Demystifying Systemic Lupus Erythematosis

When Angelina Pitt-Jolie received a preventative double mastectomy upon finding out she had the BRC-A2, a gene known to increase the risk of acquiring breast cancer, the world had a peak interest in breast cancer and prevention measures. Equally, when Selena Gomez announced her Lupus diagnosis this past year, there was an overwhelming interest in the media. To jump on the bandwagon of popular media, HSI presents an article on the mysterious Systemic Lupus Erythematousus (SLE) and its ongoing research.


By Michelle Le
When Angelina Pitt-Jolie received a preventative double mastectomy upon finding out she had the BRC-A2, a gene known to increase the risk of acquiring breast cancer, the world had a peak interest in breast cancer and prevention measures. Equally, when Selena Gomez announced her Lupus diagnosis this past year, there was an overwhelming interest in the media. To jump on the bandwagon of popular media, HSI presents an article on the mysterious Systemic Lupus Erythematousus (SLE) and its ongoing research.

Systemic Lupus Erythematousus: the nuts and bolts
Systemic Lupus Erythematousus is an autoimmune disease affecting close to 1 in 1000 people worldwide with the incidence rate increasing yearly. Although the mortality rate of lupus has significantly decreased over the past 10 years, there is no real cure for SLE. A lupus diagnosis is mostly determined through clinical presentation rather than a specific serum biomarker. As a result, overlapping and evolving symptoms can make SLE difficult to recognize and diagnose. The most common clinical presentations of SLE include skin rash and photosensitivity, which enables a quick lupus diagnosis. Arthritis, nephritis, pleuritis, pericarditis, anemia and leukopenia are also symptoms commonly seen in lupus patients. While the severity of clinical symptoms is variable, the most severely affected organs are the central nervous system, the kidneys, and the lungs. Disability consequences including work loss, activity limitations, perceived mental and physical exhaustion and reduced quality of life are commonly found in SLE patients with targeted organ damage (1).
Lupus frequently affects women of child-bearing age and is more commonly diagnosed in women than in men. Lupus is significant during childbearing years as the disease will increase the risk for miscarriages by 12.4% (2,3) and the development of neonatal lupus (4) and autism (5). However, it is possible for women with lupus to have a successful pregnancy provided that pregnancy planning is discussed alongside the care of a rheumatologist. Also common in 30 to 40-year-old women with lupus is a five-to six-fold increased risk of coronary artery disease (CAD) (6).
Clinicians and patients alike are excited for the medications that are currently being developed for lupus. In the past 50 years, belimumad (Benlysta ®) has been described as the most exciting break through in lupus research. Belimumad Is a monocloncal antibody that targets BLyS, an upregulated mediator that prevents autoreactive B cells from being activated in lupus. Apart from Benlysta, off label medications such as cortisone and chemotherapy are the most commonly used for lupus management.

Research: an ongoing hope for SLE patients
While the mechanism of lupus has yet to be discovered, many researches are currently being conducted to have a greater understanding of the disease and its manifestations.

N e w s A r t i c l e s
cause miscarriages due to the effect of increasing blood clotting. Dr. Evelyne Vinet, a clinician and scientist at MUHC, studies the reproductive issues in women with lupus. In preliminary studies, Dr. Vinet and her colleagues have found that women with lupus are more likely to have a child with autism compared to women without lupus. Research on the association of lupus with malignancy is spearheaded by Dr. Sasha Bernatski and involves over 40 lupus centres. Additionally, Dr. Louis-Pierre Grenier investigates the role of increased risk of recurrent thrombosis in lupus while Dr. Joyce Rausch studies the role of anti phospholipid syndrome commonly present in lupus. Elucidating the mechanism of lupus manifestation is equally important as studying clinical presentations. In the basic science department, Dr. Emil Nashi is studying the B cell activation pathway involved in lupus. Specifically, Dr. Nashi is investigating how B cells respond to their environment and comparing this between lupus patients and people without autoimmune disease.

What's next for lupus research?
Though research is promising, there is still much to be learned in this field of autoimmune diseases. Going forward, Dr. Pineau of the McGill Lupus Clinic believes that there needs to be an increased focus placed on lupus epigenetics and associated microbiome to have a better understanding of lupus development and to predict lupus severity in individuals. Medication development for lupus management is also on the radar. There is no doubt that many questions about SLE have yet to be answered. Research in SLE presents as a promising field for rising young scientists. ¾