Specific aspects of the long-term course of systemic lupus erythematosus (clinical observation and literature review)

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with multisystem manifestations and a variable course. The article presents an observation of the course of SLE for 15 years in a male who was diagnosed with SLE at the age of 37 after a one-year period of severe joint syndrome, which was the reason to initially suggest “rheumatoid arthritis.” A year after the manifestation of the joint syndrome in the patient, the clinical picture of SLE was presented by carditis (paroxysms of nodal tachycardia), immunological (LE-cells, antibodies to native DNA and anticardiolipin), hematological abnormalities (anemia, leukopenia, thrombocytopenia), alopecia, lupus nephritis with nephrotic syndrome and antiphospholipid syndrome (renal vein thrombosis). During the last hospital admission, echocardiographic examination revealed signs of valvular heart disease: thickening of the leaflets of the mitral and aortic valves, which may be due to the lupus process itself and antiphospholipid syndrome. The patient was observed in the clinic for 15 years. During the entire period of the disease, the course was characterized by alternating periods of flares and remissions of the activity of the lupus process (relapsing-remitting variant). The patient was on supportive immunosuppressive therapy (methylprednisolone, cyclophosphamide) all this time. The levels of SLE activity, determined by the SLEDAI-2K index at the time of the patient’s admissions, were assessed as high and very high ones. If in the early years of the disease kidney damage was manifested by nephrotic syndrome, then in the last 5 years lupus nephritis has occurred with isolated urinary syndrome. During the last hospitalization, echocardiographic examination revealed signs of valvular heart disease with leaflet thickening of the mitral and aortic valves with moderate mitral insufficiency. The article analyzes authors’ experience of long-term follow-up of SLE patients with a discussion of the literature data on the clinical features of the disease.

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