№3-2014

Autoimmune diseases (continued)

Beginning in №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 region, on the lips, on the auricles, on the genitals. In this case, the nose is usually depigmented. The general condition of dogs with this disease does not change. Among the predisposed breeds are the Scottish Shepherd, German Shepherd, Siberian Husky. Differential diagnoses include mucocutaneous pyoderma, pemphigus, erythema multiforme, lymphoma, nasal solar dermatitis, nasal depigmentation, drug reactions, uveodermatological syndrome, contact dermatitis, and systemic lupus erythematosus. It is considered to be an extremely rare disease in cats, clinically manifested by lesions on the auricles and on the front of the head in the form of peeling, crusting and alopecia. The point of view of the authors in different sources is commonplace, since there are opinions that the diagnosis of discoid lupus erythematosus in the described cases in cats can be ambiguous.

Establishing diagnosis

Diagnosis is based on history, clinical examination, response to proposed therapy, and histological findings. Characteristic histological changes in discoid lupus erythematosus were previously considered 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 no clinical or histological differences between discoid lupus erythematosus and pyoderma of the mucocutaneous zones. In this regard, there is a recommendation according to which it is proposed to use the antibiotic of first choice in dermatological doses as a trial therapy. This, in turn, can make it possible to differentiate one problem from another.

Therapy

At the initial stage, cephalexin in doses of 22-30 mg / kg / 12 hours, for 30 days, can be chosen as therapy. 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, in the absence of a response, after 60 days locally - 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 canceled over several months to the minimum effective dose.

Clinical case of discoid lupus erythematosus from our practice

A 7-year-old male mixed breed of dog was admitted to our clinic. From the anamnesis, it appeared that within a few 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, discoid lupus erythematosus.

As an initial therapy, cephalexin in the accepted doses was proposed, but there was no effect after a few weeks of using the drug, moreover, we noted the negative dynamics of 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 culture, which confirmed the sensitivity of the microflora to this antibiotic. We took material for histological examination and, until the results were obtained, we prescribed local therapy with 0.1% tacrolimus. At the same time, 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, given the trend towards the development of clinical signs, introduced cyclosporine at doses of 10 mg/kg/day into the regimen at the same time. This combination quickly brought the patient into remission (photos 11-12). To date, we are reducing the frequency of giving cyclosporine, conducting further monitoring of the patient.

Conclusions:

The history, physical examination, primary dermatological tests, and especially biopsy are important for making a diagnosis in the presence of autoimmune diseases.
The results of a biopsy may not always be useful for making a diagnosis: in some cases, due to incorrect biopsy taking, in some cases, due to objective reasons (features of the histopathological picture).
Trial therapy, thought out and as safe as possible for the patient, can also be a good guide on the way 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), one 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, dogs can get lupus. 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 wide variety of self antigens. Too unclear? In other words, it is a disease in which the body's immune system becomes "hyper-protective", 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 synovial membrane of the articular capsules, in the skin and blood vessels. In some cases, antibodies may appear that specifically attack certain blood cells. It happens somewhat less often that the attacked macrophages, leukocytes, basophils, etc., simultaneously attack the vascular walls, other cells and tissues of the body.

Systemic lupus erythematosus in dogs is rare, but is thought 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 tend to think that lupus can be called a hereditary disease of German Shepherds to a certain extent, since their population is especially susceptible to this pathology. As a rule, the disease develops at the age of six years. Gender and physiological state of the animal do not play a role.

Symptoms and affected systems

Thus, the symptoms of lupus in dogs depend both on the type of antibodies produced and on 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 the synovial membranes (soft tissue lining the inner surfaces in the joints).

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

Lameness, unnatural position of the legs.

Pain in the muscles, gradual exhaustion of the animal.

Less often you can see the response from the skin and the endocrine system of the body. Clinical signs in this case are as follows:

Deposition of immune complexes in the skin.

Skin lesions that occur for no apparent reason, suddenly. They are symmetrical or unilateral: redness, swelling, ulcers, depigmentation and / or hair loss. Unfortunately, not all breeders pay attention to these signs.

A very characteristic symptom are ulcers both on the skin and on all visible mucous membranes. A lot of damage near the mouth, nose (pictured), anus. In some cases, the ulcers are so extensive and severe that the dog cannot 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.

A sudden lesion of other organs and tissues can be diagnosed, and this depends solely on what kind of “target” the lymphocytes choose for themselves.

Note that the classic symptom of this condition in dogs is frequent, sudden nosebleeds. Often they appear even before skin lesions.

What causes it and how is it diagnosed?

Until now, the cause of lupus erythematosus in dogs has not been unequivocally determined. Scientists suggest that in most cases this pathology is genetically determined, since in the same German shepherds (which we have already written about), lupus is very common throughout the entire population.

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

In particular, American veterinarians were able to achieve something similar by keeping experimental animals on a diet with a small amount 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 not help the treatment anyway, and you will waste time).

Immediately, we note that discoid lupus in dogs (like other autoimmune diseases) is difficult to diagnose. A complete blood count is required, a biochemical study is performed, and a urine test is done. You need to tell the veterinarian when the clinical signs began to appear, what preceded them, and how sudden the onset of the disease was. Joint pain, kidney problems, skin lesions, breakdown of red blood cells, low platelet counts, and general weakness are signs that suggest lupus.

But here it should be mentioned that the final diagnosis can only be made on the basis of a professional genetic examination. "By eye" the presence or absence of such a specific disease can never be judged.

Therapeutic methods

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

So, when the dog's joints hurt and collapse, he is prescribed painkillers, complete rest is recommended. This approach will help slow down the development of the disease and prevent further destruction of the articular 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 walk with your pet only 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 body tissues. Be that as it may, only a veterinarian should deal with their appointment.

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

Causes and symptoms

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

The first sign of lupus is frequent nosebleeds. In the future, 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 there is an active destruction of connective tissues, the joints are affected first of all - 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 should examine the dog's medical history, familiarize himself with all the symptoms and order the necessary tests.

The spleen and other parts of the immune system strive to rid the body of old, diseased, or damaged red blood cells, which is 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 shows outward signs of the disease.

The clinical signs of AIHA usually develop gradually and progress, but sometimes an apparently healthy animal has a sudden decline and an acute hemolytic crisis. Symptoms are usually associated with a lack of oxygen: weakness, severe lethargy, lack of appetite, increased heart rate and breathing. Heart murmurs and pallor of the mucous membranes (gums, eyelids, etc.) are possible. More severe cases develop fever and jaundice (icterus), which is a yellow discoloration of the gums, whites of the 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 features and by the results of a clinical blood test indicating anemia; at the same time, erythrocytes of irregular shape or stuck together are often found. To confirm the diagnosis, a Coombs reaction can be performed. Corticosteroids are the primary treatment for any autoimmune disease. Initially, 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 affected animals require lifelong steroid therapy, and the risk of relapse remains.

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

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

Blood transfusion is rarely used. The addition of a foreign protein can actually exacerbate the crisis by increasing the production of bilirubin and other waste products for the liver to process and by suppressing the bone marrow's normal response to anemia. For life-threatening anemia, blood transfusion (after cross-matching) is possible in combination with immunosuppressive therapy.

Immune-mediated thrombocytopenia

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

The prognosis for AIHA is poor. With a lightning-fast development of a crisis state, animals often die before the start of active therapy, while in other cases it is not always possible to achieve remission or maintain it. With IOT, the prognosis is usually good, although ovariohysterectomy is recommended after the platelet count has returned to normal. This reduces the risk of uterine bleeding in the event of a relapse. Affected dogs and bitches should not be bred due to the effects of steroids on offspring and the risk of hereditary transmission of susceptibility.

Autoimmune skin diseases

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

"The Pemphigus 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 border of the skin and mucous membranes, 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, brittle and break easily. Skin lesions are described as red, weeping, ulcerated plaques.

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

Pemphigus foliaceous ("Pemphigus foliaceous")- a rare disease that affects the oral cavity or areas on the border of the skin and mucous membranes. Bubbles form briefly; The most common symptoms are redness, crusting, peeling and hair loss. Pemphigus foliaceus usually begins on the face and ears and often spreads to the limbs, paw pads, and groin. Secondary skin infections often develop, and in severe cases, fever, depression, and refusal to feed may occur.

Erythematous pemphigus ("Pemphigus erythematosis") clinically appears as foliate and often develops on the nose. Ultraviolet radiation exacerbates this form of pemphigus and can lead to a misdiagnosis of nasal solar dermatitis ("collie nose"). This form is considered to be a benign form of pemphigus foliaceus. The term "bullous pemphingoid" is similar to the term "pemphigus" (pemphigus), and these diseases are also similar in clinical course. At the same time, vesicles 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 possible only with the help of a biopsy. Evaluation of the vesicles is critical to making a 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 an autoimmune dermatitis on the face. Most common in collies and shelties; more than 60% of affected dogs are females. Often the lesion is described as a "butterfly silhouette" on the bridge of the nose; it must be differentiated from nasal solar dermatitis and pemphigus erythematosus.

Finally, a syndrome similar to Vogt-Koyanagi-Garada syndrome (VCG) is an extremely rare disease, possibly of an autoimmune nature, leading to depigmentation and concomitant eye damage. The black pigments of the nose, lips, eyelids, paw pads, and anus turn pale to pink or white, and acute uveitis (eye inflammation) develops. If treated early, blindness can be prevented, but lost pigment usually does not come back. As you can see from the above descriptions, many autoimmune diseases have similar manifestations, except for discoid lupus, they do not have a breed, sex or age predisposition.

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

For the treatment of diseases from the group of pemphigus or pemphingoid, preparations of gold have been proposed. In the case of depigmentation of the nose, tattooing the affected areas helps prevent sunburn and the possible development of squamous cell carcinoma.

The prognosis for discoid lupus is usually good, but may vary for other conditions. Many dogs with VCH are euthanized due to blindness. Breeding sick dogs is not recommended. There is currently 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 almost like any other disease. The symptoms of SLE can be acute (sudden onset) or chronic and are usually cyclical. Unsustainable fever refractory to antibiotics is one of the hallmark clinical features; another sign is a stiff gait or lameness, passing 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 bridge of the nose (butterfly-shaped).

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

As with the diagnosis of other similar diseases, first of all it is necessary to do a complete clinical blood test, a biochemical analysis of the serum and a urine test. The method of definitive diagnosis of SLE is the determination of antinuclear antibodies (ANA). This method detects positive cases more consistently 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 specialized in the analysis of animal samples.

Therapy is based on the anti-inflammatory and immunosuppressive action of corticosteroids or more powerful drugs - Cytoxan and Imuran. However, due to the wide variety of manifestations of lupus, individual therapy may be required in each case. If an 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 maintenance treatment for a dog with kidney dysfunction.

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

Polyarthritis

Immune-mediated polyarthritis occurs both in the SLE described above and independently. This classification includes several different specific diseaseshowever, all the main symptoms are similar. Typical signs include high fever, soreness and swelling of the joints, and lameness that shifts from one limb to another. In some cases, enlarged lymph nodes are found. In deforming (erosive) arthritis, such as rheumatoid arthritis (RA), an X-ray of the joints is informative, but in non-deforming (non-erosive) types, it does not show changes. Blood test values can be normal, high, or low.

In uncomplicated immune-mediated polyarthropathies, about half of the cases can be achieved with corticosteroids in remission. In the remaining cases, cytoxin 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 generally 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 mellitus) can be caused by the rejection of hormone-forming cells by the immune system. Keratoconjunctivitis sicca (KCM or dry eye syndrome) due to a cessation of tear production is treatable with cyclosporine, which is used to suppress rejection. Chronic active hepatitis (liver disease) can also have an immune basis. These and many other areas of medicine are currently being researched for possible links to the complex world of autoimmune disease.

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

The main signs of the manifestation of the disease

Fibrinoid dystrophy of the connective tissue is considered 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 its own body cells.

The disease is rare, but to a greater extent this is due to the poor level of diagnosis of systemic lupus erythematosus. Doctors of the DobroVet EC, based on practical observations, speak about the belonging of some dog breeds 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 in this breed of dogs that a greater number of cases of SLE are recorded. The sex 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.

The main causes and methods of diagnosis

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

Leukemia, fungal and bacterial infections can also cause SLE. All observations of veterinarians indicate the multifactorial nature of the pathology.

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

Analysis of blood and urine.
Detailed history (first symptoms, how and when they appeared).
Study of the kidneys.
Inspection of the skin, etc.

The following symptoms suggest systemic lupus erythematosus in a dog: impaired kidney function, joint pain, breakdown of red blood cells, weakness, skin lesions, low platelet count.

It is important to remember that a definitive diagnosis can only be made through genetic testing, until then SLE can act as a preliminary finding.

Symptoms of lupus erythematosus in dogs

Clinical manifestations depend on which antibodies are produced by the body and on which area (localization) their action is directed. An important role in the course of signs is played by factors: infectious processes, environmentally poor conditions, genetic predisposition, taking pharmaceuticals.

Damage to the musculoskeletal system:

Damage to the synovial membranes (the tissue that lines the joints).
Swollen joint tenderness is the leading symptom of lupus erythematosus in most dogs.
Unnatural positioning of the legs, lameness.
Exhaustion of the animal, pain in the muscles when walking.

Disruption of the endocrine system:

Sudden formations on the skin.
The appearance of symmetrical or unilateral foci of redness.
The formation of depigmentation, ulcers, swelling on the skin.

Most breeders do not pay attention to these symptoms and only when the lesions cover a large area turn to the veterinarian.

A characteristic symptom indicating lupus erythematosus is ulcers in the nose, mouth and anus, bleeding and poorly healing. In advanced cases, the area of the wound is so extensive and painful that the dog cannot eat, drink, or defecate normally.

Symptoms that threaten the life of the animal:

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

Other types of lesions of organs and systems are often diagnosed, it all depends on what will be 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 difficult. At home, it is permissible to carry out therapeutic measures in cases where there are no signs of an advanced disease.

Specific treatment has not been developed, all methods used depend on which organs and systems are affected.

When the joints are affected, painkillers are prescribed, complete rest, which helps to stop the development of the pathological process. Limiting exposure to UV rays, prolonged exposure to the sun can provoke an aggravation of the disease.

A diet low in protein is essential as systemic lupus erythematosus almost always affects the kidneys. Immunosuppressants, corticosteroids help relieve inflammation in the lymph nodes.

In any case, ignoring the primary signs is unacceptable, self-treatment, especially the use of local preparations for visible skin lesions, does not give results. Almost all therapeutic measures should be carried out in a veterinary clinic, take care of your pets!

Veterinary center "DobroVet"

Letitia Barlerin

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

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

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

discoid lupus erythematosus

Discoid lupus erythematosus is a generally benign skin disorder and is relatively common in canine dermatology (about 26%). The etiology of this dermatosis is unknown, found in animals it has an autoimmune nature. Until now, this disease has been considered in humans as one of the variants of systemic lupus erythematosus. But for comparative pathology, this is an unsuccessful model, since they do not find similarities in the composition of the inflammatory cell infiltrate in animals and humans.

clinical trial

Discoid lupus has been described in many species: human, dog, horse, seal, Vietnamese pig, without predisposition of sex or age, as found in cats and dogs, but with a predominance of breed characteristics in the latter (Table 1)

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

Discoid lupus erythematosus

Vulgar pemphigus

Vegetative pemphigus

foliaceous pemphigus

Vitiligo

Erythematous pemphigus

bullous pemphigoid

Disseminated lupus erythematosus

Atrophic articular polychondrid

Vasculitis

Alopecia areata

Uveodermoid syndrome

In dogs, the classic course manifests itself in a symmetrical lesion of the facial surface (nose, nostril, jowls, periocular region) with depigmentation (nose, nostrils, articulation at the level of the lobule and nose) in the form of erythema, skin erosion, crusts, scales and ulcerations. Atypical localization of the lesion is: pavilion of the auricles (with bilateral and erythemal otitis media), oral vestibule at the level of the cheeks with ulceration, erythematous pododermatitis of four limbs and nasogenital hyperkeratosis (in the Siberian husky), as well as ulceration and scaly-crustal lesions in the genital area ( scrotum, prepuce, vulva). The lesions are not pruriginous and are not aggravated by sun exposure (a very important differential diagnostic sign). The skin has an atrophic picture: the clinic can proceed hidden with the presence of only depigmentation of the nostrils, or, conversely, it 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 had a polymorphic character. Crusts, ulcerations, sometimes papules, pustules, vesicles predominantly affect the facial surface, ears, neck and may sometimes have a generalized form of the disease. In horses, lesions are alopecia, scaly-crustal, 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 responsible for the depigmentation of the nasal tip: vitiligo, oculocutaneous syndrome (in this case, eye lesions), a group of pemphigus (in particular, erythematous pemphigus), systemic lupus erythematosus, dermatophytosis, leishmaniasis, demodicosis, bacterial folliculitis, contact hypersensitivity, drug reaction, dermatomyositis, fungoid mycoses, lupus dermatoses in a German marriage.

additional research

Histological examination of biopsy material of the skin

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

A typical histological picture of lupus is the presence of deep dermatitis, manifested in the form 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 exposed to a degenerative effusion that can cause detachment at the level of the dermoepidermal junction.

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

Often there is a picture of the absence of pigmentation in the surface layer of the dermis (macrophages absorb free melanin in the epidermis). In a chronic course, degenerative dropsy 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, the results obtained with this technique are used with caution due to the large amount of unreliable data. This method allows you to detect a depot of granules and dashed 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 affected by discoid lupus and are common in cats (3 out of 4). Given the low titer of antibodies in these animal species, the proposed method does not have a high diagnostic value.

disseminated lupus erythematosus

Disseminated lupus erythematosus (DEV) or systemic lupus erythematosus is primarily considered an autoimmune dermatosis. Unlike pemphigus and discoid lupus, the skin manifestation in this disease may be the only form of its manifestation in relation to other symptoms with a characteristic absence of a clinical picture; it may also have a polymorphic character: a systemic and autoimmune disorder (the formation of autoantibodies against the main composition of cells), affecting while most tissues and organs. It has long been believed that DEV is a 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 under control. 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 the dog by Lewis, Schwartz and Henry in 1965. Canine DEV is currently a model for the study of this disease in humans, and for 20 years the veterinary school in the city of Lyon has been studying spontaneous cases of this nosology in lines of dogs suffering from lupus. Luc Shaban (Laboratory of Immunopathology, ENVL) presented generalized data that is relevant for canine lupus, where he talks about the fallacy of the need for long-term follow-up for a diagnosis that is "overdue": the disease is not identified and, as a result, it is not curable!

Table 2. Clinical signs of DEV in dogs (Fournell, Shaban, Cox et al. 1992)

Fever................................... .100%
Non-erosive polyarthritis .............. .91%
Mucocutaneous lesion ................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), a mixture of German Shepherds and more often males (in humans, it has been shown over 40 years of studies that women are more likely to get DEV). Dog breeds that are small or obese do not appear to be affected by DEV. (Table 1) DEV is noted 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 Chaban, the symptoms of DEV are not defining, even if they are detected in 60% of cases. The symptomatology of skin pathology is 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 highest exposure or sensitivity to ultraviolet radiation:

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

Areas of thin skin and light coat (ventral abdominal wall, armpits, groin) and dorsal metacarpal and carpal joints: erythema due to increased insolation, localized or diffuse alopecia, pruriginous erythematous-squamous plaques, and also, to a greater or lesser extent degree, the presence of crusts or ulceration. Animals like to lie on their backs under the sun and, as a result, have violations of the skin in the ventral part of the body surface. Mucosal lesions in the vestibule of the oral cavity with ulceration 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 skin lesions, the hypothesis of DEV will be based on the location of the lesions and their association with other non-cutaneous symptoms.

Non-skin symptoms

General violations. Hyperthermia, as a stable symptom, is characterized by a graphic representation of teeth in the form of a saw 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 dorsal and gluteal muscle groups with pain during movement (lameness, difficulty in lifting and refusal to jump or while climbing stairs). In the late stage of the disease, the joints of the extremities may be deformed with a tendency to plantigrade and curvature of the axis of the joints; and as the most rare - their increase. Also, the presence of a temporo-mandibular disorder with hypotrophy of the masetters is often noted. Inflammation of the joints is both generalized and local in nature, proceeding subclinically between crises. Forced extension and flexion of the joints with gradual increase 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. It is noted at the initial stage of its development with the formation of glomerulonephritis (proteinuria exceeds 0.5 g / l or the presence of microscopic hematuria) and with a subsequent risk of developing renal failure, leading to the death of the patient. Therefore, the analysis of urine and sediment, after centrifugation, should be regular.

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

Polyadenomegaly and splenomegaly are observed in 50% of cases, a puncture biopsy of the ganglia provides the detection of eosinophilic adenitis.

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

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

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

Hemorrhagic gastroenteritis.

Lupus disease has a specific manifestation, the diagnosis is always difficult. Identification is based on the initial stage of the 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 development 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 in order to substantiate the reliability of the diagnosis of an autoimmune disease, additional research methods are required.

additional research methods

Non-specific research methods

General biochemical analysis includes counting the blood formula and determining the quantitative content of platelets. This is the first thing to do, because blood disorders can be subclinical. Sometimes lymphopenia can be severe (less than 1000 lymphocytes per mm3), which is one of the symptoms of this disease. A biochemical blood test and a urinalysis can assess the functional state of the kidneys. Histological examination provides analysis of the skin if these symptoms prevail and are similar to those of discoid lupus. It is also necessary to take a biopsy of the synovial fluid or kidney.

Immunological disorders

Serum antinuclear antibodies (sANAT).

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

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

Studies 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 in 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.

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

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

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

Antibodies against soluble antigens or ATRA (extractable nuclear antigens) - 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%. They currently have very high specificity in two species and therefore may be markers in this disease. Also of interest are anti-type 1 or T1 (20% in dogs) and a small amount of 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 in the diagnosis of DEV, while a positive direct Coombs test confirming the presence of antibodies detected by erythrocytes 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 with autoimmune hemolytic anemia, which may be associated with this disease. The direct skin sample immunofluorescence method gives similar results with the same diagnostic score in discoid lupus,

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

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, regulate the immune response in the body. Their small number indicates DEV disease. Shaban and colleagues believe that quantification of the T-suppressor lymphocyte population can be not only diagnostic, but also prognostic when conducted in parallel with the 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 human medicine, and the abnormalities associated with complement, cytokines (mediators of the immune system during inflammation) and other immune cells in DEV are not sufficiently investigated in dogs to be used to diagnose DEV.

diagnostic guide

basics of the clinic

A clinical study consists in a thorough search for characteristic symptoms (painful joints during their manipulation, examination of the skin, detection of skin lesions on the abdominal surface, etc.), and the 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 non-specific (leuco formula, thrombogram, urinalysis), and specific research methods. In this case, one should start with the detection of ANAT (all), then, search for specific indicators.

using the macaw model

Currently, the American Rheumatology Association (ARA) used in human medicine is used to diagnose DEV in a dog. (see table 3). The table contains clinical symptoms borrowed from ARA and adapted for diagnosing DEV in dogs.

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

Criteria	Definitions
	Erythema is observed in the region of thin and poorly protected skin areas of the skin (front surface)
discoid lupus	Depigmentation, erythema, erosions, ulcerations, crusts and scales, affecting mainly the facial surface (tip of the nose, nose and lips, periocular region)
photosensitivity	Aggravation of skin lesions depending on the time of exposure to the sun
Ulceration in the cheeks	Ulceration in the mouth and throat
	There is non-deforming arthritis in two or more joints characterized by pain on movement (flexion, extension), inflammation, effusion, or para-articular infiltration, not often controlled
Serous inflammation	Pleurisy, aseptic pericarditis
Kidney 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) change in general condition
Hematological changes	a) hemolytic anemia with reticulocytosis b) leukopenia (less than 3000/mm3) more than or less than 2 tests c) lipopenia (less than 1000/mm3) d) trobopenia (less than 100000/mm3) in the absence of treatment
Immunological disorder	a) presence of anti-histone antibodies b) presence of anti-Sm antibodies c) presence of anti-type 1 antibodies
Antinuclear antibodies	Titer of antinuclear antibodies detected by immunofluorescence or other methods (in the absence of treatment that can cause their formation)

Confidence in the diagnosis can be achieved if at least four symptoms are comparable in the course of the evolution of this nosology (even if they do not have a simultaneous manifestation), taking into account the presence of ANA-t - a mandatory criterion. The presence of two criteria gives the right to suspect DEV and to assume - in case of detection of three criteria.

differential diagnosis

The polymorphism of lupus and the "blurring" of the clinical picture over time is complemented by clinical symptoms, which greatly complicates the differential diagnosis due to symptoms similar to DEV (joint pain, skin disorders), which requires the exclusion of the presence of discoid lupus erythematosus, etc. Differential diagnosis has great difficulties in relation to such a disease as leishmaniasis, in which there is also a disorder of the immune system, including the circulation of immune complexes, the depot of which are sibbled organs. Pathogenesis, clinic, as well as the presence of ANAT are characteristic of this nosology. In case of doubt, evidence of DEV, it is necessary to exclude the presence of Leishmania. Tayuken it is necessary to take into account the geographical distribution of leishmaniasis.

lupus prognosis

Discoid lupus has a favorable prognosis if the 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 may be in the treatment at an early stage of the disease, with the absence or presence of moderate kidney pathology (the initial stage of the development of glomerulonephritis). Remission can be achieved with the appointment of immunosuppressants (Azathioprine, Cyclophosphamide ...) or even better when combined with an immunoregulator (Levamisole) associated with corticosteroids (Table 4). At the same time, biological control is necessary. If the ANAT titer correlates 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 karelative signs. Changes in the population of TCD8+ lymphocytes in the presentation of Luc Chaban is the most qualitative criterion (during remission, their number increases by more than 200 cells/mm3). Thanks to the use of monoclonal antibodies and lymphocyte typing, it is currently possible. Upon receipt of reliable research data, this method can be used in veterinary medicine.

Tab. 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.

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

Note: Watch for signs of neutropenia.

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 seriously attacked. Unfortunately, this disease is not only found in dogs, cats and even people get sick, but it is more common in dogs. The disease is dangerous, it can provoke inflammation in the heart, lungs, kidneys and joints. There are two types of lupus erythematosus: discoid and systemic.

Symptoms of lupus in dogs

The disease manifests itself in a mild or severe degree, it is very difficult to differentiate the two types of lupus. The disease disrupts the work 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 on time, lameness, arthritis or other inflammatory joint diseases may occur. In some cases, anemia, hair loss, infectious diseases were noted.

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

Discoid lupus erythematosus

If the depigmentation, ulcers, or lesions are only on the skin of the face, nose, or oral mucosa, then your dog has discoid lupus. Nosebleeds may indicate the presence of this ailment, and if such cases are repeated, it is impossible to delay visiting a doctor. Very often, the ears, scrotum, and vulva are affected.

Attention! External signs alone are not enough to make a diagnosis of lupus in dogs. A correct conclusion can only be made on the basis of a comprehensive examination of the animal's body; for this, 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 by the results of an analysis of urine, blood, skin biopsy, etc.

If you notice the slightest deviations from the norm in the behavior and appearance of your pet, you should immediately consult a doctor, otherwise the lost time may not have the best effect on the course and treatment of a formidable illness.

Causes of the disease

"What is the reason?" Unfortunately, there is no definite answer to this question yet. Most experts believe that the cause is a genetic predisposition. Various external and internal factors can provoke an ailment: 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 who are not yet six years old get sick, more often females get sick.

Individuals who live on the street fall into the risk zone. A malfunction of the immune system can be the result of leukemia, a bacterial or fungal disease. American scientists have found that lupus erythematosus in dogs can occur if you feed them moldy foods. But the treatment of the disease does not depend on the causes that caused it, therefore, if the mechanism is running, all forces must be directed to 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 subjected to too much physical exertion, unjustified frequent stress can also provoke this disease. Animal feed should be varied and balanced and nutritious.

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

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 course of the disease, and this is most often the case with systemic lupus, the dog is subject to hospitalization, she is prescribed complex treatment, including immunosuppressants.

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

For a speedy recovery, it is very important to provide the animal with peace, good nutrition, comfortable conditions, in which case, the disease may not progress, and the articular tissue will remain intact. Try to avoid stress, limit your pet's movements, it may need 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 lesions of the skin are insignificant, then they are treated with a hormonal ointment. If the degree of damage is large, injections of prednisolone, 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 a four-legged friend. But, if you strictly follow all the recommendations of the doctor, your pet will get better. Remember that this autoimmune disease is not a 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 that your pet will be able to maintain health, and nothing will threaten his life.

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A disease characterized by disorders of the hormonal system is lupus erythematosus. With this disease, the body's own completely healthy cells are attacked.

The disease affects all body systems, forcing the immune system to attack full-fledged cells and tissues, confusing them with harmful bacteria and viruses, trying to destroy them.

In dogs with lupus, a huge amount of immune complexes are formed, stored in the kidney section responsible for filtration, in the tissues lining the articular bags of the wrists, knees and other joints, in the skin, in blood vessels and other organs of the animal.

Predisposition of certain breeds of dogs to the disease

Today, the disease is considered quite rare, but some experts consider this rarity equal to poor-quality diagnostics. The fact is that it can be difficult to recognize this disease even for an experienced veterinarian. According to studies, lupus is most common in dogs of the following breeds:

collie;
English Shepherds;
poodles;
German Shepherds;
some types of hounds;
Irish setters.

Most often, the disease manifests itself in German shepherds, and at the age of about 6 years. The gender of the animal and its physical characteristics do not matter.

Symptoms

The clinical picture depends on the part of the body where the immune complexes are localized and on the specification of the autoantibodies. Different body systems produce their own picture of the disease.

Lupus erythematosus in dogs in the photo

Photo. Lupus erythematosus in dogs

Musculoskeletal system

Symptoms from this side are most often the following:

pain and inflammation of the joint bags;
lameness;
muscle weakness and soreness.

Leather

On the skin, signs of the disease are noticeable, such as:

damage;
ulcers at the junctions of the skin with mucous membranes (near the lips, nose, anus). Abundant, extensive ulcers lead to loss of appetite, a strong decrease in the weight of the animal;
baldness, loss of coat color, ulcers, redness.

kidneys

Manifestations of the disease from the kidneys are of the most dangerous nature, affecting the entire body as a whole:

enlargement of the liver and kidneys;
autoantibodies fight cells responsible for blood clotting;
inflammation of the lymph nodes;
when lymphocytes attack, other body systems are also affected.

Important! Most often, the very first sign indicating developing lupus is frequent nosebleeds. After that, reddening of the skin and ulceration of the mucocutaneous junctions appear.

Causes of the disease

Why lupus erythematosus occurs in dogs, veterinarians cannot yet say for sure.

To date, veterinarians are not ready to answer why dogs develop lupus erythematosus. Most experts are inclined to the version of genetic predisposition, sometimes aggravated by inflammatory processes, infections, a significant amount of ultraviolet rays.

For example, scientists have noticed that dogs living on the street get sick more often - this gives a reason to associate the disease with ultraviolet radiation. In addition, a shift in the immune system is provoked by leukemia, bacterial and fungal diseases.

The experiences of American doctors show that a long-term diet, which includes mold toxins, leads to the appearance of symptoms similar to lupus erythematosus. Such experiments prove that there can be many reasons for the manifestation of diseases. However, their detection in this case is not essential, since it does not have a significant impact on the treatment of the disease.

Diagnosis of the disease

Lupus, like other diseases of the autoimmune system, is difficult to diagnose. To identify it, a complete blood count, biochemical study, and urinalysis are required. The veterinarian needs to know how long the symptoms have been, what preceded them, how suddenly they appeared.

On a note! The diagnosis can only be made after a complete examination. It is impossible to judge the presence of such a serious and specific disease on the basis of only external manifestations.

Treatment for lupus erythematosus in dogs

If, when contacting a doctor, the condition of the animal is severe, the blood cells are prone to decay, it must be hospitalized. If the lesions are not so severe, the doctor may prescribe outpatient treatment. The doctor, prescribing therapy, takes into account the form of the disease, the stage of development, the affected organs, the age of the animal and concomitant diseases.

Important! If the skin is slightly affected, it is treated with hormonal ointments. In more advanced cases, injections of glucocorticoids, mainly prednisol, are required. Non-steroidal anti-inflammatory drugs are often used. Even the simplest cases require many months of treatment.

When sending a dog for treatment at home, the doctor strongly recommends that you provide her with maximum comfort and peace. This will help reduce the rate of progression of the disease by preventing joint destruction. In order to prevent the dog from moving around a lot, it is wise to put him in a cage.

Many doctors (not just veterinarians) believe that with this condition, sun exposure should be reduced as much as possible. It is advisable to walk the dog only in the early morning and after sunset. Since lupus affects the kidneys, it is worth switching the animal to a diet containing a minimum of protein so as not to overload the excretory system.

Many veterinarians advise less exposure to the sun with your dog.

To relieve pain, suppress the "enraged" immune system, you should use only those drugs that the doctor prescribes in a particular situation. The set of drugs depends on the degree of organ damage, on which specific systems have been attacked.

Prevention

As a preventive measure, you should try to prevent prolonged exposure to the sun in dogs of breeds most susceptible to lupus. In addition, you should monitor changes in the pet's body in order to catch the disease at an early stage.

Knowing that the disease is hereditary, it is impossible to allow the reproduction of sick animals.

Observation

Lupus erythematosus is an unpredictable disease, its treatment requires long-term immune suppression. During treatment, side effects are not uncommon. At first, you need to visit the veterinarian every seven days, the doctor will draw up a further schedule based on the condition of the animal. Only a specialist should monitor the progress / regression of the disease - the disease cannot be left to chance.