chloelogoa

Systemic lupus erythematosus (SLE)

 talalogoa

SLE is a multi-system autoimmune disease characterized by the formation of autoantibodies against various self-antigens and immune complexes. SLE can affect many different body organs, including the skin. Some of the more common clinical signs include fevers, joint pain, skin lesions, enlarged lymph nodes, enlarged abdominal organs, kidney problems, anemia, low platelet counts, lethargy, poor appetite. Affected patients may display only a few of these signs or many of these signs. SLE can be tricky to diagnose and challenging to treat.

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What is Lupus Erythematosus

systemic lupus erythematosus, cutaneous (discoid) lupus erythematosus
http://www.upei.ca/cidd/

What is lupus erythematosus?
There are several forms of lupus erythematosus that are recognized in people, two of which have been identified in dogs. Lupus is an autoimmune disorder, meaning that the body mounts an inappropriate immune response to some part of itself.

Systemic lupus erythematosus (SLE) is an uncommon but severe disorder in which the inappropriate immune response is widespread in the body, and can cause arthritis, kidney disease, anemia, and skin disease. Cutaneous lupus erythematosus (CLE) is thought to be a milder variant of SLE, and the problems are confined to the skin. CLE is also called discoid lupus erythematosus

How is lupus erythematosus inherited?
unknown, but the condition runs in families.

What breeds are affected by lupus erythematosus?
CLE is seen more often than SLE, although both conditions are uncommon. There is a breed predisposition for the collie, Shetland sheepdog, and German shepherd, as well as crosses of these breeds.

For many breeds and many disorders, the studies to determine the mode of inheritance or the frequency in the breed have not been carried out, or are inconclusive. We have listed breeds for which there is a consensus among those investigating in this field and among veterinary practitioners, that the condition is significant in this breed.

What does lupus erythematosus mean to your dog & you?
SLE most commonly affects joints, muscle, skin, blood, and/or kidneys. The condition tends to wax and wane, so your dog will have periods of remission and of flare-up. The kinds of problems you may notice include shifting lameness (ie varies depending on which joint is affected at any time), weakness and pale gums (due to anemia), and/or increased drinking and urination (kidney disease). The face and the feet are the areas of the skin most often affected, with ulcers and loss of pigment on the nose, and ulceration and thickening of the footpads.

With CLE, you are most likely to see red, scaling areas of inflammation on your dog's face, and loss of pigment from the nose. There may also be lesions on the ears and thickening of the footpads. Affected dogs are otherwise healthy.

Nasal scarring is common with both SLE and CLE. Exposure to ultraviolet light is a factor (especially in CLE), and so the condition is seen more often and is more severe in the summer and in sunny parts of the world.

How is lupus erythematosus diagnosed?
Because SLE can affect many different body systems, diagnosis is challenging. (In fact it is sometimes called, "the great imitator"). Once suspected, diagnosis is confirmed by specific blood tests and biopsy for examination by a veterinary pathologist.

CLE is diagnosed through examination of biopsy samples.

For the veterinarian: The list of rule-outs with SLE is extensive, due to the varied and changeable cutaneous and systemic manifestations of this disorder. Diagnosis is based on signs of multisystem involvement (most commonly anemia, thrombocytopenia, glomerulonephritis, polyarthritis, nasal and footpad dermatitis, fever of undetermined origin), a positive antinuclear antibody test, and histopathologic and immunopathologic evaluation.

Diagnosis of CLE is by histopathologic and immunopathologic evaluation.

How is lupus erythematosus treated?
Treatment for SLE generally requires relatively high doses of steroids in combination with chemotherapy. In general, dogs with joint, muscle, or skin disease seem to respond better to medication, and have longer periods of remission, than those with severe blood or kidney problems. Unfortunately, many dogs with SLE die or are euthanized within a year of diagnosis, either due to the disease itself,  the inability to control it, and/or unacceptable drug reactions. In other dogs, the disease can be well-controlled with medication for several years.

CLE is treated with relatively lower doses of steroids plus vitamin E and fatty acid supplements. Treatment generally needs to be lifelong, and dogs usually do well on it.

Exposure to ultraviolet radiation worsens the skin lesions in both conditions, so sunscreen is adviseable and dogs should be sheltered from peak sunlight  (approximately 10:00 to 3:00).

For the veterinarian: Treatment for SLE must be individualized for each dog, generally starting with large doses of systemic glucocorticoids, and going to other immunomodulating or chemotherapeutic drugs if necessary.  There is a good discussion of treatments for both forms of lupus erythematosus in the reference below.

Breeding advice
Although the mode of inheritance is not known for either cutaneous or systemic lupus erythematosus, these conditions run in families. Affected animals should not be bred and it is prudent to avoid breeding their close relatives as well.
FOR MORE INFORMATION ABOUT THIS DISORDER, PLEASE SEE YOUR VETERINARIAN.

Resources
Scott, D.W., Miller, W.H., Griffin, C.E. 1995. Immunologic Skin Diseases. In Muller and Kirk's Small Animal Dermatology. p. 578-588. W.B. Saunders Co., Toronto.
Copyright © 1998 Canine Inherited Disorders Database. All rights reserved. Revised: July 23, 2001.
This database is a joint initiative of the Sir James Dunn Animal Welfare Centre at the Atlantic Veterinary College, University of Prince Edward Island, and the Canadian Veterinary Medical Association.
reprinted with kind permission from:-
 Alice Crook, DVM,Coordinator, Sir James Dunn Animal Welfare Centre, Atlantic Veterinary College,University of Prince Edward Island, 550 University Ave.Charlottetown, PEI C1A 4P3
http://www.upei.ca/cidd
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SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
Note for Pet Owners:

This information is provided by Provet for educational purposes only.

You should seek the advice of your veterinarian if your pet is ill as only he or she can correctly

advise on the diagnosis and recommend the treatment that is most appropriate for your pet.

Description
Systemic lupus erythematosus (commonly known as SLE) is a rare autoimmune-mediated disease which is seen in dogs and very rarely in cats.. SLE causes a variety of signs and most often cases are presented because of lameness or skin disorders.

Cause
The primary cause of SLE is unknown in animals and humans although several factors have been suggested, including :

1.  Genetic inheritance

2.  Exposure to environmental factors - eg ultraviolet light - which definitely induces a photosensitivity reaction in affected animals

3.  Exposure to viral infections

4.  Endocrine factors

5.  Drug administration (anticonvulsants, contraceptives, hydralazine, isoniazid, penicillamine, procainamide and vaccinations (dogs)

6.  Suppressor T cell deficiency and other immunological disorders

Whatever the primary cause the disease is characterised by the production of non-specific antibodies (called antinuclear antibodies - ANAs)  by the animal which may attack specific cells or tissues, for example :

Red blood cells - erythrocytes

White blood cells - leukocytes

Platelets

These ANAs combine with free DNA to form DNA-antiDNA complexes and can become deposited in a variety of tissues causing a Type III hypersensitivity reaction,  including :

The walls of arterioles causing necrosis and fibrosis

The synovial membrane

The glomeruli - resulting in glomerulonephritis

It is interesting to note that both dogs and humans with SLE have low concentrations of thymic factors in their blood.

Breed Occurrence
SLE usually occurs in middle-aged dogs (range 2-12 years, mean 5.8 years) and certain breeds are reported to be over-represented in population studies of  the disease, including : Afghan Hounds, Beagles, German Shepherd Dogs, Irish Setters, Old English Sheepdogs, Poodles, Rough Collies and Shetland Sheepdogs.

In cats the condition is very rare, but the Himalayan, Persian and Siamese cats may be predisposed to develop SLE

There is no age or sex predilection .in dogs or cats.


Signs
The clinical signs associated with SLE in dogs include :
* Most common signs
Anaemia - due to haemolysis of red blood cells *

Fever *

Recurrent shifting lameness associated with a polyarthritis - seen in 75% of cases *

Oral ulcers *

Polydipsia and polyuria with proteinuria due to glomerulonephritis *

Skin lesions including alopecia, cellulitis, crusting, erythema, furunculosis, panniculitis, seborrhoea, ulcers (mucocutaneous junctions and footpads), scar formation -50% of cases * The lesions can affect the face, ears , limbs,  and body Splenomegaly

 Coagulopathy due to thrombocytopenia

Recurrent shifting lameness associated with a polymyositis

Lymphadenopathy

Myocarditis and pericarditis

Neurological signs including seizures, psychoses and polyneuropathies

Pneumonitis or pleuritis

Thyroiditis


Signs in the cat include :
Anaemia

Coagulopathies due to thrombocytopenia

Conjunctivitis

Fever

Lung disease

Lymphadenopathy

Myopathy

Neurological disorders (including behavioural changes)

Oral ulcers

Polyarthritis

Skin lesions - in about 20% of cats with SLE

Renal failure

Complications: Multiple organ system involvement makes diagnosis complicated.


Diagnosis
Diagnosis is made by identification of ANAs by an indirect immunofluorescent test, and by histopathological examination of skin biopsies.

Treatment
Treatment of SLE includes :

Corticosteroids - prednisone, prednisolone, methylprednisolone

Other immunomodulating drugs eg azathioprine, chlorambucil - sometimes in combination with corticosteroids.

Levamisole - has been beneficial in some canine cases - 2.5mg/kg every 48 hours

Aspirin has been beneficial in some canine cases 

Splenectomy

Management of  secondary disease eg renal failure

<>Prognosis
<>The prognosis is unpredictable to poor - and it is worse if coagulopathy or haemolytic anaemia  are present. It is reported that over 40% of cases die in the first 12 months following diagnosis, but long term remission does occur in some dogs.


Long term problems
Euthanasia is often requested in animals that are refractory to treatment.   

Copyright (c) 1999 - 2007 Provet. All rights reserved. Email: info@provet.co.uk  
reprinted with kind permission of Provet

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Systemic lupus erythematosus (SLE) possible in working German Shepherd

http://www.vetinfo4dogs.com

Question:
My K-9 is a long haired male neutered G/S 6.5 years old 90 lbs. After seeing the dog the vet. suspected SLE, due to his platelet count being low and skin conditions. A battery of tests were conducted including ANA test, all have been normal. His platelets have been in and around the 150's. I have also noticed a slow down in his drive. All these things have transpired since June. The vet is confident he has SLE but is unsure how to 5proceed, should he treat it conservatively as SLE or not at all and monitor the dog. Some say because he is a working dog, and it is early in the diagnosis, treat him for SLE, he stands a better chance of continuing to work then. The other choice is to do nothing and see what develops. The bad thing about that is if he worsens he will be removed from service. Would the proper thing to do be to refer it to a Specialist to review. Wait a month and retest the blood? Start treatment conservatively? Is there a test that will clear this up? I know that I am not giving you much medically, but I believe the vet has made all the right moves. Any advice you can offer would be greatly apprieciated. My supervisors will be making a decision soon as to Deiter's future, I just want to help make the right one! Thank you!
James-

Answer:
Systemic lupus erythematosus (SLE) is very hard to diagnose with certainty. The "major" signs of SLE are arthritis affecting multiple joints, without evidence of cartilage erosion, multiple painful muscles, skin sores with bullae (blisters), increased protein in the urine, immune-mediated hemolytic anemia (IMHA), decreased platelet numbers (thrombocytopenia) and decreased white blood cell count.

The "minor" signs of SLE are fevers for no apparent reason, oral ulcers, inflammation of the pleura (the lining of the chest cavity) or pericardium (lining around the heart), heart muscle inflammation, enlarged lymph nodes,
dementia and seizures. Most dogs with SLE will test positive on anti-nuclear antibody (ANA) testing. Even a weak positive ANA is considered significant in dogs. Not all dogs with SLE have positive ANA tests, though.

To make a diagnosis of SLE in dogs, the recommended criteria are:  the presence of two major signs and a positive ANA test OR one major sign, two minor signs and a positive ANA test OR two major signs that aren't
explained by another condition even if there isn't a positive ANA test.

German shepherds are prone to discoid lupus, which looks like SLE but is usually confined to the face, especially the area around the nose. Dogs with discoid lupus usually have negative ANA tests.  They also get phemphigus, which is another immune mediated disease.

I don't think of platelet counts in the 150,000 range as being low but it is apparent from answering questions on line that many vets do.

Due to the significance of the diagnosis in a working dog, I do think that it is worthwhile to get the opinion of a specialist. In this case, it is probably acceptable to consider a board certified dermatologist or an internal medicine specialist.
Hope this helps some.
Mike Richards, DVM

Discoid Lupus treatment in German Shepherd

http://www.vetinfo4dogs.com

Question:
 I have had a biopsy done on my German Shepherd and found out that she does in fact have Discoid Lupus.  My question now relates to treatment.  The clinic I took her to told me that the pathologist said that my dog's case is very mild and in the very beginning stages so they suggested I go for the lowest type of treatment.  I went by the clinic the other day and what they are telling me to give her is 4 capsules of Tetracycline 250 mg. each day (2 capsules 2 times a day) and also Vitamin E, Vitamin B and some fish oil capsules also twice a day.  I have no problem with the vitamin supplements but I am concerned about giving her so many antibiotics for the rest of her life.  I am not much for medications even for myself and I don't feel comfortable giving my dog so many pills each day.  My question, therefore, is...Is it absolutely necessary for her to take the Tetracycline or are there other options.  Can I just give her the vitamins and not the Tetracycline? I would appreciate any advice or referral you can give me.
Thank you, Sheryl

Answer:
It helps a lot when thinking of the use of tetracyline to think of it as an immune modulator with minimal side effects rather than an antibiotic. The effects it has on the immune system are probably why tetracycline can be helpful in cases of discoid lupus rather than its antibiotic effect. When compared to other drugs with immune system effects it is very unlikely to cause problems, except for causing vomiting in some patients.

Another medication sometimes used for discoid lupus is niacinamide. At the present time I think it is usually used at the same time as tetracycline, with both medications dosed at about 250mg (small dog) or  500mg (large dog) three times a day. It is also relatively unlikely to cause serious side effects, when compared to medications such as corticocsteroids but it also causes vomiting in a fair number of dogs.

Discoid lupus can often be treated with topical medications.  A sunblocker can be helpful. You have to use a waterproof one and it should have an SPF of 30 or greater. Some dogs do better with oral supplementation of Vitamin E, usually 400 to 800 IU per day.  Keeping affected dogs indoors helps a lot, too.

Topical application of a potent corticosteroid, like fluocinolone acetonide or betamethasone dipropionate applied twice daily will often control the symptoms of discoid lupus and is preferable to using oral or injectable
corticosteroids.

It would really surprise me if the vitamins and fatty acid supplementation would work alone but it might, if you also use sunblock and try to avoid exposure to the sun, too. Topical corticosteroids work for many dogs and the combination of these things and tetracycline and niacinamide works for most dogs.

Mike Richards, DVM

SLE
Discoid Lupus


chloebutton   talabutton

The above information is simply informational. It's intent is not to replace the advice of a veterinarian nor to assist you in making a diagnosis of your pet. Please consult with your own veterinarian for confirmation of any diagnosis. Your pets life may depend on it.