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Lupus

Lupus is a systemic chronic inflammatory disease that manifests differently from one patient to another. This autoimmune disease seems to be the result of genetic and environmental factors. Studies are ongoing regarding the possible influence of the microbiota.

Varied manifestations

Lupus is a rare disease, with an estimated frequency of 10 to 150 cases per 100,000 inhabitants.1 It is a systemic autoimmune disease that appears in flares, and whose manifestations vary widely: fatigue, joint pain, rash, kidney damage, vascular, cardiac, and neurological disorders, hair loss, etc. Systemic lupus erythematosus makes up 70% of cases. Nine in 10 patients between the ages of 15 and 45  are women.2 The lack of specific symptoms complicates the diagnosis, which must be based on meticulous questioning and a blood test, including, among others, the search for antinuclear antibodies and the quantitative determination of complement proteins.2

Etiology to be determined

This disease could be the result of genetic and environmental factors.1 Several predisposing factors have been identified: estrogen, some drugs, UV radiation, stress, and Epstein-Barr virus. A few studies have also been carried out on the potential role of the microbiota. Intestinal dysbiosis has been described in subjects with lupus during the remission phase.3,4 Overall, the authors observed a microbial diversity comparable to that of healthy subjects, but with a Firmicutes/Bacteroidetes ratio that is significantly smaller in patients with lupus, with a reduction in certain Firmicutes families.3

Treatment

Treatment combines several options chosen according to the nature and severity of symptoms (nonsteroidal anti-inflammatory drugs, antimalarial drugs, corticosteroids, immunosuppressive drugs).5 A healthy lifestyle also helps control the disease (a balanced diet and regular physical activity, to the extent possible).2,5 If the role of the microbiota is confirmed, modulating it could become a promising therapeutic option.3,4

 

Sources
1- Le lupus systémiques, Orphanet https://www.orpha.net/data/patho/Pub/fr/LupusErythemateuxSystemique-FRfrPub124.pdf
2- Arthritis Foundation
http://www.arthritis.org/about-arthritis/types/lupus/what-is-lupus.php
http://www.arthritis.org/about-arthritis/types/lupus/diagnosing.php

http://www.arthritis.org/about-arthritis/types/lupus/treatment.php

3- Hevia A, Milani C, López P, et al. Intestinal dysbiosis asso-ciated with systemic lupus erythematosus. MBio 2014 ; 5 : e01548-14.

4- Zhang, H., Liao, X., Sparks, J. B., & Luo, X. M. (2014). Dynamics of Gut Microbiota in Autoimmune Lupus. Applied and Environmental Microbiology, 80, 7551–7560. http://doi.org/10.1128/AEM.02676-14
5- Lupus systémique, Société Nationale Française de Médecine Interne (SNFMI) http://www.snfmi.org/content/lupus-systemique

 

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