Systemic Lupus Erythematosus: Historical Perspective, Global Epidemiology, Immunological Dysregulation, and Multifactorial Etiology

Abstract

Background:
Systemic lupus erythematosus (SLE) is a multisystemic autoimmune inflammatory disease, that  is chronic and complex. Its pathogenesis is a complex of intrinsic factors and environmental stimuli, hormonal effects, and epigenetic processes, and  it causes a severe deregulation of the immune system. The main symptoms of the disease is an abnormal immune response, where autoregulated T cells trigger B cells to produce auto pathogenic autoantibodies. The clinical presentation of SLE is so diverse, covering mild and self-limiting manifestations, such as fatigue, skin rash, and joint pain, to severe and life-threatening organ involvement, which may include lupus nephritis, neurological problems and heart diseases. The disease can either attack one organ or manifest itself as a systemic disorder with more than one organ at a time. This broad range of clinical and serological heterogeneity is one of the distinguishing features of SLE and creates a great difficulty in the diagnosis of the disease, its monitoring, and treatment .It is crucial to gain a complete picture of the immunopathological processes and heterogeneity of SLE to enhance the accuracy of the diagnostic process, at the same time optimizing the personalized approach to treatment, and minimizing morbidity and mortality in the course of long-term follow-up of the disease.