SYSTEMIC LUPUS ERYTHEMATOSUS

an autoimmune disease in which a person's

immune system attacks various organs or cells of the body, causing damage and dysfunction. Lupus is called a multisystem disease because it can affect many different tissues and organs in the body.

PATHOPHYSIOLOGY
Results from disturbed immune regulation that

causes exaggerated production of autoantibodies Cause: UNKNOWN Risk factors:

Genetic Hormonal Environment medications

 Increase autoantibody is thought to result from

abnormal suppressor T-cell function

CLINICAL MANIFESTATIONS

SYSTEMIC MANIFESATIONS
Musculoskeletal system
Athralgas and arthritis Joint swelling, tenderness, and pain

Skin manifestations
Papulosquamous or annular polycylic lesions

Chronic rash that has erythematous papules or plaques

and scaling Butterfly-shaped rash across the bridge of the nose and cheeks

 Skin manifestations
Oral ulcers

Cardiac manifestations
Pericarditis Atherosclerosis

Renal manifestations
Signs and symptoms of renal damage

CNS manifestations
Subtle changes in behavior patterns or cognitive ability Depression and psychosis

Eleven criteria to diagnose lupus:

Malar rash - "butterfly-shaped" red rash Discoid rash Photosensitivity Oral ulcers Arthritis Serositis Kidney disease (nephritis) Neurological disorder Blood disorder Immunologic disorder Positive anti-nucleRt antibody

MEDICAL MANAGEMENT

Goals of Treatment
Preveting progressive loss of organ function

Reducing the likelihood of acute disease

Minimizing disease-related disabilities Preventing complications from therapy

Pharmacologic therapy
Basis: concept that local tissue inflammation is

mediated by exaggerated or heightened immune response NSAIDs along with corticosteroids

 Corticosteroids
used for anti-inflammatory or immunosuppressant

effects Used topically for cutaneous manifestations Low oral dose for minor disease activity High doses for major disease activity

Nursing responsibilities

Steroid withdrawal syndrome consisting of lethargy, fever, myalgia can develop following abrupt discontinuance Acute adrenal insufficiency (even death) may occur if the drugs are withdrawn abruptly. Prior to initiation of long-term steroid therapy, perform baseline ECGs, blood pressures, chest and spinal radiographs, glucose tolerance tests, and evaluations of HPA-axis function in all patients

 Antimalarial medications
Hydroxychloroquine Effective for managing cutaneous, musculoskeletal

and systemic features of SLE

Nursing responsibilities
Use cautiously in patients with a history of bleeding

disorders, GI bleeding, and severe hepatic, renal, or cardiovascular disease may also decrease response to diuretics or antihypertensive therapy.

 IMMUNOSUPPRESSIVE AGENTS
Reserved for patients who have serious forms of

SLEwho have not responded to conservative therapies

PATIENT EDUCATION ON MEDICATIONS

Take medication as directed per physician order

Do not stop taking medication without discussing

it with primary care physician Bed rest avoid high-pressure situations sun block

 physically active

relaxation techniques
inform patients about weight control, low-fat diet,

and exercise social support system

RHEUMATOID ARTHRITIS

 Autoimmune reaction primarily occurs in the

synovial tissue