Among the rare autoimmune diseases of pets, lupus erythematosus in dogs is the most common and studied. chronic pathology. When it occurs, the immune system malfunctions and begins to produce antibodies against the body’s own cells.. This situation leads to the development of inflammatory processes in internal organs, skin, and joints.

Some experts believe that pathology is primarily caused by genetic predisposition. Lupus erythematosus is most often diagnosed in breeds such as long-haired collies, Scottish and German shepherds, Afghan hounds, poodles, Irish setters, and hounds.

According to other veterinarians, factors such as:

• chronic inflammatory processes in the body;
• severe bacterial, viral, fungal infections;
• regular consumption of low-quality moldy products;
• long-term use of certain medications, including those that affect the immune system;
• excessive influence of ultraviolet radiation on the pet’s body. Animals that are constantly outdoors are at risk;
• long-term stress.

Predisposing factors include gender and age: females and pets older than 6-8 years get sick more often.

Types of pathology and their symptoms:

• Discoid. Very rare. Collies and German Shepherds are at risk. It manifests itself primarily as a violation of the normal pigmentation of the skin on the nose. Then the pathological process becomes more complicated inflammatory reaction. At the tip of the nose there is redness, swelling, erosion, and ulcers. As it dries, crusts form.

Ulcers may bleed or fester if complicated by a bacterial infection. Lesions are less common in the area of ​​the auricle and oral cavity. At severe defeat mucous membrane, the dog loses appetite and loses weight. In some cases, regular nosebleeds are observed.

Discoid lupus erythematosus

Animals living in hot climates are more likely to suffer from discoid lupus due to exposure to ultraviolet radiation.

• System. The cause of development is considered to be a genetic predisposition, viral and bacterial infections, illiterate use of immunosuppressants and hormonal drugs. With systemic lupus, many tissues of the body are affected. Most often, the musculoskeletal system suffers from an attack of antibodies.
• The synovial membranes lining the articular surface are primarily affected. Clinically, this is expressed in their puffiness and swelling. The animal experiences severe pain.

The owner may observe lameness and an unnatural gait. The dog avoids sudden movements, becomes lethargic and inactive. On palpation, muscle soreness is detected.

Systemic lupus erythematosus

Changes in the skin are also observed. The dog develops alopecia. The skin becomes dry, covered with ulcers and crusts. As a rule, baldness affects the head, ears, tail and limbs. Hyperkeratosis may be observed in the paw area. Skin lesions are often complicated by bacterial infection, which leads to the development of severe pyoderma.

A malfunction of the immune system also leads to the development of anemia in a sick pet. Often with systemic lupus there is neurological disorders– , seizures.

• Symmetrical. An autoimmune disease that primarily affects the claws is called symmetrical lupus onychodystrophy. The disease is typical for German shepherds and often affects females under 6 years of age. Symptoms include claw defects on all paws. Microflora joins the pathological process and inflammation develops. The animal is limping and constantly licking its paws. Soreness leads to lethargic state, appetite decreases.

Lupus onychodystrophy

With lupus erythematosus, symptoms often appear sluggish and are similar to many pathologies. If suspected, a thorough visual examination of the skin is performed. In this case, the doctor pays attention to the nature of the skin rashes, the presence of photodermatitis, and the symmetry of the lesions. Equally important is the observation of the pet’s behavior and the manifestation of neurological abnormalities.

If discoid lupus is suspected in a dog, it is advisable to undergo a skin biopsy.. A general and biochemical blood test can help in establishing a diagnosis. Proteinuria is detected in the urine. The cell test for lupus is often false negative, such as with leishmaniasis, making diagnosis difficult. Structural changes in the kidneys, characteristic of autoimmune pathology, are detected by ultrasound.

Differential diagnosis is carried out in relation to a number of diseases. First of all, in a furry patient, demodicosis, leishmaniasis, and dermatophytosis are excluded. It is also necessary to conduct a bacteriological analysis for pyoderma and bacterial folliculitis.

The treatment will be long. First of all, a veterinarian will prescribe effective antibiotic therapy to prevent the development of purulent inflammation skin. The drug is selected individually. Drugs such as Cyclosporin A, Azathioprine, Mycophenolate, which have an immunosuppressive effect, are often used. Cutaneous forms of lupus are treated with hormonal ointments.

If joints are affected, rest is prescribed, allowing you to relieve the load from the musculoskeletal system. The dog is kept indoors, excluding exposure to ultraviolet radiation as much as possible.

The main drugs are immunosuppressants, for example, Tacrolimus. High doses of glucocorticosteroids, such as Prednisolone, significantly reduce the production of lymphocytes and immunoglobulins in the body of a sick animal, which is necessary for an autoimmune disease. The course of treatment can range from 8 weeks to six months.

Prognosis for a sick animal veterinary specialists do careful. According to the observation of therapists, 40% of four-legged friends die during the first year of the development of pathology. This occurs due to complications of the disease with a bacterial infection, chronic renal failure, the development of pneumonia and sepsis. If there is a positive response of the body to the use of glucocorticoids, the prognosis is favorable.

Read more in our article about lupus in dogs.

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Causes of lupus erythematosus in dogs

Among the rare autoimmune diseases of domestic animals, lupus erythematosus in dogs is the most common and studied chronic pathology. The disease lies in the fact that the furry pet’s immune system malfunctions and begins to produce antibodies against the body’s own cells.

This situation leads to the development of inflammatory processes in internal organs, skin, and joints. It is in these tissues that pathological antigen-antibody immune complexes are most often formed, aimed at destroying viable cells of the animal.

Pathogenesis of lupus erythematosus

There is no consensus among veterinarians about the causes of autoimmune diseases in pets. Some experts believe that pathology is primarily caused by genetic predisposition. Thus, lupus erythematosus is most often diagnosed in breeds such as long-haired collies, Scottish and German shepherds, Afghan hounds, poodles, Irish setters, and hounds.

According to other veterinarians, the following factors lead to a rare autoimmune disease:, How:

Predisposing factors include gender and age. Thus, among females the disease is observed much more often than among males. According to the supervision of veterinary specialists, pets over 6-8 years old should be under close attention owner. Trigger a pathological mechanism in the immune system, according to experienced dog breeders, maybe long-term stress.

Types of pathology and their symptoms

In veterinary practice, the main forms of autoimmune disorders are distinguished: discoid, systemic and symmetrical lupus. Types of the disease differ in clinical presentation, gender and genetic predisposition.

Discoid

This clinical form of pathology is very rare. Veterinary experts do not see a relationship between gender and age, but there is a risk for breeds such as collies and German shepherds. Discoid lupus erythematosus in dogs manifests itself primarily as a violation of the normal pigmentation of the skin on the nose.

Then the pathological process is complicated by an inflammatory reaction. At the tip of the nose there is redness, swelling, erosion, and ulcers. As it dries, crusts form. Ulcers may bleed or fester if complicated by a bacterial infection. Less commonly, lesions are observed in the area of ​​the auricle and oral cavity. With severe damage to the mucous membrane, the dog loses appetite and loses weight. In some cases, your pet experiences regular nosebleeds.

Discoid lupus erythematosus

According to the observation of veterinary therapists, animals living in hot climates are more likely to suffer from discoid lupus due to exposure to ultraviolet radiation on the body.

System

A severe disorder of the immune system is systemic lupus erythematosus in dogs. The cause of the disease is considered to be genetic predisposition, viral and bacterial infections, illiterate use of immunosuppressants and hormonal drugs. With systemic lupus, many tissues of the body are affected.

Most often, the musculoskeletal system suffers from an attack of antibodies. The synovial membranes lining the articular surface are primarily affected. Clinically, this is expressed in their puffiness and swelling. The animal experiences severe pain. The owner may observe lameness and an unnatural gait. The dog avoids sudden movements, becomes lethargic and inactive. On palpation, muscle soreness is detected.

A malfunction of the immune system also leads to the development of anemia in a sick pet. Often, with systemic lupus, the owner also observes neurological disorders - convulsions, seizures.

Symmetrical

An autoimmune disease that primarily affects an animal's claws is called symmetrical lupus onychodystrophy. The disease is typical for German Shepherds and often affects females under the age of 6 years. Symptoms of lupus erythematosus in dogs include nail defects on all limbs.

Microflora joins the pathological process and inflammation develops. The animal is limping and constantly licking its paws. Soreness leads to lethargy, appetite decreases.

Lupus onychodystrophy

Diagnosis of an animal

Determining the autoimmune causes of health problems requires high professionalism from a veterinarian. Symptoms of the disease often appear sluggish and are similar to many pathologies. If lupus erythematosus is suspected in dogs, first of all, a thorough visual examination of the skin is performed. In this case, the doctor pays attention to the nature of the skin rashes, the presence of photodermatitis, and the symmetry of the lesions.

Equally important is the observation of the pet’s behavior and the manifestation of neurological abnormalities.

If discoid lupus is suspected in a dog, it is advisable to undergo a skin biopsy. A general and biochemical blood test can help in establishing a diagnosis.

Thrombocytopenia, leukocytosis, or an increased number of lymphocytes may indicate an autoimmune pathology. Proteinuria is detected in the urine.

The cell test for lupus is often false negative, such as with leishmaniasis, making diagnosis difficult. Structural changes in the kidneys, characteristic of autoimmune pathology, are detected through ultrasound examination.

Differential diagnosis is carried out in relation to a number of diseases. First of all, demodicosis, leishmaniasis, and dermatophytosis are excluded in a furry patient. It is also necessary to conduct a bacteriological analysis for pyoderma and bacterial folliculitis.

Treatment of lupus erythematosus in dogs

When a pet is diagnosed with lupus erythematosus, the owner must understand that treatment will be long. First of all, a veterinarian will prescribe effective antibiotic therapy to prevent the development of purulent inflammation of the skin.

The antibacterial drug is selected individually. Drugs such as Cyclosporin A, Azathioprine, Mycophenolate, which have an immunosuppressive effect, are often used. Cutaneous forms of lupus are treated with hormonal ointments.

If the joints are affected, a pet with lupus is prescribed rest to relieve stress on the musculoskeletal system. The dog is kept indoors, excluding exposure to ultraviolet radiation as much as possible.

The main drugs that have a therapeutic effect in autoimmune pathology are immunosuppressants, for example, Tacrolimus. High doses of glucocorticosteroids, such as Prednisolone, significantly reduce the production of lymphocytes and immunoglobulins in the body of a sick animal, which is necessary for an autoimmune disease. The course of treatment is prescribed strictly individually and can range from 8 weeks to six months.

If an animal develops symmetrical lupus onychodystrophy, the damaged claw is surgically removed.

Forecast

Due to the complexity of diagnosis and the lack of a specific treatment regimen for an autoimmune disease, veterinary specialists make a cautious prognosis for a sick animal. According to the observation of therapists, 40% of four-legged friends die during the first year of the development of pathology. This occurs due to complications of the disease with a bacterial infection, chronic renal failure, the development of pneumonia and sepsis.

If there is a positive response of the body to the use of glucocorticoids, the prognosis is favorable.

Lupus erythematosus in dogs is a rare disorder of the immune system. The disease can affect both individual tissues, for example, the skin of the nose, and organs and systems - musculoskeletal, kidneys, lungs. Symptoms are similar to many skin diseases, the lack of specific diagnostic methods makes it difficult to detect pathology in a timely manner.

Treatment is usually conservative and based on the use of antibiotics and glucocorticosteroid drugs.

Useful video

Watch this video about the symptoms, diagnosis and treatment of systemic lupus erythematosus in dogs:

Lupus erythematosus in dogs is a fairly rare immune disease. Let's just say that with this disease, the immune system performs its functions too diligently, as a result of which healthy cells, organs and tissues are subject to serious attack. Unfortunately, this disease occurs not only in dogs; cats and even people get sick, but it occurs more often in dogs. The disease is dangerous; it can provoke inflammatory processes in the heart, lungs, kidneys and joints. Lupus erythematosus comes in two types: discoid and systemic.

Symptoms of lupus in dogs

The disease manifests itself in mild or severe degrees; it is very difficult to differentiate the two types of lupus. The disease disrupts the functioning of all organs and systems, because healthy cells and tissues are destroyed with the same force and speed if they were viruses or bacteria. The heart, kidneys, blood and skin suffer. If treatment is not started promptly, lameness, arthritis, or other inflammatory diseases joints. In some cases, anemia, hair loss, and infectious diseases were noted.

The disease may be accompanied by frequent urination, fever, gums become white, joints and muscles weaken, the dog becomes lethargic and lies down more often. In cases where the lymph nodes become enlarged, the same happens to the liver and spleen, then anxious behavior is observed, the animal experiences discomfort, fusses, and can be aggressive.

Discoid lupus erythematosus

If depigmentation, ulcers or lesions are only on the skin of the face, nose, or oral mucosa, then your dog has discoid lupus. For availability of this disease may indicate nosebleed, and if such cases recur, you should not hesitate to visit a doctor. Very often the ears, scrotum, and vulva are affected.

Attention! External signs alone are not enough to diagnose lupus in dogs. A correct conclusion can only be made based on comprehensive examination the animal's body, for this purpose clinical tests are done. The peculiarity of autoimmune diseases is that they affect more than one organ. An accurate picture of what is happening can be obtained from the results of a urine test, blood test, skin biopsy, etc.

Having noticed the slightest deviations from the norm in behavior and appearance your pet needs to see a doctor immediately, otherwise the lost time may not in the best possible way influence the course and treatment of a terrible disease.

Causes of the disease

“What is the reason?” - unfortunately, there is no clear answer to this question yet. Most experts believe that the cause is a genetic predisposition. The disease can be triggered by various external and internal factors: inflammatory processes in the body, infections, long exposure to the sun, frequent stress, fear, etc.

What breeds are at risk? These are collies, English shepherds, poodles, German shepherds, Afghan hounds. Most often, German shepherds that are under six years old get sick; bitches are more likely to get sick.

Individuals who live on the street are at risk. Immune system dysfunction may be a consequence of leukemia, bacterial or fungal disease. American scientists have found that lupus erythematosus in dogs can occur if they are fed moldy foods. But the treatment of the disease does not depend on the reasons that caused it, therefore, if the mechanism is started, all efforts must be directed towards treatment.

That is why it is so important to pay due attention to the health of your pets. Lupus-prone breeds should only be walked before sunrise or after sunset. They should not be exposed to too much physical activity, unjustified frequent stress can also provoke this disease. Animal feed should be varied, balanced and nutritious.

Diseases of the joints, kidneys and other organs must be diagnosed and treated in a timely manner, and due attention should be paid to immunity. If dogs get enough protein, minerals and vitamin, their immune system will function normally. Hereditary nature has been proven of this disease Therefore, animals should not be allowed to reproduce.

Treatment of the disease

The main thing is to prevent possible complications and try to alleviate the condition of the sick animal. Treatment depends on the type of lupus, the degree of damage to organs and systems, and the general condition of the patient.
In cases of severe disease, and this most often happens with systemic lupus, the dog is subject to hospitalization and is prescribed complex treatment, including immunosuppressants.

But, in most cases, they are limited outpatient treatment. We must not forget that every animal has its own individual characteristics, the doctor must take into account the severity of the disease, the stage at which it is, the extent of the damage, the age and health of the dog.

For speedy recovery It is very important to provide the animal with rest, good food, comfortable conditions, in this case, perhaps the disease will not progress, and the articular tissue will remain undamaged. Try to avoid stress, limit your pet's movements, perhaps he needs to be put in a cage for a while, this will not be very pleasant, but it is quite justified.

If the diagnosis is discoid lupus erythematosus, and the skin lesions are minor, then they are treated with hormonal ointment. If the degree of damage is large, injections of prednisolone and non-steroidal anti-inflammatory drugs are given. Vitamin E is prescribed, it promotes the regeneration of skin cells and prevents the development of secondary infections, and other drugs.

You need to be prepared for the fact that the treatment process will be quite complicated; it will take several months to treat your four-legged friend. But, if you strictly follow all the doctor’s recommendations, your pet will recover. Remember that this autoimmune disease is not a death sentence. With it, the animal can live for many more years. But the sooner you pay attention to the disease, the more effective the treatment will be, which means your pet will be able to remain healthy, and nothing will threaten its life.

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Text of the article and photos from the SMALL ANIMAL DERMATOLOGY A COLOR ATLAS AND THERAPEUTIC GUIDE 2017

Translation from English: veterinarian Vasiliev A

Peculiarities

Systemic lupus erythematosus in dogs and cats is a multisystem immune-mediated disease characterized by the production of various autoantibodies (eg, ANA, rheumatoid factor, red blood cell antibodies) that form circulating immune complexes. It is rare in cats and uncommon in dogs. Collies, Scottish Shepherds and German Shepherds are predisposed.

Dogs

Symptoms are often nonspecific and can wax and wane. Symptoms of skin lesions are common, variable, and often similar to those seen in other skin diseases. Erosion of mucous or mucocutaneous junctions may be observed. Skin lesions may include erosions, ulcers, desquamation, erythema, alopecia, crusting, and scarring of the skin. Lesions may be multifocal or diffuse. They can occur throughout the body, but the muzzle, ears, and distal limbs are most commonly affected. Peripheral lymphadenomegaly is often present.

Other symptoms may include intermittent fever, polyarthritis, polymyositis, renal failure, blood cell abnormalities, pleurisy, pneumonia, pericarditis or myocarditis, central or peripheral neuropathy, and lymphedema. Lesions of the nasal planum, ears and fingertips are unique and characteristic of an autoimmune skin disease.

Vesicular cutaneous lupus erythematosus, formerly known as ulcerative dermatosis of shelties and rough collies (UDSSC), appears to be a vesicular variant of cutaneous lupus erythematosus. It is uncommon in shelties and long-haired collies and their crosses. It is typically seen in adult dogs and lesions usually first appear during the summer months. Some dogs may go into remission during the winter and then relapse in early summer. The primary lesions are vesicles and bullae. However, these lesions are often difficult to find because they are fragile and easily ruptured.

Secondary lesions include round, polycyclic and crescent-shaped ulcerations. These lesions typically occur on poorly haired skin (eg, groin, axilla, ventral abdomen, medial thighs) and may progress to involve mucocutaneous junctions, concave auricles, oral cavity, and finger pads. Affected dogs may become weakened and develop sepsis due to a secondary bacterial skin infection.

Cats

Skin lesions are variable and may include dermatosis with erythema, alopecia, desquamation, crusting, and scarring; exfoliative erythroderma and excessive peeling (seborrhea). Lesions can be observed throughout the body, but are most often found on the face, ears and paws. There may be mouth ulcers. Other symptoms may include fever, polyarthritis, renal failure, neurological or behavioral abnormalities, hematological abnormalities and myopathy.

Differential diagnoses

Differential diagnoses include other causes of multisystem disease, such as drug reaction, rickettsia and other infections (viral, bacterial, fungal), neoplasia, and other autoimmune and immune-related skin diseases.

Diagnosis

1 It is often difficult to make a definitive diagnosis. All differential diagnoses must be excluded. The following findings support the diagnosis and when several findings supporting the diagnosis are found simultaneously (clusters of symptoms), then the diagnosis of systemic lupus erythematosus is highly likely:

• Hemogram anemia (Coombe test may be positive or negative), thrombocytopenia, leukopenia or leukocytosis.
• Urinalysis: proteinuria.
• Arthrocentesis (polyarthritis) sterile purulent inflammation (rheumatoid factor may be positive or negative)
• ANA test: a good screening test because most patients with systemic lupus erythematosus have positive ANA titers. However, a positive result is only supportive of the diagnosis and is not pathognomonic for systemic lupus erythematosus, since positive titers can be associated with many other chronic or infectious diseases such as bartonellosis, ehrlichiosis and leishmaniasis. False negative results may occur (10%).
• Cell test for lupus erythematosus: a positive result indicates high probability diseases, but this test is not a good screening test because false negative results are common.

2 Titers should be examined for the presence of rickettsial infection to exclude tick-borne disease.

3 Dermatohistopathology: Focal thickening of the basement membrane zone, subepidermal vacuolization, hydropic or lichenoid superficial dermatitis, or leukocytoclastic vasculitis are characteristic. However, these changes are not always observed and findings may be nonspecific.
4 Immunofluorescence or immunohistochemistry (skin biopsy specimens): plaque deposits of immunoglobulin or complement in the basement membrane area. These methods are non-diagnostic in themselves, since they may cause false positive results and false negatives are common.

Treatment and prognosis

1 Symptomatic shampoo therapy may be helpful in removing crusts.

2 Appropriate long-term antibiotic therapy (minimum 4 weeks) should be prescribed for the treatment and prevention of secondary pyoderma in dogs. Dogs that received antibiotics during the induction phase of immunosuppressive therapy have significantly higher survival rates than dogs that were treated with immunosuppressive drugs alone. Antibiotic therapy should be continued until immunosuppressive therapy brings the autoimmune disease under control.

3 The goal of treatment is to control the disease and its symptoms using the safest treatments at the lowest possible doses. Typically, combination therapy (see Table) should be used to provide comprehensive treatment while minimizing the side effects of monotherapy. Depending on the severity of the disease, more or less aggressive treatment methods should be chosen. To achieve remission of the disease, more high doses, and then decrease over 2-3 months to the lowest effective dose

• Topical treatment given every 12 hours with a steroid or tacrolimus will help reduce the severity of focal inflammation and allow dose reduction systemic drugs required to control symptoms. During remission, frequency of use local drugs should be minimized in order to reduce local side effects.
• Conservative methods Systemic treatments (see) include drugs that reduce the severity of inflammation and have few or no side effects. These drugs help reduce the need for more aggressive treatments, such as steroids or chemotherapy.
• Steroid therapy is one of the most predictable treatments for autoimmune skin disease, but the side effects associated with the high doses required to control symptoms can be severe. Although glucocorticoid therapy alone may be effective in maintaining remission, the doses required may result in unwanted side effects, especially in dogs. For this reason, the use of nonsteroidal immunosuppressive drugs, alone or in combination with glucocorticoids, is usually recommended for long-term maintenance treatment. --Immunosuppressive doses of oral prednisolone or methylprednisolone should be given daily (see Table). Once lesions have resolved (after ≈2–8 weeks), the dose should be gradually reduced over several (8–10) weeks to the lowest possible dose every other day that maintains remission . If significant improvement is not observed within 2 to 4 weeks of starting treatment, a concurrent skin infection should be ruled out and alternative or additional immunosuppressive agents then considered. --Alternative steroids for prednisone- and methylprednisolone-refractory cases include triamcinolone and dexamethasone (see ). --In cats Treatment with immunosuppressive doses of triamcinolone or dexamethasone is often more effective than therapy with prednisolone or methylprednisolone. Oral triamcinolone or dexamethasone should be given daily until remission is achieved (≈2–8 weeks), and then the dose should be gradually reduced to the lowest possible dose and dosing should be as infrequent as possible to maintain remission. --If unacceptable side effects develop or there is no significant improvement within 2 to 4 weeks of starting treatment, consider the use of an alternative glucocorticoid or nonsteroidal immunosuppressive drug (see section 4.4).
• Nonsteroidal immunosuppressive drugs that may be effective include (Atopica), oclacitinib (Apoquel), azathioprine (dogs only), chlorambucil, cyclophosphamide, mycophenolate mofetil, and leflunomide (see Table). Positive response observed within 8-12 weeks of initiation treatment When remission is achieved, then gradually try to reduce the dose and frequency of use of a non-steroidal immunosuppressive drug for long-term maintenance treatment.

4 The prognosis is guarded if hemolytic anemia, thrombocytopenia, or glomerulonephritis is present. In up to 40% of cases, death occurs within the first year of treatment as a result of renal failure, poor response to treatment, drug complications, or secondary systemic infection (pneumonia, sepsis). The prognosis is more favorable for animals that respond to glucocorticoid therapy alone. In this case, approximately 50% of patients have a long survival period. Regular monitoring of clinical symptoms, general and biochemical blood tests is required, with treatment adjustments as necessary.

Photo 1 Systemic lupus erythematosus in dogs and cats. Erythematous erosive dermatitis with alopecia in the area of ​​the muzzle, nasal planum and ears in an adult Jack Russell Terrier. Lesions of the nasal planum and auricles are unique features of autoimmune skin disease.

Photo 2 Systemic lupus erythematosus in dogs and cats. The same dog from photo 1. Depigmentation and cortical erosion of the nasal planum.

Photo 3 Systemic lupus erythematosus in dogs and cats. Severe crusting, erosive dermatitis with depigmentation of the nasal planum.

Photo 4 Systemic lupus erythematosus in dogs and cats. Erosive dermatitis in the gum area. Lesions of the oral mucosa can be observed with pemphigus vulgaris, bullous pemphigoid, systemic lupus erythematosus and vasculitis.

Photo 5 Systemic lupus erythematosus in dogs and cats. Erosion on the dog's palate.

Photo 6 Systemic lupus erythematosus in dogs and cats. Cortical lesions of the auricles with alopecia. A tissue defect with a notch indicates an underlying vasculitis associated with systemic lupus erythematosus.

№3-2014

Autoimmune diseases (continued)

Started in No. 2.2014

Discoid lupus erythematosus

General information

This disease is common in dogs. Lesions in the form of erythema, erosions, crusts spread on the nose and bridge of the nose, in the periorbital area, on the lips, on the ears, on the genitals. In this case, the nose usually becomes depigmented. The general condition of dogs with this disease does not change. Predisposed breeds include Scottish Shepherd, German Shepherd, and Siberian Husky. Differential diagnoses include mucocutaneous pyoderma, pemphigus, erythema multiforme, lymphoma, nasal solar dermatitis, nasal depigmentation, drug reactions, uveodermatologic syndrome, contact dermatitis, and systemic lupus erythematosus. It is believed that in cats this is an extremely rare disease, clinically manifested by lesions on the ears and on the front of the head in the form of peeling, crusts and alopecia. The point of view of the authors in different sources is common, since there are opinions that the diagnosis of discoid lupus erythematosus in the described cases in cats can be ambiguous.

Making a diagnosis

The diagnosis is based on history, clinical examination, response to proposed therapy, and histology results. The characteristic histological changes in discoid lupus erythematosus were previously considered to be lymphocytic or lymphocytic-plasma cell lichenoid superficial dermatitis with hydropic degeneration of basal keratinocytes. A very important aspect: according to relatively recent data reflected in publications, today it is believed that there are neither clinical nor histological differences between discoid lupus erythematosus and pyoderma of the mucocutaneous zones. In this regard, there is a recommendation that suggests using a first-choice antibiotic in dermatological doses as a trial therapy. This, in turn, may allow one problem to be differentiated from another.

Therapy

At the initial stage, cephalexin can be chosen as therapy in doses of 22-30 mg/kg/12 hours, for a course of 30 days. In the event that there is no response to therapy, immunomodulators are used: Omega-3 fatty acids, vitamin E, in addition to this - niacinamide and tetracycline. Then, if there is no response, after 60 days, topical glucocorticoids. And only then, after 60 days, if there is no effect from the prescribed therapy, prednisolone is prescribed in an anti-inflammatory dose, which is then slowly withdrawn over several months to the minimum effective dose.

Clinical case of discoid lupus erythematosus from our practice

A mixed-breed dog, a male, aged 7 years, was admitted to our clinic. His history revealed that over several weeks he developed lesions on his nose and prepuce (Figures 9-10). This was accompanied by itching of these areas and self-injury. Among the differential diagnoses, we considered mucocutaneous pyoderma, pemphigus, epitheliotropic lymphoma, and discoid lupus erythematosus.

Cephalexin was proposed as initial therapy in the doses taken; there was no effect after several weeks of using the drug; moreover, we noted negative dynamics clinical manifestations. The choice of such therapy was due to the fact that cytological studies from under the crusts determined the microbial coccal flora. Antibiotic therapy was accompanied by bacterial culture, which confirmed the sensitivity of the microflora to this antibiotic. We collected material for histological examination and until the results were obtained, local therapy with 0.1% tacrolimus was prescribed. In this case, a partial response to the proposed therapy was noted.

The histological results indicated that we were faced with mucocutaneous pyoderma. Nevertheless, we continued therapy with tacrolimus and, taking into account the tendency towards the development of clinical signs, simultaneously introduced cyclosporine into the regimen at doses of 10 mg/kg/day. This combination quickly put the patient into remission (photos 11-12). Today, we are reducing the frequency of cyclosporine administration while continuing to monitor the patient.

Conclusions:

• To make a diagnosis in the presence of autoimmune diseases, anamnesis, physical examination, initial dermatological tests and especially biopsy are important.
• The results of a biopsy may not always be useful for making a diagnosis: in some cases due to incorrect biopsy sampling, in others due to objective reasons (features of the histopathological picture).
• Trial therapy, thoughtful and as safe as possible for the patient, can also be a good guide to the final diagnostic choice.
• Literature:
• Muller & Kirk's Small Animal Dermatology 7th Edition 2012. P. 432-461.
• Nebraska Veterinary Medical Association. 2010 CONVENTION PROCEEDINGS. January 21–23, 2010. Holiday Inn & Convention Center Kearney, Nebraska. R. 3-7.
• Muller & Kirk's Small Animal Dermatology 6th Edition 2001. P. 678-713.

In the not so distant past, on all the screens of the country (and not only ours) you could see a series dedicated to one eccentric doctor... Who was simply delighted with lupus! But what kind of disease is this, and does it affect our pets? Yes, lupus can happen in dogs. No, the dog does not turn into a wolf.

Basic information about the disease

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease characterized by the formation of antibodies against a large number of autoantigens. Too unclear? In other words, it is a disease in which the body's immune system becomes "overprotective", attacking the cells, organs and tissues of its own body, mistaking them for harmful bacteria, viruses and fungi. Naturally, this does not lead to anything good.

High levels of antigen-antibody complexes form in the zona glomerulosa of the kidneys, the synovium of the joint capsules, in the skin and blood vessels. In some cases, antibodies may appear that specifically attack certain blood cells. Somewhat less often, it happens that the attacked macrophages, leukocytes, basophils, etc., simultaneously attack the vascular walls, other cells and tissues of the body.

Systemic lupus erythematosus is rare in dogs, but its rarity is believed to be largely due to poor diagnosis of the disease. It is believed that collies, German shepherds, English shepherds, Afghan dogs, some hounds, Irish setters and poodles have a certain predisposition to it. Currently, many veterinarians are inclined to think that lupus, to a certain extent, can be called a hereditary disease of German shepherds, since their population is especially susceptible to this pathology. Typically, the disease develops around the age of six. The gender and physiological state of the animal do not play a role.

Symptoms and affected systems

Thus, the symptoms of lupus in dogs depend on both the type of antibodies produced and the location of the underlying lesions. However, genetic, environmental, pharmacological, and infectious factors can play a negative role. Consider the response of the musculoskeletal system:

• Deposition of immune complexes in synovial membranes (soft tissue lining the internal surfaces of the joints).

• Swollen and/or painful joints are a major sign of lupus in many dogs.

• Lameness, unnatural position of the legs.

• Muscle pain, gradual exhaustion of the animal.

It is less common to see a response from the skin and endocrine system of the body. Clinical signs in this case are as follows:

• Deposition of immune complexes in the skin.

• Lesions of the skin that occur suddenly for no apparent reason. They can be symmetrical or one-sided: redness, swelling, ulcers, depigmentation and/or hair loss. Unfortunately, not all breeders pay attention to these signs.

• A very characteristic symptom is ulcers both on the skin and on all visible mucous membranes. There are many injuries around the mouth, nose (pictured), and anus. In some cases, the ulcers are so extensive and severe that the dog is unable to defecate, eat, or drink normally.

All this is not good, but these symptoms do not pose a direct threat to the life of the animal. Another thing is the following clinical signs and processes:

• Deposition of immune complexes in the kidneys.

• Hepatonephromegaly, that is, a sharp increase in the volume of the kidneys and liver.

• Production of antibodies against red blood cells, white blood cells or platelets.

• Lymphadenopathy - swollen lymph nodes.

• Sudden damage to other organs and tissues can be diagnosed, and this depends solely on what “target” the lymphocytes choose for themselves.

Note that the classic sign of this disease in dogs is frequent, sudden nosebleeds. They often appear even before skin lesions.

What causes it and how is it diagnosed?

The reason why lupus erythematosus develops in dogs has not yet been clearly determined. Scientists suggest that in most cases this pathology is genetically determined, since in the same German shepherds (as we have already written about), lupus is very common within the entire population.

It was possible to establish that animals that spend all their time outdoors get sick more often. This is most likely due to ultraviolet radiation. There is also evidence that some viral diseases, including infections of bacterial and fungal origin, can contribute to inappropriate behavior of the immune system.

In particular, American veterinarians were able to achieve something similar by keeping experimental animals on a diet with small amounts of mold toxins for a long time. So the possible causes of lupus are extremely diverse. In any case, identifying the exact predisposing factor is impractical (it will still not help treatment, and you will waste time).

Let us immediately note that discoid lupus in dogs (like other autoimmune diseases) is difficult to diagnose. A complete blood test is required, its biochemical examination is performed, and a urine test is performed. You need to tell your veterinarian when clinical signs began to appear, what preceded their onset, and how sudden the onset of the disease was. Joint pain, kidney problems, skin lesions, red blood cell breakdown, low platelet count and general weakness, - these are the signs that allow you to suspect the presence of lupus.

But here it should be mentioned that the final diagnosis can only be made on the basis of professional genetic examination. It is never possible to judge by eye the presence or absence of such a specific disease.

Therapeutic techniques

If the dog’s condition is serious, and there are already signs of blood hemolysis, it must be urgently hospitalized, since the treatment of lupus in dogs in this case is very difficult. However, in situations where severe effects have not yet been identified, therapy at home is acceptable. Of course, there is no specific treatment, and specific therapeutic techniques depend on the systems that were affected in a particular case.

So, when a dog’s joints hurt and become damaged, he is prescribed painkillers and complete rest is recommended. This approach will help slow down the progression of the disease and prevent further destruction of the joint tissue. Many veterinarians (and even “human” doctors) strongly advise limiting the time a dog spends in the sun. If you live in an area where the weather is often sunny, you should only walk your pet in the early morning or late evening. Since the kidneys are almost always affected by lupus, a diet with a small amount of protein, which does not burden the excretory system, will not hurt.

There are many medications that can be used to treat lupus. Immunosuppressants are always used to reduce the response of the immune system and corticosteroids to reduce inflammation in the lymph nodes and other tissues of the body. Be that as it may, only a veterinarian should prescribe them.

Lupus erythematosus in dogs belongs to a group of diseases that are characterized by disturbances in the hormonal system, when the body begins to attack its own healthy cells.

Causes and symptoms

The disease primarily affects the skin, causing specific forms dermatitis. On the other hand, lupus is accompanied by impaired kidney function and gradual destruction of connective tissue, including bone elements.

The first sign of lupus is frequent nosebleeds. Subsequently, redness appears on the skin. In the absence of timely treatment, the affected areas of the skin begin to become covered with ulcers that resemble small open wounds.

And since it goes active destruction connective tissues, then the joints are primarily affected - this is how polyarthritis appears. An increase in body temperature is often observed.

Diagnosis and treatment

Diagnosing lupus erythematosus, like any other autoimmune disease, is quite difficult. The veterinarian must review the dog's medical history, become familiar with all the symptoms, and prescribe the necessary tests.

The spleen and the rest of the immune system strive to rid the body of old, diseased, or damaged red blood cells, which are their normal function. If a large percentage of cells are affected and they are destroyed faster than they are replenished, AIHA develops and the animal develops external signs of the disease.

Clinical signs of AIHA usually develop gradually and progress, but sometimes an apparently healthy animal suddenly declines and experiences an acute hemolytic crisis. Symptoms are usually associated with a lack of oxygen: weakness, severe lethargy, lack of appetite, increased heart rate and breathing. Possible heart murmurs and pallor of the mucous membranes (gums, eyelids, etc.). In more severe cases, fever and jaundice (icterus) develop, i.e. yellow coloring gums, whites of eyes and skin. This is due to the accumulation of bilirubin, one of the breakdown products of hemoglobin.

Diagnosis is usually made by these clinical signs and by CBC results indicating anemia; in this case, red blood cells are often found to be irregularly shaped or stuck together. To confirm the diagnosis, a Coombs test can be performed. The main treatment for any autoimmune disease is corticosteroids. At the beginning of treatment, very high immunosuppressive doses are used to induce remission, and then the dose is slowly reduced over many weeks or months to a low maintenance dose. Most sick animals require lifelong therapy steroids, but the risk of relapse remains.

If steroids alone are not enough, more powerful immunosuppressive drugs can be added: Cytoxan (cyclophosphamide) or Imuran (azathioprine). These are very effective chemotherapy drugs, so the dog should remain under close monitoring due to the possibility of side effects, including the possibility of a decrease in the number of white blood cells in the blood.

In cases that cannot be treated, splenectomy can be recommended - surgical removal of the spleen. The positive effect of this intervention is due to two mechanisms: the dog produces fewer antibodies against red blood cells and the main organ responsible for their destruction is removed. An animal without a spleen can live a completely normal life.

Blood transfusions are rarely used. Adding a foreign protein may actually make the crisis worse by increasing the production of bilirubin and other waste products that the liver must process and suppressing the bone marrow's normal response to anemia. For life-threatening anemia, blood transfusion (after cross-matching) in combination with immunosuppressive therapy is possible.

Immune-mediated thrombocytopenia

Treatment is the same as for AIHA - high doses of corticosteroids and the addition of cyclophosphamide or vincristine if corticosteroids are ineffective. Possible removal of the spleen; however, the surgical risk is higher due to worse blood clotting with IOT. In some cases, transfusion of fresh whole blood or platelet-rich plasma is effective.

The prognosis for AIHA is cautious. With the rapid development of a crisis condition, animals often die before the start of active therapy, while in other cases it is not always possible to achieve remission or maintain it. The prognosis for IOT is usually good, although ovariohysterectomy is recommended once the platelet count has normalized. This reduces the risk of uterine bleeding in case of relapse. Affected males and females should not be used for breeding due to the effects of steroids on the offspring and the risk of hereditary transmission of susceptibility.

Autoimmune skin diseases

Autoimmune skin diseases belong to the group of infrequent or rare diseases. Making a diagnosis can be difficult, especially for a general practitioner who has seen no more than 1-2 cases in his entire career. Diagnosis of such diseases usually requires skin biopsy and immunofluorescence staining, and the prognosis for recovery varies. Corticosteroids are considered the main treatment.

"Pmphigus complex"- a group of four autoimmune skin diseases characterized by the appearance of “vesicles” or “vesicles” (blisters), erosions and ulcers. At pemphigus vulgaris ("pemphigus vulgaris") lesions are usually located in the oral cavity and at the skin-mucosal interface, that is, between the hairy skin and the mucous membrane. These areas include the eyelids, lips, nostrils, anus, prepuce and vulva. Skin lesions in the groin or armpits also occur. The bubbles are thin, fragile and break easily. The skin lesions are described as red, weeping, ulcerated plaques.

And when "pemphigus vegetans" the affected areas are thick, irregular in shape, and proliferate to form vegetative lesions with exudation and pustules. It is believed that this is a benign form of pemphigus vulgaris.

Pemphigus foliaceous– a rare disease that affects the oral cavity or areas at the border of the skin and mucous membranes. Bubbles form briefly; the most common symptoms are redness, crusting, flaking and hair loss. Pemphigus foliaceus typically begins on the face and ears and often spreads to the limbs, footpads, and groin. Secondary skin infections often develop; in severe cases, fever, depression and refusal to feed are possible.

Erythematous pemphigus ("Pemphigus erythematosis") clinically it appears leaf-shaped and often develops on the nose. Ultraviolet radiation aggravates this form of pemphigus and may lead to misdiagnosis solar dermatitis nose (“collie nose”). This form is considered a benign form pemphigus foliaceus. The term “bullous pemphingoid” is similar to the term “pemphigus” (pemphigus), and the clinical course of these diseases is also similar. At the same time, blisters and ulcers of the same type can be found in the oral cavity, at the border of the skin and mucous membranes, in the armpits and in the groin. Differentiation is only possible with the help of a biopsy. Evaluation of the blebs is critical to diagnosis and because they rupture soon after formation, the dog often has to be admitted to the hospital and examined every 2 hours until a biopsy can be obtained.

Left: Pemphigus in a dog.
On the right is Pemphigus in a cat.

Discoid lupus erythematosis is believed to be a benign form of systemic lupus and is autoimmune dermatitis on the face. Most often found in collies and shelties; more than 60% of sick dogs are females. The lesion is often described as a "butterfly silhouette" on the bridge of the nose; it should be differentiated from solar nasal dermatitis and erythematous pemphigus.

Finally, a syndrome similar to Vogt-Koyanagi-Garada syndrome (VKG) is an extremely rare disease, possibly of an autoimmune nature, leading to depigmentation and associated ocular damage. The black pigments of the nose, lips, eyelids, paw pads and anus fade to pink or white, and acute uveitis (inflammation of the eyes) develops. If treatment is started promptly, blindness can be prevented, but lost pigment is usually not restored. As you can see from the above descriptions, many autoimmune diseases have similar manifestations, except for discoid lupus, they do not have a breed, gender or age predisposition.

As with other autoimmune diseases discussed previously, the main goal of treatment is to suppress the body's immune response large doses systemic glucocorticoids. If steroids are ineffective, more powerful drugs such as Cytoxin or Imuran are prescribed.

Gold preparations were proposed for the treatment of diseases from the group of pemphigus or pemphingoid. In cases of nasal depigmentation, tattooing the affected areas helps prevent sunburn and the possible development of squamous cell carcinoma.

The prognosis for discoid lupus is usually good, but can vary for other diseases. Many dogs with ICH are euthanized due to blindness. Breeding sick dogs is not recommended. Currently, there is insufficient information on the heritability of autoimmune skin diseases.

Systemic lupus erythematosus

Systemic lupus erythematosus (SLE) (or simply lupus) is a classic example of a multisystem autoimmune disease. Lupus is often referred to as the “great imitator” because it can present like almost any other disease. Symptoms of SLE can be acute (sudden development) or chronic and usually cyclical. Intermittent fever that does not respond to antibiotics is one of the distinguishing clinical features; another sign is a stiff gait or lameness that moves from one limb to another (polyarthritis, see below). Other possible signs include hemolytic anemia or thrombocytopenia, leukopenia (low white blood cell count), or symmetrical dermatitis, especially on the dorsum of the nose (butterfly-shaped).

In SLE, two other organ systems may be affected. Polymyositis (inflammation of many muscle groups) causes gait changes, muscle wasting, fever and pain, and behavioral changes characteristic of dogs in pain. Inflammation of the glomeruli, the functional units of the kidneys, causes a condition called glomerulonephritis. It leads to loss of protein in the urine and ultimately to kidney failure.

As with the diagnosis of other similar diseases, it is first necessary to do a complete clinical blood test, serum biochemical analysis and urine analysis. The definitive diagnosis of SLE is the determination of antinuclear antibodies (ANA). This method identifies positive cases with greater consistency than older methods, and its results are less affected by time and steroid therapy. Only a few ml are required for analysis. serum, which must be sent to a veterinary laboratory specializing in the analysis of samples from animals.

Therapy is based on the anti-inflammatory and immunosuppressive effects of corticosteroids or more powerful drugs - Cytoxan and Imuran. However, due to the wide variety of lupus manifestations, individualized treatment may be required on a case-by-case basis. If infection develops due to a decrease in white blood cells and immunosuppressive therapy, antibiotics should be prescribed. A low-protein diet can also be used as a maintenance treatment for dogs with kidney dysfunction.

The prognosis for SLE is guarded, especially when complicated by renal disorders. Severe generalized infections of the kidneys (pyelonephritis), joints ( septic arthritis) or blood (septicemia) are usually incurable and develop at a late stage of the disease.

Polyarthritis

Immune-mediated polyarthritis occurs both in SLE described above and independently. This classification includes several different specific diseases, but all the main symptoms are similar. Typical signs include high fever, painful and swollen joints, and limping that moves from one limb to the other. In some cases, increased lymph nodes. In deforming (erosive) arthritis, for example, rheumatoid arthritis (RA), radiography of the joints is informative, but in non-deforming (non-erosive) types it does not show changes. Blood test results may be normal, elevated, or decreased.

In uncomplicated immune-mediated polyarthropathy, remission can be achieved with corticosteroids in approximately half of cases. In the remaining cases, cytotoxin or imuran is prescribed to induce remission, and then steroids are used to maintain it. The prognosis for these diseases, with the exception of rheumatoid arthritis, is usually good. RA is more common in small breeds.

Recently, researchers have begun to explore the possible role of the immune component in many well-known diseases. Endocrine disorders (such as hypothyroidism or diabetes) can be caused by the immune system rejecting hormone-producing cells. Keratoconjunctivitis sicca (KKS or dry eye syndrome), which develops due to the cessation of tear production, can be treated with cyclosporine, which is used to suppress rejection. Chronic active hepatitis(liver disease) may also have an immune basis. In these and many other areas of medicine, research is currently underway to find a possible connection with complex world autoimmune diseases.

Lupus erythematosus is a dermatosis of autoimmune origin in dogs, it is rare and manifests itself in acute and chronic forms. Diagnosis is difficult, upon examination veterinarian reveals erythema and ulcers on the skin. The localization of damage is different; internal organs are involved in the pathological process.

The main signs of the disease

Fibrinoid dystrophy connective tissue considered to be the basis in the pathogenesis of the disease. Lupus erythematosus in dogs is a multisystem autoimmune pathology, characterized by the presence of “hyperprotection” - an abnormal reaction of the animal’s immune system to the body’s own cells.

The disease is rare, but to a large extent this is most likely due to the poor level of diagnosis of systemic lupus erythematosus. Doctors at the DobroVet Center, based on practical observations, say that some dog breeds belong to SLE:

• German Shepherds.
• Afghan hounds.
• English Shepherds.
• Poodles.
• Collie.
• Irish Setters.

It is especially noted that German shepherds have a genetic predisposition to lupus erythematosus, since it is this breed of dog that is registered larger number cases of SLE. The gender and physiological state of the animal does not play a big role in the development of the disease; as a rule, the pathology is diagnosed after 6 years.

Main causes and diagnostic methods

The reasons why lupus erythematosus develops in dogs are not fully understood. There are observations indicating a genetic predisposition (German shepherds), the manifestation of pathology due to improper maintenance of animals (especially homeless ones), with strong exposure to ultraviolet radiation.

Leukemia, fungal and bacterial infections can also cause SLE. All observations by veterinarians indicate a multifactorial pathology.

Discoid lupus erythematosus in dogs, like any autoimmune pathology, is difficult to diagnose; the basis of research includes:

1. Blood and urine analysis.
2. Detailed medical history (first symptoms, how and when they appeared).
3. Kidney research.
4. Examination of the skin, etc.

The following symptoms may suggest that your dog has systemic lupus erythematosus: kidney dysfunction, joint pain, red blood cell breakdown, weakness, skin lesions, low platelet levels.

It is important to remember that a final diagnosis can only be established with genetic testing; until then, SLE can act as a preliminary conclusion.

Symptoms of lupus erythematosus in dogs

Clinical manifestations depend on which antibodies are produced by the body and which area (localization) their action is directed to. Factors that play an important role in the development of symptoms include infectious processes, poor environmental conditions, genetic predisposition, and use of pharmaceuticals.

Damage to the musculoskeletal system:

• Damage to the synovial membranes (tissue lining the joints).
• Painful, swollen joints are a leading sign of lupus in most dogs.
• Unnatural leg positioning, lameness.
• Exhaustion of the animal, muscle pain when walking.

Disruption endocrine system:

1. Sudden formations on the skin.
2. The appearance of symmetrical or one-sided foci of redness.
3. Formation of depigmentation, ulcers, swelling on the skin.

Most breeders do not pay attention to these symptoms and only when the lesions occupy a large area do they contact a veterinarian.

A characteristic symptom indicating lupus erythematosus is ulcers in the nose, mouth and anus that bleed and do not heal well. In advanced cases, the wound area is so extensive and painful that the dog cannot eat, drink, or defecate normally.

Symptoms that pose a threat to the life of the animal:

• Hepatonephromegaly (sharp increase in the volume of the liver and kidneys).
• The presence of antibodies against platelets, leukocytes, erythrocytes.
• Lymphadenopathy.

Other types of damage to organs and systems are often diagnosed, it all depends on what is chosen by lymphocytes as target cells. According to practical observations, one of the classic signs of lupus erythematosus in dogs is sudden nosebleeds.

What to do and how to treat?

Urgent hospitalization is required for a dog if there are signs of blood hemolysis and treatment in this case is complex. At home, it is permissible to carry out therapeutic measures in cases where there are no signs of advanced disease.

No specific treatment has been developed; all methods used depend on which organs and systems are affected.

If joints are affected, painkillers and complete rest are prescribed, which helps stop the development of the pathological process. Limiting exposure to UV rays and prolonged exposure to the sun can worsen the disease.

A diet with a small amount of protein is necessary, since systemic lupus erythematosus almost always affects the kidneys. Immunosuppressants and corticosteroids help relieve inflammation in the lymph nodes.

In any case, ignoring primary signs is unacceptable; independent treatment, especially the use of local drugs for visible skin damage, does not produce results. Almost all therapeutic activities must be carried out in a veterinary clinic, take care of your pets!

Veterinary center "DobroVet"

Laetitia Barlerin

Discoid and disseminated erythematous lupus are two autoimmune diseases with a characteristic clinical picture, different diagnosis and prognosis

The final diagnosis of autoimmune dermatoses is made based on a combination of anamnestic, clinical and additional methods research.

These two nosologies had already been described in humans before they began to be studied in animals. The etymology of the word "Lupus" comes from the typical clinical manifestation on the face of young women (more often susceptible to systemic lupus erythematosus compared to men) in the form of erythema around the eyes, nose and usually around the mouth, which resembles a wolf, but we are not talking about an animal, but about half mask made of velor, which was worn in the 17th and 18th centuries.

discoid erythematous lupus

Discoid erythematous lupus is usually a benign skin disorder and is relatively common in canine dermatology (about 26%). The etiology of this dermatosis is unknown; found in animals, it is of an autoimmune nature. Until now, this disease was considered in humans as one of the variants of systemic lupus erythematosus. But for comparative pathology this is an unsuccessful model, since no similarities are found in the composition of the inflammatory cell infiltrate in animals and humans.

clinical trial

Discoid lupus has been described in many species: humans, dogs, horses, seals, Vietnamese pigs, without the presence of a sex or age predisposition, as found in cats and dogs, but with a predominance of breed characteristics in the latter (Table 1)

Table 1. Main autoimmune dermatoses in dogs, known breed predisposition

• Discoid erythematous lupus
German shepherd, Belgian Shepherd, collie, Breton epagnole, pointer, Siberian sled husky, Shetland sheepdog
• Pemphigus vulgaris
• Pemphigus vegetans
Breed predisposition unknown
• Folia pemphigus
Akita Inu, Chow Chow, Dachshund, Newfoundland, Schipper, German Shepherd, Collie
• Vitiligo
German Shepherd, Belgian Shepherd, Doberman, Rottweiler, Dachshund, Bobtail
• Erythematous pemphigus
German Shepherd, Collie
• Bullous pemphigoid
Collie, Doberman
• Disseminated erythematous lupus
German Shepherd and crossbreeds, Belgian Shepherd, Briard, Bouvier, Setter, Bobtail, Boxer, Spaniel, Beagle, Cocker
• Atrophying articular polychondrid
Tervuren
• Vasculitis
Dachshund, Jack Russell Terrier, Scotch Terrier, Greyhound, Rottweiler
• Alopecia areata
Breed predisposition unknown
• Uveodermoid syndrome
Siberian sled husky, Samoyed husky, Akita inu, chow chow

In dogs, the classic course is manifested in a symmetrical lesion of the facial surface (nose, nose, jowls, periocular area) with depigmentation (nose, nostrils, articulation at the level of the nose and nose) in the form of erythema, skin erosion, crusts, scales and ulcerations. Atypical localization of the lesion is: the pavilion of the ears (with bilateral and erythemal otitis), the vestibule of the oral cavity at the level of the cheeks with ulcerations, erythematous pododermatitis of the four limbs and nasogenital hyperkeratosis (in the Siberian husky), as well as ulcerations and scaly-crustal lesions in the genital area ( scrotum, prepuce, vulva). The lesions are not pruriginous in nature and are not aggravated by insolation (a very important differential diagnostic sign). The skin has an atrophic picture: the clinic can be hidden with only depigmentation of the nostrils or, conversely, can be very pronounced, as for example in dogs with a white coat, deprived of protection against natural insolation. Several cases have been described in cats. The picture of the lesion as a whole was polymorphic. Crusts, ulcerations, sometimes papules, pustules, vesicles predominantly affect the facial surface, ears, neck and can sometimes have a generalized form of the disease. In horses, lesions are observed in the form of alopecia, scaly-cortical, sometimes erythematous and hyperpigmented with topography predominantly at the level of the muzzle, withers and ears.

differential diagnosis

Differential diagnosis is based on dermatoses and, mainly, on those that are responsible for depigmentation of the tip of the nose: vitiligo, oculocutaneous syndrome (in this case, eye lesions), a group of pemphiguses (in particular, erythematous pemphigus), systemic lupus erythematosus, dermatophytoses, leishmaniasis, demodicosis, bacterial folliculitis, contact hypersensitization, reaction to medicines, dermatomyositis, fungoid mycoses, lupus-like dermatoses in a German marriage.

additional research

Histological examination biopsy material skin

Skin analysis must be of high quality. To do this, it is necessary to avoid biopsy in the area of ​​ulceration! It is preferable to use squamous manifestations, scaly-cortical pustules, or “healthy” skin at the periphery of the ulcerations. To facilitate diagnosis, histological analysis of biopsy material should be performed from samples taken from different sites.

The typical histological picture of lupus is the presence of deep dermatitis, manifested as dropsy and lichenoid.

"Deep dermatitis" is observed at the level of the dermoepidermal junction and, more precisely, at the basal part of the epidermis.

"Dropsy" - the cells of the basal layer are subject to degenerative effusion, which can cause detachment at the level of the dermoepidermal junction.

“Lichenoid” (lichenoid or lichen-like) is a lymphoplasmacytic infiltrate controlled at the level of the dermoepidermal junction.

A picture of lack of pigmentation in the superficial layer of the dermis is often observed (macrophages absorb free melanin in the epidermis). In chronic cases, degenerative hydrops of basal keratinocytes and lichenoid infiltrate may be absent, but thickening of the basement membrane in this case is the only element of orientation.

Direct immunofluorescence method

As with other dermatoses of autoimmune origin, results obtained with this technique should be used with caution due to a large number unreliable data. This method makes it possible to detect granule depots and broken lines at the level of the dermoepidermal junction represented by Ig A, Ig M, Ig G and/or active complement.

Indirect immunofluorescence method

Used to detect circulating antinuclear antibodies, which are extremely rare in dogs with discoid lupus and common in cats (3 out of 4 cases). Considering the low titer of antibodies in these animal species, the proposed method does not have high diagnostic value.

disseminated erythematous lupus

Disseminated erythematosus lupus (DEL) or systemic lupus erythematosus is primarily considered an autoimmune dermatosis. Unlike pemphigus and discoid lupus cutaneous manifestation in this disease, it may be the only form of its manifestation in relation to other symptoms with a characteristic absence of a clinical picture; it can also be polymorphic in nature: a systemic and autoimmune disorder (formation of autoantibodies against the main composition of cells), affecting most tissues and organs. For a long time it was believed that DEV is relatively rare disease in humans, and today the frequency of this disease is increasing. For example, in the USA, 50,000 new cases are added to the already known population of patients every year, and it has been established that 1,000,000 individuals with this pathology are currently being monitored. It remains to be seen whether this is a trend towards a real explosion of this disease or is associated with a high level of diagnosis.

DEV is widely known but not well documented in cats, horses, monkeys, and some snakes and iguanas. DEV was first described in dogs by Lewis, Schwartz and Henry in 1965. Canine DEV currently represents a model for the study of this disease in humans, and for 20 years now the veterinary school in Lyon has been studying spontaneous cases of this nosology in lines of dogs suffering from lupus. Luk Shaban (Immunopathology Laboratory, ENVL) presented a summary of data relevant to canine lupus, where he talks about the misconception of the need for long-term follow-up to make a diagnosis that is “late”: the disease is not identified and, as a result, is not curable!

Table 2. Clinical symptoms for DEV in dogs (Fournelle, Chaban, Cox et al. 1992)

• Fever...................................100%
• Non-erosive polyarthritis...................91%
• Mucocutaneous lesions................60%
• Ulcers of the buccal mucosa........................10%
• Kidney damage........................65%
• Blood disorders........................60%

• Hemolytic anemia...................13%
• Thrombopenia........................4%
• Leukocytosis.............................30%
• Leukopenia........................ .20%
• Lymphopenia........................10%

Other clinical manifestations............50%

• Polyadenomegaly and splenomegaly
• Polymyositis
• Polyneuritis
• Pleurisy
• Pericarditis...............................<10%
• Chronic pneumonia
• Damage to the central nervous system

clinical trial

Affected populations

DEV predominantly affects German Shepherds (about 50% of cases), German Shepherd mixes, and more often males (in humans, it has been shown in 40 years of studies that women are more likely to develop DEV). Small or obese dog breeds do not appear to be affected by DEV. (Table 1) DEV is observed at the age of 5 to 6 years, ranging from 6 months (cases of this disease in the youngest individuals are reliable) to 13 years. Currently, DEV is diagnosed at an earlier age (without the manifestation of the first clinical symptoms), which indicates a high level of knowledge and diagnosis of this nosology.

Symptoms

Skin symptoms

According to Luc Shaban, the symptoms of DEV are not decisive, even if they are detected in 60% of cases. The symptoms of skin pathology are relatively variable, unless, of course, we talk about the lesions that are characteristic of lupus.

The topography of the lesions is probably the only element that is considered in relation to this category of dermatoses. This is due to the areas of the skin that had the greatest exposure or sensitivity to ultraviolet radiation:

Facial surface (nose, tip of the nose, eyes, ear pavilions and jowls) - lesions similar to the clinical picture of discoid lupus;

Areas of thin skin and weak hair cover (ventral abdominal wall, armpits, groin) and in the dorsal region of the metacarpal and carpal joints: erythema due to increased insolation, localized or diffuse alopecia, pruriginous erythema-squamous plaques, and also, to a greater or lesser extent degree, the presence of crusts or ulcerations. Animals like to lie on their backs in the sun and, as a result, have skin disorders in the ventral part of the body surface. Lesions of the mucous membrane in the vestibule of the oral cavity with ulcerations in the cheeks, mouth (gums, tongue, palate) and pharynx are the least common (about 10%), but their manifestations are a convincing argument for making a diagnosis. Finally, in the case of skin lesions, the hypothesis of the presence of DEV will be based on the location of the lesions and their association with other non-cutaneous symptoms.

Non-cutaneous symptoms

General violations. Hyperthermia, as a stable symptom, is characterized by a graphic image of saw-tooth teeth and a fibril peak exceeding a temperature of 40°. The general condition gradually worsens, often with secondary complications in the form of polyarthritis or kidney damage, as well as cachexia and amyotrophy occurring on the limbs and sometimes on the head, giving the animal a specific picture of the facial surface.

Joint damage. This is an important symptom, because this complication occurs in 100% of cases and manifests itself early. The animal suffers from non-erosive polyarthritis (not detected by radiographic examination), localized on the limbs and/or in the spinal cord. There is early atrophy in the dorsolumbar and gluteal muscle groups with the presence of pain when moving (lameness, difficulty getting up and refusal to jump or climb stairs). IN late stage diseases of the joints of the limbs can be deformed with a tendency to plantigrady and curvature of the axis of the joints; and, as the most rare occurrence, their increase. The presence of temporo-mandibular disorders with masetter malnutrition is also often noted. Inflammation of the joints is both generalized and local in nature, occurring subclinically between crises. Forced extension and flexion of the joints with gradual intensification is a good way to detect mild pain, which should not be neglected.

Kidney damage. This is the second important clinical symptom (65% of cases), even if it is not always easy to identify. Marked on initial stage its development with the formation of glomerulonephritis (proteinuria exceeds 0.5 g/l or the presence of microscopic hematuria) and with the subsequent risk of developing renal failure, leading to the death of the patient. Therefore, analysis of urine and sediment after centrifugation should be regular.

Blood test. Carried out in 60% of cases. It requires determination of a hemogram, as additional clinical examination can rarely indicate this form of complication, with the exception of the presence of anemia and severe peripheral thrombocytopenia. Violations are of various types. The most rare combination of symptoms is hemolytic anemia, leukocytosis, leukopenia, lymphopenia (these anomalies are rare, but quite symptomatic) and thrombopenia (the most common change in all platelets without clinical manifestation).

Polyadenomegia and splenomegaly are observed in 50% of cases; puncture biopsy of the ganglia provides the detection of eosinophilic adenitis.

Other symptoms. They are less common and may be subclinical in nature.

Pleurisy, pericarditis: with rapidly occurring serositis in humans, also observed in cats;

Disturbance of the central nervous system: in humanitarian medicine it is the main symptom when treating a patient (violation of the general condition, convulsions). It is much more difficult to assess in animals.

Hemorrhagic gastroenteritis.

Lupus disease has a specific manifestation pattern, and the diagnosis is always difficult. Identification is based on the initial stage of development of this disease and the interruption of periods of remission, both primary (if hemolytic anemia or piroplasmosis is suspected) and secondary, caused by symptomatic treatment (prescription of corticoids). In addition, the clinical picture is polymorphic. Symptoms do not appear all at once. They change from the beginning of one phase of the disease to another, therefore, in the first stage of development it is very easy to miss this diagnosis. The longer the disease process, the more likely it is to detect a combination of several clinical symptoms.

In conclusion, it should be said that additional research methods are required to substantiate the reliability of the diagnosis of an autoimmune disease.

additional research methods

Non-specific research methods

A general biochemical analysis includes calculating the blood count and determining the quantitative content of platelets. This is the first thing to do, because blood disorders can occur subclinically. Sometimes lymphopenia can be severe (less than 1000 lymphocytes per mm3), which is one of the symptoms of this disease. Biochemical blood tests and urine tests allow us to assess the functional state of the kidneys. Histological examination provides analysis of the skin if these symptoms predominate and are similar to those of discoid lupus. It is also necessary to take a biopsy of synovial fluid or kidney.

Immunological disorders

Serum antinuclear antibodies (sANAT).

Their presence is determined in 100% of cases of the disease. In all animal species, this parameter is relevant as a test for the detection of DEV.

The total content of antinuclear antibodies circulating in the body, considered as the main cause of the disease, forms a depot of immune complexes in various tissues. The indirect immunofluorescence method makes it possible to detect them in the serum of patients. An antigen is nuclear material obtained from various substrates: leukocytes in mouse blood smears, hepatocytes in a mouse liver section, most often - human carcinoma cell cultures.

Tests should be considered positive if the target cells have a different fluorescence pattern. Despite the use of this method for diagnosing sANAT, it is not pathognomonic for this pathology, since these antibodies are also found in other diseases. In the case of DEV, their titer is increased (more than 256), mainly during the period of unfavorable development of the disease.

The typing and specificity of sANAT indicate that this is not a homogeneous group, since the target antigens - components of the cell nucleus - vary (DNA, proteins, nucleoplasm components, etc.). Detection of nuclear antigens of specific ANAT requires a higher level of laboratory research technique than determination of the total content of all ANAT. The method today is not an integral part of routine laboratory testing in veterinary medicine, but the results of which should not be neglected.

Native Anti-DNA antibodies have high specificity for lupus in humans (controlled in 80% of patients and only with this disorder), but have not been detected in dogs.

Antihistone antibodies (proteins surrounding DNA strands) have been found at similar frequencies in canine and human lupus (30-70%). The plate titration technique is very sensitive but poorly specific. In addition, antihistone antibodies may be present in other diseases, such as leishmaniasis, and, naturally, subsequently constitute a problem in differential diagnosis.

Antibodies against soluble antigens or ATRA (extractable nuclear antigens) are antibodies directed against elements of the nucleoplasm (and in small quantities against chromatin molecules). Among them, anti-Sm about 16% is detected in dogs suffering from lupus, while their detection in humans with this disease is 70%. Currently, they have very high specificity in two species and, therefore, can be markers for this disease. Also of interest are anti-type 1 or T1 (20% in dogs) and in small quantities anti-type 2 or T2 (9%), which are absent in humans and have been found in dogs with lupus.

Other autoantibodies

The search for rheumatoid factors is of little interest for the diagnosis of DEV, while a positive direct Coombs test confirming the presence of antibodies detected by red blood cells would perhaps be an additional argument, but is not so necessary. As a result, only 17% of dogs with lupus have this response: less than 30% of cases have autoimmune hemolytic anemias that may be associated with the disease. The direct immunofluorescence method of a skin sample gives similar results with the same diagnostic assessment in discoid lupus,

The proposed method is used in the analysis of kidney biopsies with a positive result in the case of glomerulonephritis in lupus disease.

T lymphocytes

With DEV, lymphopenia can be detected, usually in the active phase of the disease. It was found that in humans and dogs we are talking about one characteristic feature associated with a sharp decrease in the population of T-suppressor lymphocytes and, more precisely, CD8+ cells. These cells have a suppressive and cytotoxic effect and regulate the immune response in the body. Their small number indicates DEV disease. Shaban and colleagues believe that quantification of the suppressor T lymphocyte population can be not only a diagnostic assessment, but also prognostic when paralleled with a control study of the latter during the treatment of dogs suffering from lupus, as they observed a positive correlation between the number of T/CD lymphocytes 8+ and ongoing treatment.

Other immunological abnormalities

Other avenues of investigation are also important in humane medicine, and abnormalities related to complement, cytokines (immune system mediators of inflammation) and other immune cells in DEV have not been sufficiently studied in dogs to be used to diagnose DEV.

diagnostic guide

basics of the clinic

A clinical study consists of a thorough search for characteristic symptoms (pain in joints during manipulation, examination of the skin, detection of skin lesions on the abdominal surface, etc.), and collection of anamnesis data (changes in symptoms over time), which is an important step for additional methods research. Suspicion of lupus disease directs us to conduct additional nonspecific (leukoformula, thrombogram, urine analysis) and specific research methods. In this case, you should start by detecting ANAT (all), then search for specific indicators.

using the macaw model

Currently, to diagnose DEV in a dog, they use the method used in humane medicine, developed by the American Rheumatology Association (ARA). (see table 3). The table contains clinical symptoms borrowed from the APA and adapted for diagnosing DEV in dogs.

Table 3. Diagnostic criteria for DEV in dogs (adapted APA criteria) (Chaban, Fornel Monnier, 1995)

Criteria	Definitions
	Erythema is observed in the region of thin and poorly protected areas of the skin (facial surface)
Discoid lupus	Depigmentation, erythema, erosion, ulceration, crusts and scales, affecting mainly the facial surface (tip of the nose, nose and lips, periocular area)
Photosensitivity	Worsening of skin lesions depending on time spent in the sun
Ulcerations in the cheek area	Ulcerations in the mouth and throat
	Non-deforming arthritis is observed in two or more joints characterized by pain during movement (flexion, extension), inflammation, effusion or periarticular infiltration, not often controlled
Serous inflammation	Pleurisy, aseptic pericarditis
Renal dysfunction	Persistent proteinuria of three crosses or more, 0.5 g/l, casts, microscopic hematuria or hemoglobinuria.
Central nervous system disorder	In the absence of good anticonvulsant treatment or in case of metabolic disorders (uremia, ketosis or electrolyte imbalance): a) convulsions b) changes in general condition
Hematological changes	a) hemolytic anemia with reticulocytosis b) leukopenia (less than 3000 per mm 3) more or less than 2 tests c) lipopenia (less than 1000 per mm 3) d) tropopenia (less than 100,000 per mm 3) in the absence of treatment
Immunological disorder	a) presence of antihistone antibodies b) presence of anti-Sm antibodies c) presence of anti-type 1 antibodies
Antinuclear antibodies	Titer of antinuclear antibodies detected by immunofluorescence or another method (in the absence of treatment that can cause their formation)

Confidence in the diagnosis can be based on the comparability of at least four symptoms in the process of evolution of a given nosology (even if they do not have simultaneous manifestations), taking into account the presence of ANA-t - a mandatory criterion. The presence of two criteria gives the right to suspect DEV and make assumptions if three criteria are found.

differential diagnosis

The polymorphism of lupus and the “blurring” of the clinical picture over time is complemented by clinical symptoms, which extremely complicates the differential diagnosis due to symptoms similar to DEV (joint pain, skin disorders), which requires excluding the presence of discoid lupus erythematosus, etc. Differential diagnosis is very difficult in relation to a disease such as leishmaniasis, in which there is also a disorder of the immune system, including the circulation of immune complexes, which are deposited in sibling organs. Pathogenesis, clinical picture, as well as the presence of ANAT are characteristic of this nosology. If there is doubt about evidence of DEV, the presence of leishmania must be excluded. It is necessary to take into account the geographical distribution of leishmaniasis.

lupus prognosis

Discoid lupus has a favorable prognosis if correct treatment is carried out and exposure to insolation is excluded. An unfavorable prognosis for DEV is in the case of a late stage of the disease, in association with renal pathology. In this case we are talking about euthanasia.

A favorable outcome can be achieved when treated at an early stage of the disease, with the absence or presence of moderate kidney pathology (the initial stage of development of glomerulonephritis). Remission can be achieved by prescribing immunosuppressants (Azathioprine, Cyclophosphamide...) or even better when combined with an immunoregulator (Levamisole) associated with corticosteroids (Table 4). In this case, biological control is necessary. If the ANAT titer has a correlation with the severity of the disease, then the qualitative composition of ANAT and the decline in titer have a long period, without the presence of carelation signs. Changes in the TCD8+ lymphocyte population according to Luc Chaban are the most qualitative criterion (during the period of remission their number increases to more than 200 cells/mm 3). Thanks to the use of monoclonal antibodies and lymphocyte typing, this is now possible. If reliable research data is obtained, this method can be used in veterinary medicine.

Table 4. Treatment of DEV (Shaban 1997)

Induction: Prednisone: 1-2 mg/kg/day orally, then the dose is reduced over one to two months until complete cessation. + Levamisole (SOLASKIL ND): 3-7 mg/kg orally once every two days for 4 months.

Error: Levamisole 3-7 mg/kg orally once every two days for 4 months.

Note: Monitor for neutropenia.