Lupus erythematosus

A. Definition

Systemic lupus erythematosus (also known as SLE) is a chronic inflammatory disease that occurs when your body’s immune system attacks your own tissues and organs. Inflammation caused by Lupus can affect many different body systems, including your joints, skin, kidneys, blood cells, brain, heart, and lungs. Lupus erythematosus may manifest as a systemic disease or as a cutaneous form, also known as incomplete lupus erythematosus. Lupus has four main types:

  • systemic
  • discoid
  • drug-induced
  • neonatal

The most distinctive sign of lupus — a facial rash that resembles the wings of a butterfly unfolding across both cheeks — occurs in many, but not all, cases.

B. General information
Lupus can be difficult to diagnose because its symptoms often mimic those of other ailments. It can develop in any age group with varying results. Typically, the disease tends to be more acute in those who are of younger age. Patients with juvenile onset Lupus are more vulnerable to mucocutaneous (alopecia, skin rash, and ulceration of the mucus membranes) manifestations of the disease more so than any other age group. However, patients with late onset Lupus have a much higher morbidity rate. Nearly 50% of those with late onset Lupus die of their infection. This is most likely due to the age of the patients with late onset Lupus since the manifestation of their disease is much less severe than younger patients. Women who are of childbearing age are also particularly at risk.

Caucasians seem to have a more mild manifestation of the disease than people of other races. Their survival rates after five years are typically around 94%-96%, while patients of African, and some Asian ethnicities have survival rates closer to 79%-92%. The only documented ethnicity with a higher survival rate than Caucasians are Koreans, who have survival rates nearer to 98%. Among Caucasians, the most common causes of death were complications involving the cardiovascular system, the respiratory system, and malignancies.

C. Social Security Medical Listing 14.02 – Systemic lupus erythematosus
Lupus is frequently, but not always, accompanied by constitutional symptoms or signs including severe fatigue, fever, malaise, involuntary weight loss. Major organ or body system involvement can include: Respiratory (pleuritis, pneumonitis), cardiovascular (endocarditis, myocarditis, pericarditis, vasculitis), renal (glomerulonephritis), hematologic (anemia, leukopenia, thrombocytopenia), skin (photosensitivity), neurologic (seizures), mental (anxiety, fluctuating cognition (“lupus fog”), mood disorders, organic brain syndrome, psychosis), or immune system disorders (inflammatory arthritis). Immunologically, there is an array of circulating serum auto-antibodies and pro- and anti-coagulant proteins that may occur in a highly variable pattern.

Necessary criteria for the Social Security Administration to determine that your Lupus is disabling include:

A. Involvement of two or more organs/body systems, with:

  • One of the organs/body systems involved to at least a moderate level of severity; and
  • At least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss), or

B. Repeated manifestations of SLE, with at least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) and one of the following at the marked level:

  • Limitation of activities of daily living.
  • Limitation in maintaining social functioning.
  • Limitation in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace.

Generally, but not always, the medical evidence will show that your SLE satisfies the criteria in the current “Criteria for the Classification of Systemic Lupus Erythematosus” by the American College of Rheumatology found in the most recent edition of the Primer on the Rheumatic Diseases published by the Arthritis Foundation.

Your representative can help you determine whether your Lupus is severe enough for you to qualify for disability benefits under the Social Security Administration.