[Acute lupus erythematosus disseminatus in adults: clinical aspects & course]

Acute systemic lupus erythematosus (SLE) is characterized by a variety of manifestations and by the almost constant presence of anti-nuclear antibodies. In order to distinguish it from other systemic diseases, eleven diagnostic criteria have been laid down, four of which at least must be present. In 50 p. 100 of the cases the disease is revealed by a non-destructive inflammatory polyarthritis which is highly suggestive when associated with a "butterfly" facial erythema. The main prognostic criteria are renal lesions and their histological type. Nervous system involvement seems to be less frequent and less severe nowadays, but it may leave sequelae. Pleuropericarditis and vascular thrombosis are commonly part of the clinical set up. Antinuclear antibodies are detected by immunofluorescence in more than 95 p. 100 of the patients, but they are not specific to SLE. Their absence in the initial phase of the disease may throw doubts on the diagnosis. Antibodies to DNA and Sm are more specific but inconstant. SLE is a chronic disease with intermittent flare-ups: 30 p. 100 of the patients may hope for a prolonged complete remission. At present, the survival rate at 10 and 20 years is higher than 80 p. 100 and 70 p. 100 respectively at the cost of a very close supervision but also of iatrogenic complications in increasing numbers.