sensitivity to sunlight, mouth ulcers, and inflammation of the lung or heart linings.

Mild cases are managed with simple pain-killers, or anti-inflammatories (NSAIDs).  Some patients will require blood-thinning treatment.  Cortico-steroid injections into joints can be helpful.

Surgery for SLE is less often needed than for Rheumatoid Arthritis.  Knuckle joint deformity is treated with silicone joint replacement and ligament reconstruction.  Some patients with severe deformities benefit from finger joint fusion in a functional position.