Lúpus eritematoso sistêmico: manifestações clínicas e diagnóstico

Abstract

Introduction: Of all cases, 70 to 90% occur in women (generally of childbearing age). Systemic lupus erythematosus (SLE) is more common and serious among black and Asian patients than among white patients. It can affect patients of any age, including newborns. In some countries, the prevalence of SLE rivals that of rheumatoid arthritis. SLE is probably precipitated by still unknown environmental triggers, which produce autoimmune reactions in genetically predisposed people. Some drugs (eg, hydralazine, procainamide, isoniazid, tumor necrosis factor [TNF] inhibitors) cause a reversible lupus-like syndrome. Objectives: discuss the clinical aspects of systemic lupus erythematosus and its diagnosis in adults. Methodology: Literature review from Scielo, PubMed and VHL databases, from April to June 2024, with descriptors systemic lupus erythematosus; clinic; diagnosis; adults. Articles from 2019-2024 (total 45) were included, excluding other criteria and choosing 5 full articles. Results and discussion: Clinical findings are very variable. SLE can develop abruptly with fever or insidiously, for months or years, with episodes of arthralgia and malaise. Vascular headaches, epilepsy or psychoses may be the initial findings. Manifestations may appear in any organ or system. Periodic exacerbations may also occur. Joint symptoms range from intermittent arthralgias to acute polyarthralgias, and occur in approximately 90% of patients, and may precede other manifestations by years. Most lupus polyarthritis is not destructive or deforming. However, in prolonged disease, deformities without bone erosion may occur. The prevalence of fibromyalgia is increasing, which can cause diagnostic confusion in patients with periarticular and generalized pain and fatigue. Skin lesions include butterfly-wing (flat or raised) malar erythema and generally spare the nasolabial folds. The absence of papules and pustules and the presence of skin atrophy help differentiate SLE from rosacea. Various other erythematous, firm, maculopapular lesions can occur anywhere, including exposed areas of the face and neck, upper chest, and elbows. Skin ulcerations and blisters are rare, although recurrent ulcers of the mucous membranes (particularly in the central portion of the hard palate, close to the junction of the hard palate and soft palate, in the mucosa of the mouth and gums and in the anterior nasal septum) are common (at sometimes called mucosal lupus); findings can sometimes mimic toxic epidermal necrosis. Common cardiopulmonary symptoms include relapsing pleurisy, with or without pleural effusion. Pneumonitis is rare, although minor damage to lung function is common. Sometimes diffuse alveolar hemorrhage occurs. Traditionally, the prognosis is guarded. Other complications include pulmonary embolism, pulmonary hypertension and shrunken lung syndrome. Cardiac complications include pericarditis (most common) and myocarditis. Rare and serious complications include coronary artery vasculitis, valve involvement and Libman-Sacks endocarditis. Accelerated atherosclerosis is a cause that increasingly causes morbidity and mortality. Congenital heart block may occur in newborns whose mothers have antibodies against Ro (SSA) or La (SSB). SLE should be considered in patients, particularly young women, with any of the signs and symptoms. However, the initial symptoms of SLE may mimic other connective (or non-connective) tissue disorders, including rheumatoid arthritis if arthritic symptoms predominate. Mixed connective tissue disease can mimic SLE, but may also involve features of scleroderma, rheumatoid-like polyarthritis, and polymyositis. Infections (eg, bacterial endocarditis and histoplasmosis) can mimic SLE and may develop as a result of immunosuppression caused by treatment. Disorders such as sarcoidosis and paraneoplastic syndromes can also mimic SLE. Conclusions: The course of the disease is generally chronic, recurrent and unpredictable. Remissions can last for years. If the initial acute phase is controlled, even if it is severe (eg, with cerebral thrombosis or severe nephritis), the long-term prognosis is generally good. The 10-year survival rate in most developed countries is >95%. The improvement in prognosis is caused, in part, by early diagnosis and more effective therapies. Complications are infections due to immunosuppression or osteoporosis due to prolonged use of corticosteroids. The increased risk of coronary heart disease may contribute to premature death.