Systemic Lupus

Erythematosus
Jillian Fernandez
Objectives
• Define systemic lupus erythematosus (SLE)
• Discuss the pathophysiology of systemic lupus erythematosus
(SLE)
• State the clinical manifestations of systemic lupus
erythematosus (SLE)
• Describe the diagnostic tests required for patients with
systemic lupus erythematosus (SLE)
• Explain the medical management provided to patients with
systemic lupus erythematosus (SLE)
Systemic Lupus Erythematosus (SLE)
• Autoimmune disease that affects multisystems
• 1.5 million cases of lupus
• Prevalence of 17 to 48 per 100,000 population
• Women > Men - 9:1 ratio
• 90% cases are women
• African Americans > Whites
• Onset usually between ages of 15 and 45 years, but
• Can occur in childhood or later in life
What is systemic lupus erythematosus (SLE)?
• Lupus is a systemic autoimmune 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 can be difficult to diagnose because its signs and symptoms
often mimic those of other ailments. 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 of
lupus.
Causes
• Sunlight
• Infections
• Medications
Risk Factors
• Sex
• Age
• Race
Symptoms
• Fatigue
• Fever
• Joint pain, stiffness and swelling
• Butterfly-shaped rash on the face that covers the cheeks and bridge
of the nose or rashes elsewhere on the body
• Skin lesions that appear or worsen with sun exposure
(photosensitivity)
• Fingers and toes that turn white or blue when exposed to cold or
during stressful periods (Raynaud's phenomenon)
• Shortness of breath
• Chest pain
• Dry eyes
• Headaches, confusion and memory loss
Diagnosis

• Diagnosing lupus is difficult because signs and symptoms vary

considerably from person to person. Signs and symptoms of lupus
may vary over time and overlap with those of many other disorders.
• No one test can diagnose lupus. The combination of blood and urine
tests, signs and symptoms, and physical examination findings leads
to the diagnosis.
Laboratory Tests

• Complete blood count

• Erythrocyte sedimentation rate
• Kidney and liver assessment
• Antinuclear antibody (ANA) test
Imaging Tests

• Chest X-ray
• Echocardiogram
Biopsy

• Lupus can harm your kidneys in many different ways, and treatments
can vary, depending on the type of damage that occurs. In some
cases, it's necessary to test a small sample of kidney tissue to
determine what the best treatment might be. The sample can be
obtained with a needle or through a small incision.
• Skin biopsy is sometimes performed to confirm a diagnosis of lupus
affecting the skin.
Medical Management

• Nonsteroidal anti-inflammatory drugs (NSAIDs). naproxen sodium (Aleve) and

ibuprofen (Advil, Motrin IB, others),
• Antimalarial drugs. hydroxychloroquine (Plaquenil)
• Corticosteroids. Prednisone and methylprednisolone (A-Methapred, Medrol)
• Immunosuppressants. Examples include azathioprine (Imuran, Azasan),
mycophenolate mofetil (CellCept) and methotrexate (Trexall)
• Biologics. belimumab (Benlysta)
• Rituximab (Rituxan) can be beneficial in cases of resistant lupus. Side effects
include allergic reaction to the intravenous infusion and infections.
Surgical Management
In some cases, surgery may be required to treat complications of
lupus.

• Kidney Transplant
• Splenectomy
• Hip Replacement
Nursing Management
Collaborative:
• Much of the therapy is pharmacologic. General supportive therapy
includes adequate sleep and avoidance of fatigue because mild
disease exacerbations may subside after several days of bedrest. A
physical therapy program is important to maintain mobility and
range of motion without allowing the patient to get overtired. If the
kidneys are involved, renal dialysis or transplantation may be
required.
• The pain and discomfort of SLE can be physically and mentally debilitating.
Encourage the patient to maintain activity when the symptoms are mild
or in remission. Encourage patients to pace all activity and to allow for
adequate rest. Hot packs may relieve joint pain and stiffness. If the patient
has Raynaud phenomenon (abnormal vasoconstriction of the extremities),
use warmth to relieve symptoms and protect the patient's hands from
injury.
• Support the patient's self-image by encouraging good grooming. Suggest
hypoallergenic cosmetics, shaving products, and hair products. Encourage
the patient to use a hair stylist or barber who specializes in caring for
people with scalp disorders and to protect all body surfaces from direct
sunlight. The patient should use sunscreen with a protective factor of at
least 20 and wear a hat and long sleeves while in the sun. Note that
certain drugs (tetracycline) and foods (figs, parsley, celery) augment the
effects of ultraviolet light and therefore should be avoided.
• Fatigue and stress can lead to exacerbations of the illness. Explore
ways for the patient to get adequate rest. Because the patient's
immune system may have a diminished capacity, encourage the
patient to avoid exposure to illness.
• Explore the meaning of the chronic illness and coping strategies with
the patient. Allow adequate time to discuss fears and concerns. A
referral to a support group or counselor may also be necessary.
Complications
• Kidneys. Lupus can cause serious kidney damage, and kidney failure
is one of the leading causes of death among people with lupus.
• Brain and central nervous system. If your brain is affected by lupus,
you may experience headaches, dizziness, behavior changes, vision
problems, and even strokes or seizures. Many people with lupus
experience memory problems and may have difficulty expressing
their thoughts.
Complications cont.
• Blood and blood vessels. Lupus may lead to blood problems,
including anemia and increased risk of bleeding or blood clotting. It
can also cause inflammation of the blood vessels (vasculitis).
• Lungs. Having lupus increases your chances of developing an
inflammation of the chest cavity lining (pleurisy), which can make
breathing painful. Bleeding into lungs and pneumonia also are
possible.
• Heart. Lupus can cause inflammation of your heart muscle, your
arteries or heart membrane (pericarditis). The risk of cardiovascular
disease and heart attacks increases greatly as well.
Having lupus also increases your risk of:
• Infection
• Cancer
• Bone tissue death (avascular necrosis)
• Pregnancy complications