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Systemic lupus erythematosus 17(SLEB17)

MedGen UID:
1804329
Concept ID:
C5676884
Disease or Syndrome
Synonym: SLEB17
 
Gene (location): TLR7 (Xp22.2)
 
Monarch Initiative: MONDO:0859083
OMIM®: 301080

Definition

Systemic lupus erythematosus-17 (SLE17) is an X-linked dominant autoimmune disorder characterized by onset of systemic autoinflammatory symptoms in the first decades of life. Only affected females have been reported. Features may include classic features of SLE, such as malar rash and arthralgias, or can include less common entities such as hemiplegia and neuromyelitis optica (NMO). Laboratory studies show the presence of autoantibodies and enhanced NFKB (164011) signaling, the latter being consistent with a gain-of-function effect (Brown et al., 2022). For a phenotypic description and a discussion of genetic heterogeneity of systemic lupus erythematosus (SLE), see 152700. [from OMIM]

Clinical features

From HPO
Arthralgia
MedGen UID:
13917
Concept ID:
C0003862
Sign or Symptom
Joint pain.
Hypertensive crisis
MedGen UID:
5701
Concept ID:
C0020546
Finding
A severe, acute increase in blood pressure that may result in stroke or myocardial ischemia.
Mitral regurgitation
MedGen UID:
7670
Concept ID:
C0026266
Disease or Syndrome
An abnormality of the mitral valve characterized by insufficiency or incompetence of the mitral valve resulting in retrograde leaking of blood through the mitral valve upon ventricular contraction.
Raynaud phenomenon
MedGen UID:
20474
Concept ID:
C0034735
Disease or Syndrome
An episodic vasoconstriction resulting in discoloration of the skin and pain in the affected areas, often involving fingers or toes. Classically associated with triphasic color changes (white, blue, red) but may be biphasic. Often occurs in response to cold temperatures or emotional stress. May be primary or secondary to an underlying autoimmune disease.
Anxiety
MedGen UID:
1613
Concept ID:
C0003467
Finding
Intense feelings of nervousness, tension, or panic often arise in response to interpersonal stresses. There is worry about the negative effects of past unpleasant experiences and future negative possibilities. Individuals may feel fearful, apprehensive, or threatened by uncertainty, and they may also have fears of falling apart or losing control.
Chorea
MedGen UID:
3420
Concept ID:
C0008489
Disease or Syndrome
Chorea (Greek for 'dance') refers to widespread arrhythmic involuntary movements of a forcible, jerky and restless fashion. It is a random-appearing sequence of one or more discrete involuntary movements or movement fragments. Movements appear random because of variability in timing, duration or location. Each movement may have a distinct start and end. However, movements may be strung together and thus may appear to flow randomly from one muscle group to another. Chorea can involve the trunk, neck, face, tongue, and extremities.
Headache
MedGen UID:
9149
Concept ID:
C0018681
Sign or Symptom
Cephalgia, or pain sensed in various parts of the head, not confined to the area of distribution of any nerve.
Thrombocytopenia
MedGen UID:
52737
Concept ID:
C0040034
Disease or Syndrome
A reduction in the number of circulating thrombocytes.
Leukopenia
MedGen UID:
6073
Concept ID:
C0023530
Disease or Syndrome
An abnormal decreased number of leukocytes in the blood.
Systemic lupus erythematosus
MedGen UID:
6146
Concept ID:
C0024141
Disease or Syndrome
Systemic lupus erythematosus (SLE) is a complex autoimmune disease characterized by production of autoantibodies against nuclear, cytoplasmic, and cell surface molecules that transcend organ-specific boundaries. Tissue deposition of antibodies or immune complexes induces inflammation and subsequent injury of multiple organs and finally results in clinical manifestations of SLE, including glomerulonephritis, dermatitis, thrombosis, vasculitis, seizures, and arthritis. Evidence strongly suggests the involvement of genetic components in SLE susceptibility (summary by Oishi et al., 2008). Genetic Heterogeneity of Systemic Lupus Erythematosus An autosomal recessive form of systemic lupus erythematosus (SLEB16; 614420) is caused by mutation in the DNASE1L3 gene (602244) on chromosome 3p14.3. An X-linked dominant form of SLE (SLEB17; 301080) is caused by heterozygous mutation in the TLR7 gene (300365) on chromosome Xp22. See MAPPING and MOLECULAR GENETICS sections for a discussion of genetic heterogeneity of susceptibility to SLE.
Lymphopenia
MedGen UID:
7418
Concept ID:
C0024312
Disease or Syndrome
A reduced number of lymphocytes in the blood.
Myelitis
MedGen UID:
10230
Concept ID:
C0026975
Disease or Syndrome
Inflammation of the spinal cord.
Optic neuritis
MedGen UID:
18181
Concept ID:
C0029134
Disease or Syndrome
Inflammation of the optic nerve.
Antinuclear antibody positivity
MedGen UID:
101792
Concept ID:
C0151480
Laboratory or Test Result
The presence of autoantibodies in the serum that react against nuclei or nuclear components.
Autoimmune thrombocytopenia
MedGen UID:
116621
Concept ID:
C0242584
Disease or Syndrome
The presence of thrombocytopenia in combination with detection of antiplatelet antibodies.
Malar rash
MedGen UID:
75808
Concept ID:
C0277942
Finding
An erythematous (red), flat facial rash that affects the skin in the malar area (over the cheekbones) and extends over the bridge of the nose.
Decreased circulating complement C3 concentration
MedGen UID:
332469
Concept ID:
C1837512
Finding
Concentration of the complement component C3 in the blood circulation below the lower limit of normal.
Decreased circulating complement C4 concentration
MedGen UID:
893114
Concept ID:
C4073169
Finding
Concentration of the complement component C4 in the blood circulation below the lower limit of normal.
Anti-aquaporin 4 antibody positivity
MedGen UID:
1787176
Concept ID:
C5539529
Laboratory or Test Result
The presence of autoantibodies (immunoglobulins) in the serum that react against aquaporin-4.
Fever
MedGen UID:
5169
Concept ID:
C0015967
Sign or Symptom
Body temperature elevated above the normal range.
Recurrent fever
MedGen UID:
811468
Concept ID:
C3714772
Sign or Symptom
Periodic (episodic or recurrent) bouts of fever.
Oral ulcer
MedGen UID:
57699
Concept ID:
C0149745
Disease or Syndrome
Erosion of the mucous mebrane of the mouth with local excavation of the surface, resulting from the sloughing of inflammatory necrotic tissue.
Alopecia
MedGen UID:
7982
Concept ID:
C0002170
Finding
A noncongenital process of hair loss, which may progress to partial or complete baldness.

Professional guidelines

Recent clinical studies

Etiology

Jin HZ, Li YJ, Wang X, Li Z, Ma B, Niu L, Wang P, Pan HF, Li SD, Bao W, Wang G, Li XM, Chen Z
Lupus Sci Med 2023 Nov 24;10(2) doi: 10.1136/lupus-2023-001074. PMID: 38007228Free PMC Article
Andrade SO, Julio PR, Nunes de Paula Ferreira D, Appenzeller S
Expert Rev Clin Immunol 2021 Feb;17(2):143-153. Epub 2021 Jan 22 doi: 10.1080/1744666X.2020.1865156. PMID: 33393397
Yang H, Liu H, Zhou Z, Zhao L, Fei Y, Chen H, Zhang F, Zhang X
Clin Rev Allergy Immunol 2021 Feb;60(1):17-30. Epub 2020 Nov 7 doi: 10.1007/s12016-020-08817-2. PMID: 33159635
Pearce L
Nurs Stand 2016 Jun 22;30(43):17. doi: 10.7748/ns.30.43.17.s21. PMID: 27332581
Wang D, Zhang C, Zhou Z, Pei F
Rheumatol Int 2016 Apr;36(4):585-95. Epub 2015 Dec 7 doi: 10.1007/s00296-015-3404-0. PMID: 26643792

Diagnosis

Siegel CH, Sammaritano LR
JAMA 2024 May 7;331(17):1480-1491. doi: 10.1001/jama.2024.2315. PMID: 38587826
Dumas G, Arabi YM, Bartz R, Ranzani O, Scheibe F, Darmon M, Helms J
Intensive Care Med 2024 Jan;50(1):17-35. Epub 2023 Dec 19 doi: 10.1007/s00134-023-07266-7. PMID: 38112769
Yang H, Liu H, Zhou Z, Zhao L, Fei Y, Chen H, Zhang F, Zhang X
Clin Rev Allergy Immunol 2021 Feb;60(1):17-30. Epub 2020 Nov 7 doi: 10.1007/s12016-020-08817-2. PMID: 33159635
Pearce L
Nurs Stand 2016 Jun 22;30(43):17. doi: 10.7748/ns.30.43.17.s21. PMID: 27332581
Abulaban KM, Brunner HI
Curr Rheumatol Rep 2015 Jan;17(1):471. doi: 10.1007/s11926-014-0471-2. PMID: 25475594Free PMC Article

Therapy

Siegel CH, Sammaritano LR
JAMA 2024 May 7;331(17):1480-1491. doi: 10.1001/jama.2024.2315. PMID: 38587826
Morand E, Pike M, Merrill JT, van Vollenhoven R, Werth VP, Hobar C, Delev N, Shah V, Sharkey B, Wegman T, Catlett I, Banerjee S, Singhal S
Arthritis Rheumatol 2023 Feb;75(2):242-252. Epub 2022 Nov 11 doi: 10.1002/art.42391. PMID: 36369798Free PMC Article
Singh JA, Shah NP, Mudano AS
Cochrane Database Syst Rev 2021 Feb 25;2(2):CD010668. doi: 10.1002/14651858.CD010668.pub2. PMID: 33631841Free PMC Article
Muhammad Yusoff F, Wong KK, Mohd Redzwan N
Autoimmunity 2020 Feb;53(1):8-20. Epub 2019 Nov 27 doi: 10.1080/08916934.2019.1693545. PMID: 31771364
Navarra SV, Guzmán RM, Gallacher AE, Hall S, Levy RA, Jimenez RE, Li EK, Thomas M, Kim HY, León MG, Tanasescu C, Nasonov E, Lan JL, Pineda L, Zhong ZJ, Freimuth W, Petri MA; BLISS-52 Study Group
Lancet 2011 Feb 26;377(9767):721-31. Epub 2011 Feb 4 doi: 10.1016/S0140-6736(10)61354-2. PMID: 21296403

Prognosis

Barber MRW, Drenkard C, Falasinnu T, Hoi A, Mak A, Kow NY, Svenungsson E, Peterson J, Clarke AE, Ramsey-Goldman R
Nat Rev Rheumatol 2021 Sep;17(9):515-532. Epub 2021 Aug 3 doi: 10.1038/s41584-021-00668-1. PMID: 34345022Free PMC Article
Yang H, Liu H, Zhou Z, Zhao L, Fei Y, Chen H, Zhang F, Zhang X
Clin Rev Allergy Immunol 2021 Feb;60(1):17-30. Epub 2020 Nov 7 doi: 10.1007/s12016-020-08817-2. PMID: 33159635
Cohen H, Hunt BJ, Efthymiou M, Arachchillage DR, Mackie IJ, Clawson S, Sylvestre Y, Machin SJ, Bertolaccini ML, Ruiz-Castellano M, Muirhead N, Doré CJ, Khamashta M, Isenberg DA; RAPS trial investigators
Lancet Haematol 2016 Sep;3(9):e426-36. doi: 10.1016/S2352-3026(16)30079-5. PMID: 27570089Free PMC Article
Pearce L
Nurs Stand 2016 Jun 22;30(43):17. doi: 10.7748/ns.30.43.17.s21. PMID: 27332581
Abulaban KM, Brunner HI
Curr Rheumatol Rep 2015 Jan;17(1):471. doi: 10.1007/s11926-014-0471-2. PMID: 25475594Free PMC Article

Clinical prediction guides

Siegel CH, Sammaritano LR
JAMA 2024 May 7;331(17):1480-1491. doi: 10.1001/jama.2024.2315. PMID: 38587826
Wang H, Li T, Sun F, Liu Z, Zhang D, Teng X, Morel L, Wang X, Ye S
RMD Open 2022 Oct;8(2) doi: 10.1136/rmdopen-2022-002686. PMID: 36288823Free PMC Article
Moreno-Torres V, Castejón R, Martínez-Urbistondo M, Gutiérrez-Rojas Á, Vázquez-Comendador J, Tutor P, Durán-Del Campo P, Mellor-Pita S, Rosado S, Vargas-Núñez JA
Clin Transl Sci 2022 Jul;15(7):1676-1686. Epub 2022 May 4 doi: 10.1111/cts.13283. PMID: 35478259Free PMC Article
Abulaban KM, Brunner HI
Curr Rheumatol Rep 2015 Jan;17(1):471. doi: 10.1007/s11926-014-0471-2. PMID: 25475594Free PMC Article
Wallace DJ, Stohl W, Furie RA, Lisse JR, McKay JD, Merrill JT, Petri MA, Ginzler EM, Chatham WW, McCune WJ, Fernandez V, Chevrier MR, Zhong ZJ, Freimuth WW
Arthritis Rheum 2009 Sep 15;61(9):1168-78. doi: 10.1002/art.24699. PMID: 19714604Free PMC Article

Recent systematic reviews

Joy GM, Arbiv OA, Wong CK, Lok SD, Adderley NA, Dobosz KM, Johannson KA, Ryerson CJ
Eur Respir Rev 2023 Mar 31;32(167) Epub 2023 Mar 8 doi: 10.1183/16000617.0210-2022. PMID: 36889782Free PMC Article
Esimekara JO, Perez A, Courvoisier DS, Scolozzi P
J Stomatol Oral Maxillofac Surg 2022 Oct;123(5):e464-e473. Epub 2022 Jan 13 doi: 10.1016/j.jormas.2022.01.005. PMID: 35033725
Singh JA, Shah NP, Mudano AS
Cochrane Database Syst Rev 2021 Feb 25;2(2):CD010668. doi: 10.1002/14651858.CD010668.pub2. PMID: 33631841Free PMC Article
Tunnicliffe DJ, Palmer SC, Henderson L, Masson P, Craig JC, Tong A, Singh-Grewal D, Flanc RS, Roberts MA, Webster AC, Strippoli GF
Cochrane Database Syst Rev 2018 Jun 29;6(6):CD002922. doi: 10.1002/14651858.CD002922.pub4. PMID: 29957821Free PMC Article
Kawai K, Yawn BP
Mayo Clin Proc 2017 Dec;92(12):1806-1821. doi: 10.1016/j.mayocp.2017.10.009. PMID: 29202939

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