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SYSTEMIC LUPUS ERYTHEMATOSUS

SYSTEMIC LUPUS
ERYTHEMATOSUS

 10 x more frequent in women

 a result of disturbed immune regulation that causes an exaggerated
production of autoantibodies
 Increase in autoantibody production is thought to result from abnormal
suppressor T- cell function leading to tissue damage
 inflammation stimulates antigen, which in turn stimulate additional
antibodies, and the cycle repeats.
 Causes: genetic, hormonal, environmental (sunlight, thermal burns),
medications (hydralazine, procainamide, isoniazid, chlorpromazine, anti-
seizure) have been implicated in drug-induced SLE
 Other types of lupus:
 Discoid lupus- affects the skin
 Sub-acute cutaneous lupus erythematosus- characterized by
specific, non scarring lesion
 Drug-induced lupus- develops after a drug reaction
 Neonatal lupus – affects newborns
There are 11 American College of Rheumatology criteria for Lupus. Lupus is
differentiated from other connective tissue diseases, based on eleven criteria
offered by the American College of Rheumatology for classification purposes.
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SYSTEMIC LUPUS ERYTHEMATOSUS

 Butterfly-shaped rash across cheeks and nose

 Scaly disk-shaped rash on face, neck, ears, scalp, chest

 Sunlight sensitivity
 Mouth sores, tongue sores, inside nose sores
 Arthritis pain in joints
 Pain in chest and side when breathing or moving
 Kidney problems
 Neurologic problems
 Blood problems such as anemia, low white cell count
 Immune system malfunction
 Antinuclear antibodies

CLINICAL MANIFESTATIONS
Musculoskeletal system
 Arthralgias and arthritis (synovitis) - common
 Joint swelling, tenderness, and pain on movement
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SYSTEMIC LUPUS ERYTHEMATOSUS

 Morning stiffness
Skin manifestations
 Butterfly-shaped rash across the bridge of the nose and cheeks –
worsen during exacerbations of the systemic disease, provoked by
sunlight or artificial UV light
 Oral ulcers in the buccal mucosa or the hard palate
Cardiac manifestations
 Pericarditis – most common
 Early atherosclerosis
 Renal involvement leads to renal damage and hypertension
 CNS involvement
 Subtle changes in behavioral patterns or cognitive ability
 Depression and psychosis – common

ASSESSMENT AND DIAGNOSTIC FINDINGS

 Classic symptoms : fever, fatigue, weight loss, arthritis, pleurisy and
pericarditis
 Skin: Erythematous rashes, areas of hyperpigmentation or
depigmentation
 Scalp: alopecia; mouth and throat: ulcerations reflecting GI involvement
 Cardiovascular: auscultae for pericardial friction rub
 Papular, erythematous and purpuric lesions developing on the
fingertips, elbows, toes and forearms (may suggest vascular involvement)
 Neurologic assessment – identify and describe any CNS changes
 No single laboratory test confirms SLE ; blood tests reveals anemia,
thrombocytopenia, leukocytosis, or leucopenia and positive ANAs.
 Serum creatinine and urinalysis for renal involvement
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SYSTEMIC LUPUS ERYTHEMATOSUS

MEDICAL MANAGEMENT
 Goal: Preventing progressive loss of organ function, reducing the
likelihood of acute disease, minimizing disease-related disabilities, and
preventing complications from therapy.
Pharmacologic Therapy:
 Corticosteroids – most important
› Used topically for cutaneous manifestations, in low oral doses for
minor disease activity, and in high doses for major disease activity
 Antimalarial medications – effective for managing cutaneous,
musculoskeletal and mild systemic features of SLE
 NSAIDs used for minor clinical manifestations are often used along with
corticosteroids
 Immunosuppressive agents (alkalyting agents and purine analogues) –
used because of their effect on the immune function. Given for serious
forms of SLE that have not responded to conservative therapies

NURSING MANAGEMENT
Common Nursing Diagnoses:
 Fatigue
 Impaired skin Integrity
 Body Image Disturbance
 Deficient Knowledge for Self-Management decisions
Teachings:
 Patients should be taught to avoid exposure or to protect themselves
with sunscreen and clothing
 Patients should understand the need for routine periodic screenings as
well as health promotion activities
 Instruct patient of the importance of dietary recommendations and
continuing prescribed medications and addressing the potential side
effects that are likely to occur with their use.