Lupus in dogs treatment. Autoimmune diseases. Predisposition of certain breeds of dogs to the disease

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.

Having noticed 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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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.

Weight gain is also common with steroid use. Regular physical exams, urinalysis, and blood tests should be done to monitor the side effects of chronic chemotherapy. Affected animals should not be bred. Lupus is a disease that involves the immune system attacking her own body. There are two types of lupus in dogs. Discoid lupus erythematosus, sometimes referred to as "collie nose" or "nasal solar dermatitis," is a common immune-mediated skin disorder that typically affects the face, bridge of the nose, ears, lips, mouth, and sometimes the genitals, legs, and skin around the eye.

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.

Discoid lupus erythematosus

Systemic lupus erythematosus is a much more serious condition. It targets the skin, kidneys, liver, lungs, heart, and joints, but can appear anywhere. Affected animals exhibit displaced lameness, painful swollen joints, thickened foot pads, and a stiff gait. They become weak, lethargic, and depressed, and many other symptoms may develop. Both forms of lupus are likely highly genetic.

Discoid lupus erythematosus is an autoimmune disease in which a dog becomes allergic to its own tissues. This disease leads to crusting, depigmentation, redness and ulceration of the nose. Lesions may also appear around the eyes, ears, limbs, and other areas.

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.

This is why it tends to be more severe in summer or in sunny climates. Nose depigmentation will also make your dog more susceptible to sunburn. Fortunately, the prognosis for this disease is usually good, although treatment usually needs to be continued for life.

Treatment for lupus erythematosus in dogs

This can be done with blood tests and skin biopsies. Because the nose is a very sensitive and vascular area, a general anesthetic is essential for a proper biopsy. In some cases, applying sunscreen to depigmented areas may be helpful. Keeping the patient indoors during the day and providing generous outdoor access at night can also minimize clinical signs.

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:

  1. Analysis of blood and urine.
  2. Detailed history (first symptoms, how and when they appeared).
  3. Study of the kidneys.
  4. 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.

Topically, creams or ointments containing vitamin E or steroids may also be helpful. Oral vitamin E has also been shown to be helpful. Severe cases respond to corticosteroid therapy. Finally, recent reports have shown good success with nasal reshaping. Depigmented, ulcerated areas are excised and replaced with normal skin. Your veterinarian can suggest which treatment options are most effective.

It is an inflammatory disease, often caused by genetics and exacerbated by overexposure to the sun. Using alternative medicine approaches that consider diet, supplements, and topical applications can help relieve symptoms and fight inflammation. The medical name for collie nose is discoid lupus erythematosus. This is a form of lupus, an autoimmune disease that causes the immune system to overreact and attack body tissues. Many breeds can get a collie nose, but are most commonly found in Collies, German Shepherds, Shetland Sheepdogs, Huskies, British Spaniels, and German Shorthaired Pointers.

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.

The first symptoms of a collie nose are loss of pigmentation and increased smoothness on the dog's nose. In later stages, the dog's nose may become red or flaky or develop sores. Collie nose can also affect a dog's ears, lips, genitals, and skin around the eyes.

Causes of lupus erythematosus in dogs

Because collie nose is an inflammatory problem, including anti-inflammatory foods can be beneficial. These foods include wild salmon, sardines, rainbow trout, grass-fed beef, flaxseed oil and seeds, and other foods with omega-3 fatty acids that reduce inflammation, boost immunity, and improve skin condition. All fish must be wild to offer omega-3s. Vitamin E foods, including sunflower and safflower oils, and almonds in whole or oil form, also contain omega-6 fatty acids and antioxidant properties.

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:

Add-ons and current applications

Supplementation with omega-3, omega-6, or vitamin E may benefit bone-affected dogs for several days when fresh foods with these components are not available. Ginger also has impressive anti-inflammatory properties, according to the National Institutes of Health. Studies have shown that ginger extract suppresses several genes involved in the inflammatory response. Including ginger root in your dog's food can therefore reduce the inflammation associated with a collie's nose. Finally, topical aloe vera can help relieve your dog's itching.

  1. Sudden formations on the skin.
  2. The appearance of symmetrical or unilateral foci of redness.
  3. 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.

Introducing new things slowly and applying sunscreen

Alternative medication protocols and dietary changes should be approached gradually, and it is best to keep your veterinarian informed of any changes. Introduce new foods slowly to allow your dog's body to adjust. Read additional dosages and adjust accordingly based on your dog's weight. These steps not only allow your dog's body to adjust, but also allow you to monitor your dog for any reactions.

Autoimmune hemolytic anemia

Glomerulonephritis is inflammation of the microscopic filtering units of the kidneys known as glomeruli. Inflammation develops when immune complexes become trapped in the glomeruli. This leads to the activation of the body's inflammatory defense system, which in turn damages the glomeruli. Immune complexes often form as a result of some other disease, such as infection or cancer. However, in many dogs with glomerulonephritis, the cause of the trigger cannot be determined. Glomerulonephritis results in excessive loss of protein in the urine.

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.

Disseminated lupus erythematosus

Finding protein in the urine during a urinalysis may be the first sign that your dog has glomerulonephritis. Treatment includes giving immunosuppressants to reduce the formation of immune complexes. If left untreated, the disease can lead to chronic kidney failure.

What is the immune system

Systemic lupus erythematosus is a rare autoimmune disease that occurs in humans and dogs. Dogs with lupus have antibodies in their blood that are directed against their own body tissues. Lupus causes widespread abnormalities of the skin, heart, lungs, kidneys, joints, nervous system, and blood. Usually several organs are affected.

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.

Autoimmune skin diseases

Lupus causes such a wide variety of symptoms that it can be confused with many different diseases. Lupus symptoms can be acute or chronic, and they often come and go. Signs may include fever fluctuations; lameness that shifts from one leg to the other; arthritis affecting multiple joints; painful muscles; anemia; low level of leukocytes; mouth ulcers; skin changes including hair loss, dermal crusting, ulceration, and scarring; and involvement of internal organs such as the thyroid, spleen, or kidneys.

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.

A blood test is a common method for diagnosing lupus. Blood tests are also used to check for damage to the liver or kidneys and to look for anemia, low platelet counts, and other changes associated with the disease. Medications are usually prescribed to treat the disorder. Your veterinarian will be able to determine the most appropriate treatment for your pet.

Immune complex vasculitis occurs in dogs. At first, the anomalies are seen as purplish red dots appearing on the skin. Depending on which blood vessels are involved, marks appear on the paws, tail, ears, mouths, or tongue. Drugs are often the cause of vasculitis in dogs. The disorder is diagnosed by performing tests on specimens removed from affected areas. Vasculitis is treated by stopping the drug or drugs that suppress the immune system.

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"

One of the causes of anterior uveitis is the action of antibody-antigen complexes on the iris, which causes inflammation of the eye. Anterior uveitis often occurs during the recovery phase of canine hepatitis. Treatment for immune-mediated anterior uveitis may include whole-body corticosteroids and other drugs that suppress the immune system.

The main causes and methods of diagnosis

Revascular rheumatoid arthritis is an autoimmune disease that causes inflammation and swelling of the joints. The condition is thought to result from immune complexes that are deposited in the tissue surrounding the joints. Animals with rheumatoid arthritis often develop painful joints. It can be thought of as a lameness that shifts from foot to foot and makes it difficult to get up, walk, or climb. Diseases of the wrist, paw, and toes are most commonly affected and may show signs of inflammation, such as excessive warmth or swelling.

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.

The dog may also have a fever. In addition to symptoms, x-rays of the joints, blood work, and laboratory analysis of fluid removed from the joints may help in the diagnosis. Your veterinarian may prescribe several medications that can help a pet with rheumatoid arthritis. Carefully follow the instructions for taking your medications.

Plasma-lymphocytic synovitis may be a variant of rheumatoid arthritis. This disease occurs in medium and large breed dogs. The most common sign is hindlimb lameness, with the knee being the most commonly affected. Treatment for this disorder often requires a combination of medications that control inflammation.

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
  • German Shepherd, Belgian Shepherd, Collie, Breton Spaniel, Pointer, Siberian Sledding Husky, Shetland Sheepdog
  • Vulgar pemphigus
  • Vegetative pemphigus
  • foliaceous pemphigus
  • Akita Inu, Chow Chow, Dachshund, Newfoundland, Schipperka, German Shepherd, Collie
  • Vitiligo
  • German Shepherd, Belgian Shepherd, Doberman, Rottweiler, Dachshund, Bobtail
  • Erythematous pemphigus
  • German shepherd, collie
  • bullous pemphigoid
  • collie, doberman
  • Disseminated lupus erythematosus
  • German Shepherd & Crossbreeds, Belgian Shepherd, Briard, Bouvier, Setter, Bobtail, Boxer, Spaniel, Beagle, Cocker
  • Atrophic articular polychondrid
  • Tervuren
  • Vasculitis
  • Dachshund, Jack Russell Terrier. Scottish Terrier, Greyhound, Rottweiler
  • Alopecia areata
  • Breed predisposition unknown
  • Uveodermoid syndrome
  • Siberian riding husky, samoyed husky, akita inu, chow chow

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 depigmentation of the tip of the nose: vitiligo, oculocutaneous syndrome (in 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 can also be polymorphic in nature: 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...............................
  • 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 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 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 image 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 dorsolumbar and gluteal muscle groups with the presence of 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)

photosensitization

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.

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
  • German Shepherd, Belgian Shepherd, Collie, Breton Spaniel, Pointer, Siberian Sledding Husky, Shetland Sheepdog
  • Vulgar pemphigus
  • Vegetative pemphigus
  • Breed predisposition unknown
  • foliaceous pemphigus
  • Akita Inu, Chow Chow, Dachshund, Newfoundland, Schipperka, German Shepherd, Collie
  • Vitiligo
  • German Shepherd, Belgian Shepherd, Doberman, Rottweiler, Dachshund, Bobtail
  • Erythematous pemphigus
  • German shepherd, collie
  • bullous pemphigoid
  • collie, doberman
  • Disseminated lupus erythematosus
  • German Shepherd & Crossbreeds, Belgian Shepherd, Briard, Bouvier, Setter, Bobtail, Boxer, Spaniel, Beagle, Cocker
  • Atrophic articular polychondrid
  • Tervuren
  • Vasculitis
  • Dachshund, Jack Russell Terrier. Scottish Terrier, Greyhound, Rottweiler
  • Alopecia areata
  • Breed predisposition unknown
  • Uveodermoid syndrome
  • Siberian riding husky, samoyed husky, akita inu, chow chow

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; 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 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 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 image 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 dorsolumbar and gluteal muscle groups with the presence of 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)

photosensitization

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.

The symptoms of lupus in dogs depend on the type. The symptoms of DLE are usually benign and mostly just affect the skin, while the symptoms of SLE can be catastrophic. Here are a few symptoms you can expect with canine lupus.

Discoid lupus erythematosus (DLE) usually affects the face, nose, lips, mouth, ears, or around the eyes. Rarely, it can cause symptoms in the legs or genitals. Watch out for the next one.

  • Pale skin on the bridge of the nose
  • Redness of the skin, especially the nose, lips, and face
  • Scaly, flaky, or brittle skin
  • Ulcers or sores
  • scarring
  • Pain in the affected areas
  • Itching or scratching in the affected areas
  • Bacterial infections

Systemic lupus erythematosus (SLE) can affect almost any area of ​​the body, so symptoms can vary greatly and quickly become life-threatening. SLE is an immune disease in which the immune system starts attacking the body's cells and tissue, and depending on which organs are affected, it can be downright deadly. Here are a few common symptoms you may see with SLE.

  • Change in leg lameness
  • Arthritis, muscle pain and stiffness
  • lethargy
  • Loss of appetite
  • fever
  • Illness or damage to the skin
  • anemia
  • Hair loss
  • Enlarged lymph nodes
  • mouth ulcers
  • Seizures
  • Enlarged liver, spleen, or kidneys
  • Increased thirst or urination

Causes of Lupus in Dogs

"Lupus" is the Latin word for "wolf". The disease was named after the rash that appeared on the faces of people with a wolf-bite-like illness, although it was not thought to be caused by a wolf bite, as some mistakenly believe. The real causes of lupus are still not well understood today. There is likely a genetic component, and exposure to ultraviolet light, stress, medications, and viral infections all contribute to this condition.

Some dogs are at risk for developing SLE. The disease is more common in middle-aged women, and some breeds are predisposed, including Afghan Hounds, Hounds, German Shepherds, Irish Setters, Old English Sheepdogs, Poodles, Shetland Sheepdogs, and Rough Collies.

Diagnosing Lupus in Dogs

You will need to see your veterinarian for a proper diagnosis of any form of lupus in your dog. DLE is usually easier to diagnose, although it can mimic other conditions such as ringworm or nasal lymphoma. Diagnosis is by taking a skin biopsy from the affected area. This is a minor procedure, although your dog will need stitches after the sample is taken. This rules out other causes of the symptoms and confirms if your dog has DLE.

SLE is more difficult to diagnose because it can mimic the symptoms of many other organ-based conditions. Cancer, kidney disease, or a bad response to medication all share the same symptoms of SLE. Let your veterinarian know about any symptoms you have seen in your dog. A blood test rules out many other causes and helps diagnose SLE. Your veterinarian will look for something called antinuclear antibodies in the blood, which are a sign of SLE.

Lupus Treatment in Dogs

Treatment for lupus in dogs also depends on the type of lupus, although neither form is curable. This is why treatment focuses on symptom management and continues for the rest of the lives of affected dogs. DLE is fairly easy to treat, and your veterinarian will be focused on healing and controlling any sores, lesions, or sores that may appear. Topical steroids are often used to suppress the immune system response and reduce inflammation. Prednisone or other oral steroids may be given until the condition is under control. Antibiotics and supplements may also be provided, including vitamin B and E and omega-3 fatty acids. Exposure to ultraviolet light, including sunlight, should be limited as it worsens the condition.

SLE procedures will vary depending on the organs that are affected. The goal of treatment is to reduce inflammation and suppress the immune response that is causing the damage. NSAIDs, immunosuppressants, or steroids such as prednisone are likely to be used. Chemotherapy can further suppress the negative activity of the immune system and reduce pain. Antibiotics will be given if there is a secondary infection that needs to be treated. As with DLE, exposure to sunlight must be limited. This treatment should be continued for the rest of the dog's life.

Among the pathologies of the immune system in pets, systemic lupus erythematosus in dogs is quite common. Despite its prevalence, the disease is not always correctly diagnosed by veterinarians due to certain diagnostic difficulties. From this article you will learn why dogs get this disease, what are the main symptoms and causes of the pathology, and what is the therapy.

Lupus erythematosus is an autoimmune disease caused by a malfunction of the immune system. The protein components of healthy cells of the body act as autoantigens - substances considered by the body as foreign. As a result, an immune response occurs - the so-called antibodies are produced. These are protein compounds that can bind to cells - antigens and prevent their further reproduction. In other words, the body attacks its own cells, thereby gradually destroying itself.

Such antigen-antibody immune complexes can be found in the kidneys, synovial fluid and membranes of articular capsules, skin, and blood vessels. Therefore, more often the target of the disease is the skin, connective tissues, epithelium, joints.

Causes of the disease

This disease can have two forms in a dog, differing in their origin:

  1. Discoid lupus erythematosus has autoimmune causes;
  2. Systemic lupus erythematosus is a hereditary disease based on a genetic factor.

Both forms of the disease can have similar symptoms, so differential diagnosis often fails.

Factors that increase the risk of one or another form of the disease are:

  • inflammatory processes in the body of a bacterial, fungal or viral nature;
  • prolonged exposure to direct sunlight;
  • the use of certain medicines;
  • blood diseases (leukemia);
  • stressful situations.

Diseases are especially susceptible to elderly females, over the age of 5 years, both sterilized and not.

Some dog breeds are more prone to the disease. The same can be said for German Shepherds. But there are several other breeds whose representatives quite often have similar symptoms:

  • collie;
  • small and medium poodles;
  • afghan hounds;
  • Irish setters.

Main symptoms

The main symptoms of lupus erythematosus are manifested in the organ and system, the tissues of which are most damaged and where immune complexes are localized. The disease usually affects the skin, musculoskeletal and endocrine systems, kidneys, and lymph nodes. Consider how the disease manifests itself in each case.

Skin and connective tissue

Skin manifestations of systemic lupus erythematosus in dogs resemble those of discoid lupus erythematosus. Most often, they are bilateral. These are ulcers on the skin or mucous membranes, redness, erythema, depigmentation, erosion, scales, hair loss. First of all, they are localized around the nose, mouth, eyes or anus.

When the connective tissue is damaged, all organs where there is connective tissue are gradually involved in the pathological process - the membranes of the heart, the gastrointestinal tract, the nervous system, and the joints.

Musculoskeletal system

The musculoskeletal system suffers from systemic lupus erythematosus. In this case, immune complexes are localized in synovial membranes and on the inner surfaces of the joints.

Damage to paired joints is noted: they increase, become painful, hyperemic. Deformation of the joints leads to an unnatural position of the legs. Later muscle pains join.

Kidneys and liver

This is the most dangerous form of the disease, in which there is a systematic threat to life, since the whole organism is involved in the process. With this form of the disease, hepatonephromegaly (abnormal enlargement of the liver and kidneys) can be observed. The hematopoietic system suffers, since blood cells - erythrocytes, platelets and leukocytes - become autoantigens. The lymph nodes enlarge and become painful. The destructive effect of lymphocytes can be directed to any organ or system.

Lupus erythematosus in most dogs is acute, but sometimes takes a chronic course. The disease is preceded by nosebleeds, followed by redness on the skin. An attentive owner should not leave these alarming symptoms unattended. Timely measures taken will help to alleviate the picture of the course of the disease.

In the initial stages, short remissions can be observed, but then the course of the disease becomes systemic.

Diagnosis of the disease

Lupus erythematosus is a disease that is difficult to diagnose. When making a diagnosis, data from an external examination, anamnesis, and the results of an extended biochemical analysis of blood and urine are used. It is very important for the owner to know when the first warning signs appeared in the pet, what preceded their occurrence, how rapidly the symptoms developed.

The main criteria for making a diagnosis are:

  • the presence of photodermatitis;
  • skin rashes;
  • symmetrical joint damage;
  • the presence of seizures;
  • changes in behavior;
  • reduced content of blood particles (leukopenia, thrombocytopenia, lymphopenia);
  • kidney dysfunction.

Therapeutic methods

There is no complete cure for the disease. Treatment can reduce autoimmune aggression and improve the general condition of the patient. The technique is chosen by the doctor depending on which organs and systems are involved in the pathological process. In advanced cases, the dog is placed in a hospital, and in milder cases, treatment is carried out on an outpatient basis.

Glucocorticosteroids (Prednisolone) are used to treat lupus erythematosus. The dose is selected individually, taking into account the age of the patient and the nature of the disease. In the case of external manifestations, hormone-containing ointments are used. There are situations when lifelong use of hormone therapy is prescribed.

Discoid lupus can be successfully treated with immune-modulating drugs (Levamisole).

A sick dog should have a special lifestyle:

  • You should drastically limit your dog's exposure to the sun. To do this, you can walk it only in the early morning or evening, when solar activity falls.
  • If the joints are affected, then you can not load them. To do this, it is recommended to limit the animal's movements. The dog should be kept in a cramped room - in a cage or in a small room.
  • To relieve the burden on the kidneys, the dog needs a special diet, with a limited protein content.

Prevention and Surveillance

The main preventive measure is the exclusion of animals with hereditary forms of the disease from the breeding program to prevent the spread of genetic disorders to offspring.

Animals susceptible to illness should not be allowed outside at a time when the action of ultraviolet radiation is most active. Sunlight is a strong predisposing factor for the disease. The diet of dogs should be rich in protein, minerals and vitamins.

Sick animals need constant monitoring, since the treatment method involves long-term immune suppression. During the period of active treatment, the animal is brought for a veterinary examination every 7 days. The frequency of further visits is determined by the attending physician.