Systemic

Lupus
Erythematosus
(SLE)
What is Systemic Lupus
Erythematosus (SLE)?
➢Chronic multisystem inflammatory autoimmune disease

➢Associated with abnormalities of immune system

➢Results from interactions among genetic, hormonal, environmental, and immunologic

factors

➢The word lupus (from the Latin word for wolf) is attributed to the thirteenth century physician
Rogerius, who used it to describe erosive facial lesions that were reminiscent of a wolf's
bite.
SLE affects the following:
➢Skin

➢Joints

➢Serous membranes

➢Renal system

➢Hematologic system

➢Neurologic system
Facts about SLE
SLE affects 2 to 8 persons per 100,000 in United States.

Most cases occur in women of child-bearing years.

African, Asian, Hispanic, and Native Americans 3 times more likely to develop than
whites.

Women are 10 times more likely to develop SLE than men.

SLE is characterized by variability within and among persons.

Its chronic unpredictable course is marked by alternating periods of exacerbation and

remission.
Etiology
Etiology is unknown.

Most probable causes:

➢Genetic influence

➢Hormones

➢Environmental factors

➢Certain medications
Pathophysiology
▪Multiple susceptibility genes from the HLA complex show associations with SLE, including
HLA-DR3.
▪Onset or exacerbation of disease symptoms sometimes occurs after the onset of menarche,
with the use of oral contraceptives, and during and after pregnancy.
▪The disease tends to worsen in the immediate postpartum period.
▪Sun exposure and sunburn are the most common environmental triggers.
▪Medications include procainamide (Pronestyl), hydralazine (Apresoline), and a number of
antiseizure drugs.
▪Autoimmune reactions directed against constituents of cell nucleus,
▪DNAAntibody response related to B and T cell hyperactivity
Clinical Manifestations
▪Ranges from a relatively mild disorder to rapidly progressing, affecting many body
systems

▪Most commonly affects the skin/muscles, lining of lungs, heart, nervous tissue, and
kidneys

▪No characteristic pattern occurs in the progressive involvement of SLE.

▪Any organ can be affected by an accumulation of circulating immune complexes.

▪Generalized complaints such as fever, weight loss, arthralgia, and excessive fatigue may
precede exacerbation of disease activity.
Dermatologic Signs and
Symptoms:
▪Cutaneous vascular lesions
▪Butterfly rash
▪Oral/nasopharyngeal ulcers
▪Alopecia
▪Cutaneous vascular lesions can appear in any location but are most likely to develop in sun-
exposed areas.
▪About 20% of patients have discoid (round coin-shaped) lesions.
▪A small number of patients have persistent lesions, photosensitivity, and mild systemic
disease in a syndrome referred to as subacute cutaneous lupus.
Butterfly rash
Muskoloskelatal Signs &
Symptoms:
•Polyarthralgia with morning stiffness

•Arthritis

•Swan neck fingers

•Ulnar deviation

•Subluxation with hyperlaxity of joints

•Polyarthralgia with morning stiffness is often the patient’s first complaint and may
precede by many years the onset of multisystem disease.

•Arthritis occurs in more than 90% of patients with SLE.

Swan-neck deformities
Ulnar deviation
Cardiopulmonary Signs &
Symptoms:
▪Tachypnea
▪Pleurisy
▪Dysrhythmias
▪Accelerated CAD
▪Pericarditis
▪Cardiac involvement may include dysrhythmias resulting from fibrosis of the sinoatrial and
atrioventricular nodes.
▪This occurrence is an ominous sign of advanced disease, contributing significantly to the
morbidity and mortality seen in SLE.
Renal Signs & Symptoms:
▪Lupus nephritis

▪Ranging from mild proteinuria to glomerulonephritis

▪Primary goal in treatment is slowing the progression.Lupus nephritis (LN) occurs in

approximately 50% of patients with SLE.

▪Treatment typically includes corticosteroids, cytotoxic agents (cyclophosphamide

[Cytoxan]), immunosuppressive agents (azathioprine [Imuran]), and cyclosporine.

▪A newer drug (mycophenolate mofetil [CellCept]) may be more effective and less toxic
than cyclophosphamide, which has been the standard of treatment.
Neurologic Signs & Symptoms
•Generalized/focal seizures central nervous system (CNS), and occur in
as many as 15% of patients with SLE by the
•Peripheral neuropathy
time of diagnosis.
•Cognitive dysfunction
•Seizures are generally controlled by
•Disorientation corticosteroids or antiseizure drugs.

•Memory deficits •Various psychiatric disorders are reported

in SLE, including mood disorders, anxiety,
•Psychiatric symptoms and psychosis, although they may also be
•Generalized or focal seizures are the most related to the stress of having a major
common manifestation involving the illness or to associated drug therapies.
Hematologic Signs & Symptoms
•Formation of antibodies against blood cells
•Anemia
•Leukopenia
•Thrombocytopenia
•Some patients develop a tendency toward coagulopathy involving excessive bleeding or
blood clot development.
•A manifestation of antiphospholipid antibody syndrome is a common cause of
hypercoagulability in SLE patients, many of whom benefit from high-intensity treatment
with warfarin (Coumadin).
Signs & Symptoms of Infection:
▪Increased susceptibility to infection

▪Fever should be considered serious.

▪Patients with SLE appear to have increased susceptibility to infection, possibly related to
defects in the ability to phagocytize invading bacteria, deficiencies in production of
antibodies, and the immunosuppressive effects of many anti-inflammatory drugs.

▪Infection is a major cause of death, with pneumonia being the most common infection.
Diagnostic Studies
▪SLE is characterized by the presence of ANA, and its identification establishes the
existence of an autoimmune disease.

▪Other antibodies include anti-DNA, antineuronal, anticoagulant, anti-WBC, anti–red

blood cell (RBC), antiplatelet, antiphospholipid, and anti–basement membrane.

▪High levels of anti-DNA are rarely found in any condition other than SLE, and anti-Smith
antibody seems to be found almost exclusively in SLE.
Collaborative Care
▪Drug therapy

▪NSAIDs

▪Antimalarial drugs

▪Steroid-sparing drugs

▪Corticosteroids

▪Immunosuppressive drugs
Continuation
▪NSAIDs continue to be an important intervention, especially for patients with mild
polyarthralgias or polyarthritis.

▪Antimalarial agents such as hydroxychloroquine (Plaquenil) often are used to treat

fatigue and moderate skin and joint problems.

▪Steroid-sparing immunosuppressants such as methotrexate can serve as an alternate

treatment and are prescribed in combination with folic acid to decrease minor side
effects of corticosteroids.

▪Immunosuppressive drugs such as azathioprine (Imuran) and cyclophosphamide

(Cytoxan) may be prescribed to reduce the need for long-term corticosteroid therapy.
Assessment
▪Assess patient’s physical, psychologic, and sociocultural problems with long-term
management of SLE.

▪Assess pain and fatigue daily.

▪Subjective and objective data that should be obtained from the patient with SLE are
presented in Table
Nursing Diagnoses
▪Fatigue

▪Acute pain

▪Impaired skin integrity

▪Risk for infection

▪Risk for injury

Nursing Management
•During exacerbation, patient will become abruptly, dramatically ill.
•Record severity of symptoms and response to therapy.
Observe for:
•Fever pattern
•Joint inflammation
•Limitation of motion
•Location and degree of discomfort
•Fatigability
Nursing Management
▪Monitor weight and I&O.

▪Collect 24-hour urine sample.

▪Assess neurologic status.

▪Explain nature of disease.

▪Collection of 24-hour urine samples for protein and creatinine clearance may be ordered.

▪Careful assessment of neurologic status includes observing for visual disturbances,

headaches, personality changes, seizures, and forgetfulness.

▪Psychosis may indicate CNS disease or may be the effect of corticosteroid therapy.
Discharge Planning
▪Ambulatory and home care

▪Emphasize health teaching.

▪Reiterate that adherence to treatment does not necessarily halt progression.

▪Minimize exposure to precipitating factors.

▪Teach the patient that a variety of factors may increase disease activity, such as fatigue,
sun exposure, emotional stress, infection, drugs, and surgery.
Lupus and Pregnancy
•Infertility can result from SLE’s regimen.

•Women with serious SLE should be counseled against pregnancy.

•Neonatal lupus erythematosus (NLE) may occur in infants born of women with SLE.

•The SLE patient should understand that spontaneous abortion, stillbirth, and intrauterine growth
retardation are common problems with pregnancy.

•They occur because of deposits of immune complexes in the placenta and because of
inflammatory responses in the placental blood vessels.

•For the best outcome, pregnancy should be planned at a point when disease activity is minimal.
Psychosocial Issues
•Counsel patient and family that SLE has good prognosis.

•Physical effects can lead to isolation, self-esteem, and body image disturbances.

•Assist patient in developing goals.

•Families are anxious about hereditary aspects and want to know whether their children will also
have SLE.

•Consultation with a dermatologist may be recommended for appropriate treatment and cosmetic
products to conceal the rash.

•However, pain and fatigue are cited most frequently as interfering with quality of life.
 2018 2020
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2019