Systemic Lupus Erythematosus (SLE)

• The presentation covers Systemic Lupus Erythematosus (SLE) and its personalized medicine therapies, it was copyrighted in 2025.

Learning Objectives

• The incidence and etiologies of lupus will be explored
• How to identify systemic lupus erythematosus on the differential diagnosis will also be examined
• Signs, symptoms, and diagnosis of lupus will be addressed
• Needed lab studies, conventional medicine treatments and personalized medicine therapies for Lupus will be reviewed

Incidence of Lupus

• About 1.5 million Americans have systemic lupus erythematosus (lupus) and this equates to around 1 in 200 people
• Lupus is an autoimmune disease that disproportionately affects Blacks, Latinos, Asians, and Native Americans compared to whites

Demographics

• For every 250 Black women, one will have lupus
• Women are affected 10 times more the men
• Almost 90% of patients with SLE are women ages 15-45

Lupus characterization

• SLE is a chronic autoimmune disease that can affect any organ
• Characterized by widespread microvascular inflammation
• Antibodies to double-stranded DNA are developed

Etiology of Lupus

• Genetic factors contribute to about 10% of lupus cases
• Medications, environmental toxins, infections, and stress are contributory factors
• Physical trauma, ultraviolet light, immunological factors, and hormonal influences also contribute to lupus etiology

Genetic Factors

• More than 50 genes or genomic loci that encode for proteins implicated in the function of the immune system are associated with SLE
• Activation of both the adaptive and innate immune systems is associated with these SLE-related genes

Medications and Lupus

• 100-200 medications can cause lupus; 10% of people who had lupus are believed to have developed it from a medication
• Sulfa-drugs are known to cause flares in patient with SLE

Common Medications and Lupus

• INH, Procainamide, Hydralazine, and Calcium channel blockers can cause Lupus
• Angiotensin-converting enzyme inhibitors and Interferons can cause Lupus
• Thiazide diuretics, Terbinafine, Protein pump inhibitors, and Chemotherapy can cause Lupus

Environmental Toxins and Lupus

• Smoking is considered a risk factor, with a dose-response
• Residential exposure to pesticides in an urban population of predominantly African-American women can be associated with increased SLE risk

Pesticide and Farming Risk Factors

• Some agricultural pesticides may be associated with higher or lower risk of SLE/SS
• Overall risk associated with farming is complicated
• Complex risks can involve other factors and even childhood exposures

Impact of Air Pollutants

• The significance of evaluating the impacts of longterm exposure to ambient air pollutants in preventing SLE are important
• Necessity to identify individuals who smoke and have a high genetic risk to minimize the harmful effects of air pollution on the development of SLE

Hair Dye

• Women who use dark hair dye have a three-fold increase in developing lupus

Viral Infections and Lupus

• Several viral infections have been implicated for Lupus
• The mechanism is thought to be molecular mimicry

Epstein-Barr Virus (EBV)

• Antibodies against Epstein-Barr virus (EBV) are more prevalent in children and adults with SLE compared to the general population

Hormones and Lupus

• Female sex and hormonal influence are a risk factor for SLE
• Estrogen dominance and prolactin promote autoimmunity
• Increased B-cell activation factor production and modulation of lymphocyte and pDC activation occurs

SLE risk and contraception

• The use of estrogen-containing contraceptives can cause flares in patients and have been associated with a higher incidence of SLE

Prolactin Levels

• Elevated levels of prolactin are seen in patients with SLE

Vitamin D and Alfalfa Sprouts

• Vitamin D deficiencies are common in patients with SLE
• Alfalfa sprouts contain L-canavanine and can induce systemic lupus erythematosus (SLE) in monkeys

Alfalfa and Anemia

• A human subject developed lupus hemolytic anemia while participating in a research study requiring the ingestion of alfalfa seeds.

Silica

• Silica exposure can trigger the onset of systemic lupus erythematosus.

Pathogenesis of SLE

• Both innate and adaptive immune systems play a role in the pathogenesis of SLE
• The innate immune system activation is either Toll-like receptor dependent, or independent

Lymphocytes and SLE

• As part of the adaptive immune system, T-lymphocytes and B lymphocytes play significant role
• Both B and T cells activate each other which leads to more autoimmunity.

Signs and Symptoms

• Lupus is a chronic autoimmune and inflammatory disease that affects many body systems

Most Common Signs

• Fatigue that is prolonged or severe present in 81% of Lupus patients cases
• Arthralgias is present in 95% of Lupus patients cases
• Malar and other rashes, may burn, itch, and ooze at 74%
• Fever greater than 100F: 90%
• Photosensitivity: 30%
• Cardiac abnormalities: up to 55%
• Arthritis: 90%

Other Common Signs and Symptoms

• Cold hands and feet
• Raynaud's syndrome (17-30%)
• Premenstrual flare-ups
• Dry eyes and dry mouth
• Easy bruising
• Edema
• Depression and other neuropsychiatric disease

Common Signs and Symptoms of Lupus

• Anemia: 71%
• Seizures: 15%
• Pulmonary disease
• Migraine headaches: 10-37%
• Weight loss
• Renal disease: 50%
• Hair loss: 27%

Blood Clotting Issues

• Abnormal blood clotting at 40%
• Patients have antiphospholipid antibodies that cause the blood to clot prematurely
• Accelerated atherosclerosis is the most common cause of death in lupus patients

Lupus Disease

• The course of disease varies from patient to patient
• Some patients have a mild course, and others have a progressive disease process that is fatal

Diagnosis of Lupus

• Diagnose needs a presence of four of the following: Malar rash (More than 80% of patients with SLE suffer from mucocutaneous involvement)
• Discoid rash (25% of all lupus patients presents on ears, scalp, arms, or upper back, and if not treated can leave scars)

Other conditions

• Photosensitivity: some patients are sensitive to fluorescent bulbs and halogen lamps
• Arthritis: 80 to 90% of patients suffer from musculoskeletal involvement from mild arthralgias to deforming arthritis

Musculoskeletal Changes

• Avascular necrosis (with or without steroid use) can occur in up to 10% of patients. It usually involves the hip joints.
• Inflammatory myopathy can be seen in less than 10% of SLE cases
• Patients are at high risk for the development of fibromyalgia, incidences are high as 20%
• Rheumatoid nodules have been reported in patients.

Diagnostic Factors

• Oral ulcers indicate 40%
• Neurologic abnormalities indicate 50%
• The most common CNS manifestation is intractable headaches, reported in more than 50% of cases

Neurologic abnormalities

• Confusion, memory loss, seizures, psychosis in SLE patients

Immunologic abnormalities in Diagnosis

• Anti-DNA antibodies
• LE cell at 90%
• Anti-Sm antibodies-diagnostic
• False + test for syphilis

Other Conditions during Diagnoses

• Renal disorders at 50%
• 50% with kidney involvement have permanent damage
• Hematologic abnormalities (Hemolytic anemia, Thrombocytopenia, Leukopenia, Lymphocytopenia)

Gastrointestinal indications

• Any part of the gastrointestinal tract may be involved.
• Manifestations include esophageal dysmotility (especially upper one-third), mesenteric vasculitis, lupus enteritis, peritonitis, ascites, protein-losing enteropathy, pancreatitis, and lupoid hepatitis.
• Patients with SLE and antiphospholipid antibody syndrome can develop Budd-Chiari syndrome, mesenteric vessel thrombosis, and hepatic veno-occlusive disease.

Lymphomas and Lupus

• Lupus pneumonitis can be seen in up to 10% of lupus patients
• Lymphadenopathy is common in SLE

Lupus pathology reveals:

• Follicular hyperplasia with giant cells
• Plasma cells infiltration of the interfollicular zones, and necrosis of the paracortical T-cell zones

MI Risk

• The risk of having an acute MI is 50% greater if the patient has lupus.

Lab Studies for Lupus

• 95% of people tested with + ANA have Lupus
• More than 20% of the healthy population, especially females or relatives of patients with autoimmune diseases, can have a positive ANA, although titers more than 1:320 are uncommon

Conditions with + ANA

• • ANA can be seen in patients with other disorders also in pregnant women and elderly patients

ANA Patterns

• Several patterns of ANAs occur: speckled, homogenous, centromere, cytoplasmic, nucleolar, and dense fine speckled patterns.
• Patterns are not considered significant enough by themselves
• ANAs with a dense, fine speckled pattern (anti-DFS70) are considered least pathological.
• Patients with ANAs with this pattern rarely develop systemic autoimmune diseases.

Speckled, Homogenous and Centromere Patterns

• Specific antigens: SSA, SSB, Smith, ribonucleoprotein are the speckled patter
• Homogenous pattern: ANAs targeted at histones, chromatin, and dsDNA
• Anti-centromere antibodies: centromere pattern limited systemic sclerosis

Other Disorders and Conditions with ANA

• Rheumatological disorders: drug-induced lupus, systemic sclerosis, polymyositis/dermatomyositis, mixed connective tissue disease, Sjogren syndrome, rheumatoid arthritis, juvenile idiopathic arthritis, Raynaud's disease, cutaneous lupus, and fibromyalgia.

Autoimmune and Malignancy/Infections

• Autoimmune disorders: autoimmune hepatitis, multiple sclerosis, Hashimoto thyroiditis, and idiopathic thrombocytopenic purpura
• Several infections and malignancies have also been associated with a positive ANA.

Antibodies to DNA

• Divided into two groups: reactive with denatured, single-stranded (ss)DNA and those identifying native, double-stranded (ds)DNA
• Anti-ssDNA antibodies are nonspecific and seen as a laboratory error.

Double-stranded Deoxyribonucleic Acid

• Has more than 95% specificity for SLE but in only 60% to 70% of SLE patients.
• A negative anti dsDNA does not rule out the diagnosis of SLE

Anti-SM antibody

• Checks for antibodies against Sm (ribonucleoprotein in the nuclei of cells)
• Specific for lupus
• Rarely found in individuals with other autoimmune diseases (RA)
• Only 30% of people with lupus have

LE cell test

• Lupus erythematosus cells are seen in 40% to 50% of patients with lupus
• • in up to 20% of people who have RA
• A small percentage of patients with other autoimmune diseases: scleroderma and Sjogren's syndrome

Kidney Disorders

• Patients check complement C3 and C4 if suspected SLE

• If levels are low, complement indicates complement consumption and correlates with disease

• Diagnosis is likely if total complement level is low, low C3 and C4 levels and positive ANA

Inflammation Testing:

• Markers of inflammation such as sed rate and C-reactive protein may be elevated
• Blood Counts tests (CBC, liver and renal function tests) to assess organ involvement
• Further studies may need to be done by rheumatology

Conventional Treatments

• The goal of treatment: to prevent organ damage and achieve remission
• Choice of treatment depends on organ system/involvement severity
• Treatments can include a combination of: NSAIDS, Glucocorticoids, and Antimalarials

Antimalarials

• May include: Hydroxychloroquine, Chloroquine, and Quinine

Other Traditional Treatments

• Immunosuppressive agents (Cyclophosphamide, Methotrexate, Azathioprine) can be used
• Monoclonal antibodies (Belimumab, Rituximab) are helpful

Experimental Treatments

Currently being studied and new drugs:

• Anifrolumab
• Ustekinumab
• Baricitinib
• Atacicept

Classifying Newer Medications

• B-cell Targeted Drugs: Belimumab, Tabalumab, Blisibimod, Atacicept, Rituximab, Ofatumumab, Ocrelizumab, Obexelimab, and Epratuzumab
• T-cell Targeted Drugs: Abatacept, Dapirolizumab, and inhibitor of syk and CaMKIV
• Cytokine Targeted Drugs: Anifrolumab and Sifalimumab

Personalized Medicine Therapies

• Personalized medicine includes:
• GI health assessment, Environmental factors consideration, proper Diet/Fat and energy intake
• Tartrazine testing, Flax seed treatments, Avoid alfalfa
• Treat candidiasis

Personalized Medicine Therapies (Cont.)

• Nutritional supplements
• Hormones
• Herbal remedies
• Phytoestrogen
• Oral transfer factor
• Gamma globulin
• Environmental controls/TPE
• LDN

Alternative / Metabolic Therapies

• 40% of patients with lupus in Western countries
• Key is to test gut health
• 70% percentage of immune system that is in the GI tract

Step by Step approach for gut health

• A 5 R program should be pursued
• Remove
• Replace
• Re-inoculate
• Repair
• Rebalance

Environmental Factors Personalized Medicine

• Environmental factors: Some of the medications that have been shown to cause lupus are similar compounds to the ones in the environment that are used in industry and agriculture
• Procainamide is an aromatic amine and its manufacturing uses aromatic amines

Medications as Hydrazines

• Medications such as Hydralazine and phenelzine are similar to hydrazines used in the metal and petroleum industries.
• Hydrazines and hydrazides are in agriculture as plant growth regulators and herbicides
• Can persist in edible plants

Environmental Factors Continued

• Aromatic amines and hydrazines are metabolized by the acetylation pathway
• Slow acetylators are those that have elevated risk of developing SLE from procainamide or hydralazine
• 50% of American and western European people can be slow acetylators

Lupus Environmental Study

• Prevalence of lupus in the Georgia area (exposed to industrial emissions) was six-fold higher. The incidence was nine-fold higher than highest values reported
• Study showed detox program helped lower xenobiotic chemicals from a patient with lupus.

Sources of chemical exposure:

• Removing sources of exposure may influence disease course

Toxin Removal Treatments

• Definite method to remove major toxins (BPA) includes use of TPE plus both IV and oral nutrients

• TPE alone does not give the same spectacular results

• TPE plus includes: Microplastics decreased up to 90%; Heavy metals decreased up to 80% with aluminum decreasing up to 100%

• BPA and Phthalates up to 97% and Environmental toxins up to 95%

Case Studies on patients went gluten-free

• Studies show that when Lupus occurs with Celiac disease, patients went gluten-free (a long history of lupus cases, that resolved after going gluten-free)
• Other studies have shown that lupus symptoms improved or resolved and/or ANA titers fell to normal after the patients avoided foods they were allergic to.

Allergy testing

• One study suggests that allergy testing is useful for lupus.

Certain food types may be ill advised

• Foods to avoid include: Alfalfa sprouts, Peanuts, Soybeans, Lentils, Corn, Spinach, Carrots, Coffee, tea, cola, Alcohol, Sugar

Animal Studies and Food:

• Food restriction, low Fat diet have shown to inhibit the development of lupus
• Consumption of high fat diet exacerbated lupus.

Tartrazine and SLE

• Photosensitivity, arthralgia, and myalgia after ingestion of tartrazine (FD&C yellow #5) food dye can indicate SLE
• A possible metabolite of tartrazine is p-sulfophenylhydrazine and patients should avoid tartrazine.

Lupus patients and Alfalfa

• Patient study found alfalfa seed consumption may cause a SLE-like syndrome or may cause inactive lupus to reactivate to.
• Have patients with lupus avoid the use of ground alfalfa seeds

Infections and Lupus

• Opportunistic bacterial, mycobacterial, protozoal, other fungal, and viral infection are also increased.
• Treat any present infections

Improve Patients when treated for Candidiasis

• Patients with lupus may improve when they are treated traditionally for candidiasis.

Supplements can be helpful

• A study found that lower activity was seen as measured by Systemic Lupus Activity Measure (SLAM-R) in 23% of patients using EPA/DHA

Nutrients Supplements (for Lupus Patients)

A cross-over, double-blind study in patients with SLE were given 20 grams/day of EPA/DHA vs olive oil as placebo for 12 weeks.

• 82.4% of the patients treated with EPA/DHA improved and 23.5% of the patients receiving placebo improved Symptoms improved in the treated group but not placebo group

EPA/DHA treatment

• In yet another study which was low dose, patients with renal and other target organ involvement were give steroids for 1-2 months. Patients were also given 1 gram of EPA/DHA qd for up to three years for improvements.

Contradictory reports on EFA

• However, a small double-blind, randomized study with patients with moderate lupus showed no group saw improvement with EPA/DHA.

• In another study, 15 grams of EPA/DHA qd or placebo was given for one year but Results may have been confounded by the use of olive oil.

Flax Seed and benefits

• Dietary flax seed is potentially useful as treatment for lupus: flaxseed is rich in lignans which showed to inhibit the receptor for platelet-activating factor which is a molecule that plays a role in the inflammatory process

Flax Treatment

In an animal study, those with SLE were supplemented with 15% had decreased renal damage and mortality.

• a small study (took 15 grams of flaxseed) of lupus/renal disease found - Mean creatinine decreases mean creatinine clearance increases with dose, proteinuria improves
• In other small human trial the patients received alternate therapy for one year finding a non-significant trend to kidney function preservation

Some guidance on Flaxseed

• 30 grams, may be benefitial. Flaxseed should be ground. Flaxseed meal contains a vitamin B6 antagonist therefore take 10-20 mg B6 daily.

Vitamin D deficiency in Lupus

Vitamin D supplementation may improve disease activity when vitamin D deficient/insufficient SLE patients receive it

• Linked to the pathogenesis and progression of SLE
• Can Ameliorate inflammatory and hemostatic markers
• Vitamin D deficiency may be connected to increased thrombosis risk
• Supplementation may reduces proteinuria, higher complement levels, and improvement in global disease activity with SLE

Immunodulary and supplement support

Immune response and effects may be:

• Vitamin D supplementation is needed for insufficiency/deficiency, for its immunomodulatory and anti-fibrotic effects and can be mediated by the VDR/D3

Estrogen and metabolism during menopause

Women with Lupus metabolized estrogen more towards the 16-alpha-hydroxyestrone which then increases activity. Estrogen metabolism shift due to Indole-3-carbinol (I-3-C) (cruciferous vegs) is then seen

• 3-C, can shift estrogen which then improves

Tissue Salts

Used:

• Milk Sugar for pain and for lactose intolerance
• Magnesia Phosphorcia for 6x concentration

4 tablets of each salt tide for months

Kalm phos aids • Potassium Phosphate Depression and Insomnia

Glandular

Thymus needs A, B6, C, selenium, Fe

SPLEEN Needs B vit, C, selenium

VIT. A can balance the system.

enhanced cell activity Increased levels of ADC in trials which were reduced in the test

Other Nutrition

Magnesium : 400 to 600 Mg mglycinate.

C: 6-10 to help adrenals, co Q10: 200 to 300.

DLPA used to treat, RA and osteoarthritis

CI: Melanoma. HTN

Other Hormomoe

• DHEA
• steroids will levels
• 100 to 20- with doses to 600 ACNE

Hormonal considerations:

• DHEA levels tend to be low and steroids further lower DHEA levels
• DHEA reduces disease activity

DHEA dosages and outcomes:

• Usual dosages are 100-200 mg qd with doses up to 600 mg a day and reduces disease load in trials
• A women SLE patients study 3 to 6 months study of 10 showed in energy and fatigues and wellness

Replacement treatments for reduced levels

• One needs 200 mg qd DHEA replacement 8 of 1 women was needed sterioid needed. Low mg. Decreased side effects of disease.

• If had sides effect, lowered dose decreased

• 12 moths significantly 50% better with disease activity with one and lower steroid use in the tests

Testosterone:

• lower levels and were reduced from steroids.

Testosterone in an autoimmune has it’s benefit:

studies show -

testosterone lowers prortein in the blood.

Protocol considerations

Testosterone helps balance and reduce auto immune affect:

levels need to be replaced. saliva testosterone if Saliva to be needed replaced.

Prolactin production

Levels need to be reduced as in flare up.

Supplement options:

Lupus can be treated with natural therapies.

• Rountree, R., et al., "Lupus Erythematosus and Herbal Medicine," in Clinical Botanical Medicine. 2nd Ed. New Rochelle, NY: Mary Ann Liebert, Inc., 2009.

Gotu Kola aids

• Used to treat eczema and anxiety memory and fatigeues

Supplements aids

• Standardize extract from colcentella

Curcumin

• Is part of the ginger family
• In autoimmune it aids immunomodulatory
• It helps proetinuriatesysotlic and hemartourias

Oleopureion

• Reduces inflammation that is caused from active olive

Panicalgin aids the following.

• Anti-inflammatory
• Anti-oxidants
• Immuno suppressant.

SultoRophome:

• Found plants that is needed Ameliatore.

Icarin supplement

• aids Nephritis
• B inhibiited NF-kB

apricorns,

has a need on SNf aid.

Benefits

• Resveratrol:
• Anti toxin
• Auto Immune disease
• Helpful against stress

gltuatione cirmin,

PSK aids and improves

Other Supplements

• Cordyceps improves cell reduceds DNA/ RNA test

Gaumda - in the followings-

Reduces. Proteins can prolonged in an experiment:

Human Triat

• Needed from

• Artemissa: aids 600 mg d

• Lupus in general Aids

• Help if given phytoester.

Helpful tips-

• HEPA filters Avoid carpating or and orgabnic - TPE - Reduce with. LDM in

The synthetics in 103. P 140. in cell. - can be used. that can aid SLE.

Therapies for Autoimmunity

• • LDN effective
• Dose

Conclusion of of SLE-

• There is a lot to offer a patient via a convenient and Medicine approach
• TPE and low doses can help treatment.