Systemic Lupus Erythematosus (SLE)

Systemic Lupus Erythematosus (SLE)By:Mr. M. Sivananda Reddy

IncidenceAbout 90% of all cases occur in womenMost cases occur in women of childbearing yearsAt the age of 30 years the ratio of women to men is 10:1African, Asian, Hispanic, and Native Americans three times more likely to develop than whites

EtiologyAuto immuneEtiology is unknownMost probable causes:Genetic influenceHormonesEnvironmental factors- UV B rays, infections with CMV, HCV, smokingCertain medications- Trimethoprim, Sulphamethaxozole

PathophysiologyAutoimmune reactions directed against constituents of cell nucleus, DNAAntibody response related to B and T cell hyperactivity which is stimulated by the EstrogenThe antigen antibody complexes that are developed will be in the circulation and blocks the microvasculature and the spaces

Clinical ManifestationsRanges from a relatively mild disorder to rapidly progressing, affecting many body systemsMost commonly affects the skin/muscles, lining of lungs, heart, nervous tissue, and kidneys

Dermatologic:Cutaneous vascular lesionsButterfly rashOral/nasopharyngeal ulcersAlopecia

Butterfly Rash / Malar Rash

MusculoskeletalPolyarthralgia with morning stiffnessArthritisSwan neck fingersUlnar deviationSubluxation with hyperlaxity of joints

Swan Neck Deformity

Ulnar deviation:

CardiopulmonaryTachypneaPleuritisDysrhythmiasAccelerated CADPericarditis

RenalLupus nephritisRanging from mild proteinuria to glomerulonephritis

Nervous systemGeneralized/focal seizuresPeripheral neuropathyCognitive dysfunctionDisorientationMemory deficitsPsychiatric symptoms

HematologicFormation of antibodies against blood cellsAnemiaLeukopeniaThrombocytopeniaCoagulopathyAnti-phospholipid antibody syndrome

InfectionIncreased susceptibility to infectionsFever should be considered seriousInfections such as pneumonia are a common cause of death

Diagnostic Studies

Antinuclear antibodiesANA and other antibodies indicate autoimmune diseaseAnti-DNA and anti-Smith antibody tests most specific for SLEESR & CRP are indicative of inflammatory activity.

CBC for hematologic problemsUltrasound Abdomen for lupus nephritisX-rays of affected jointsChest x-ray for pulmonary problemsECG for cardiac problems

TreatmentDrug therapyNSAIDs- AcetaminophenAntimalarial drugs- HydroxychloroquineCorticosteroids- PrednisoneImmunosuppressive drugs

Nursing ManagementNursing DiagnosesFatigueAcute painImpaired skin integrityIneffective therapeutic regimen managementBody image disturbance

Nursing InterventionsObserve forFever patternJoint inflammationLimitation of motionLocation and degree of discomfortFatigability

Monitor weight and I&OCollect 24-hour urine sampleAssess neurological statusExplain nature of diseaseProvide support

Ambulatory and home careReiterate that adherence to treatment does not necessarily halt progressionMinimize exposure to precipitating factors fatigue, sun, stress, infection, drugsTeach energy conservation and relaxation exercisesTeach regarding ROM to prevent contractures

Psychosocial issuesCounsel patient and family that SLE has good prognosisPhysical effects can lead to isolation, self-esteem, and body image disturbancesAssist patient in developing goals