Systemic Lupus Erythematosus

Safaa EID
Medical surgical and critical care
department
 Definition
• is an autoimmune disease of the body's
connective tissues.

• Autoimmune means that the immune system

attacks the tissues of the body.
• attacks parts of the cell nucleus.

• between the ages of 15 and 40, although it

can show up at any age.
 Pathogenesis

• A healthy immune system produces

proteins called antibodies and specific cells
called lymphocytes.

• that help fight and destroy viruses, bacteria,

and other foreign substances that invade the
body.
• In lupus, the immune system produces
antibodies against the body's healthy cells
and tissues.
• These antibodies, contribute to the
inflammation of various parts of the body
and can cause damage to organs and tissues.
• Lupus can affect
-joints, skin, kidneys, heart, lungs, blood
vessels, and brain.
 Causes
• The exact causes is not known.

• Inherited genes, viruses, ultraviolet light,

and drugs may all play some role.

• Genetic factors increase the tendency of

developing autoimmune diseases
• female hormones play an important role in
the expression of SLE.
• a key enzyme's failure to dispose of dying
cells may contribute the development of
SLE.

• a genetic mutation

• Drug-induced lupus. ( hydralazine, beta-

blokers, isoniazid) .
 There are several kinds of lupus:
• Discoid lupus
erythematosus is
• a chronic skin disorder
• red, raised rash appears
on the face, scalp, or
elsewhere
• The rash may last for
days or years .
• Sub acute cutaneous lupus erythematosus refers
to skin lesions that appear on parts of the body
exposed to sun. The lesions do not cause scarring.

• Drug-induced lupus is a form of lupus caused by

medications. Many different drugs can cause drug-
induced lupus

• Neonatal lupus is a rare disease that can occur in

newborn babies of women with SLE
 • Sjögren's syndrome is an autoimmune
disorder in which immune cells attack and
destroy the excroin glands that produce
tears and saliva.

• Sjögren's syndrome is also associated with

rheumatic disorders such as rheumatoid
arthritis
Secondary sjogren’s syndrome
• Dry eyes
• Dry mouth
 Clinical manifestations

• The symptoms of SLE come on in

waves, called flares or flare-ups. In
between flares, patients may have
almost no symptoms.
• general discomfort, extreme fatigue,
fever, and weight loss at some point.
 “Common Symptoms of Lupus

• Painful or swollen joints and muscle pain

• Unexplained fever
• Red rashes, most commonly on the face
• Chest pain upon deep breathing
• Unusual loss of hair
• Pale or purple fingers or toes from cold or
stress .
• Sensitivity to the sun
• Swelling (edema) in legs or around eyes
• Swollen glands
• Extreme fatigue
• Malar rash:

• This is a "butterfly-
shaped" red rash over the
cheeks below the eyes and
across the bridge of the
nose.
• It may be a flat or a raised
rash.
• The rashes are made worse
by sun exposure.
• Raynaud’s
phenomenon
• is commonly found in
lupus.
• reaction of distal digits to
cold or emotion, in which
the skin colour changes
from white to blue to red)
• Maculopapular
eruption
• Vasculitic skin
lesion
• Alopecia
• Oral ulcer:

• Painless sores in the

nose or mouth need to
be observed and
documented by a
doctor.
 Different symptoms in different
body systems :

• Kidneys
Inflammation of the kidneys (nephritis)
Lungs

Central nervous system:

• Blood vessels:
• Blood vessels may become inflamed
(vasculitis)
• Muscles and Bones:
• joint pain or inflammation.
• The pain can come and go, or it can be
long lasting.
• Blood:
• anemia, leucopenia (a decreased number
of white blood cells), or thrombocytopenia
(a decrease in the number of platelets in the
blood, which assist in clotting).
• Heart:
• (myocarditis and endocarditis) or the
membrane that surrounds it (pericarditis).
• Digestive System:
• Symptoms include abdominal pain, loss of
appetite, nausea, and sometimes vomiting.
• psychological and emotional effects
• such as grief, depression, and anger,
depression
• Pregnancy.
• However, the chances of miscarriage,
premature birth, and death of the baby in
the uterus are high.
 Diagnostic studies
– Complete blood count (CBC)
– Erythrocyte sedimentation rate (ESR)
– Urinalysis
– Blood chemistries
– Antinuclear antibody test (ANA)
– Other autoantibody tests (anti-DNA)
• Skin biopsy
• Kidney biopsy
 Treatment
• A conservative regimen of physical and
emotional rest is required
• protection from direct sunlight
• a healthful diet
• prompt treatment of infections
• pregnancy must be planned for times when
the disease is under control, and the patient is
on allowable medications.
 Medications
1-NSAIDs:
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
such as ibuprofen and naproxen.
2- Antimalarials:
• (Plaquenil). It may be used alone or in
combination with other drugs
3- Corticosteroids:
4- Immunosuppressives: For some patients
whose kidneys or central nervous system are
affected by lupus, such as cyclophosphamide
(Cytoxan)
- restrain the overactive immune system by
blocking the production of immune cells.
 Other therapy
• Plasma exchange
• Intravenous Immunoglobulin
• Stem cell transplantation
• Immune therapy ( anti-IL10, anti-CD20,
and immune tolerance therapy)
 Nursing care
• Minimize appearance of lesions.
• Alleviate discomfort
• Minimize fatigue.
• Maintain weight at optimal range
• Teach the patient to recognize fever and signs and
symptoms of infection.
• Maintain joint function and increase muscle
strength.
– Recognize anemia and develop a plan of
care
– Minimize episodes of bleeding.
– Minimize incidence of infection.
– Educate the patient about immunizations
– Educate patient nutritional status.
Thanks