Systemic Lupus Erythematosus2

8/13/2019 Systemic Lupus Erythematosus2

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Systemic Lupus Erythematosus

Daniel Ryan M. Arriola II


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Background Information

Overall prevalence of SLE isestimated to be 1 per 2500 persons

Occurs 10 times more frequently in

women than in men and

approximately three times more

frequently in African Americans than inCaucasians


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Unknown cause

Tissues and Cells are damaged by

immune system

Lupus literally means wolf - lesions of

skin

Erythematosusredness of the skin

due to inflammation


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Systemicnot confined in the skin butcan affect tissues and cells all through

out the body

Another systemic effect is the presence of

low grade fever in most cases of SLE


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Autoimmune disorder

Combination of self antibodies with

self-antigen forms immune complexes

Inflammation and tissue destructions

Multisystemcan affect different

systems of the body


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Autoimmmune or Connective Tissue

Disorders

An illness that occurs when the body isattacked by its own immune system.

The bodys immune system malfunctions

and produces large amounts of harmfulsubstances called autoantibodies.

Autoantibodies, unlike normal antibodies

that target foreign invaders such asviruses and bacteria, attack the bodiesown tissue and cells.


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Autoantibodies

Autoantibody-mediated inflammationand cell damage and destruction can

affect blood cells, skin, joints, kidneys,

lungs, nervous system, and otherorgans of the body.


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Development of Autoimmunity


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PATHOPHYSIOLOGY


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Predisposing Factors

Genetic Predisposition

Gender

Environmental stimuli start Immune

Responses

Autoantibodies Appear through

autoimmunity


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Regulation of theAutoantibodies Fails:Clinical disease

Chronic inflammation and progressive

damage


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Formation of Auotantibodies

Specifically, B cells and T cells both

contribute to the immune response inSLE. B cells are instrumental in

promoting the onset and flares of the

disease

Clinical Manifestations


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CLINICALMANIFESTATIONS


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The Joints and Muscles

Involvement of the musculoskeletalsystem, with arthralgias and arthritis,

is a common presenting feature of

SLE Joint swelling, tenderness, and pain

on movement are also common

Frequently, these are accompanied bymorning stiffness

Onset of disease may be insidious or

acute


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The Skin

Several different types of skinmanifestations may occur in pts withSLE, including subacute cutaneouslupus erythematosus, which involvespapulosquamous or annular polycycliclesions, and discoid lupuserythematosus, which is a chronic

rash that has erythematous papules orplaques and scaling and can causescarring and pigmentation changes


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The Skin Cont.

The most familiar skin manifestation(occurring in more than 50% of pts

with SLE) is an acute cutaneous

lesion consisting of a butterfly-shapedrash across the bridge of the nose and

cheeks

In some cases of discoid lupuserythematosus, only skin involvement

occurs


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The Skin Cont.

In some pts with SLE, the initial skininvolvement is the precursor to more

systemic involvement

The lesions often worsen duringexacerbations (flares) of the systemic

disease and possibly are provoked by

sunlight or artificial ultraviolet light


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Malar or Butterfly Rash


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Acute Cutaneous: Malar Rash

Note Sparing of Nasolabial Folds


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Chronic

Cutaneous:

Discoid

Note Scarring,

Hyperpigment

-ation


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Discoid RashStimulated by UV light


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Livedo Reticularis


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Cardiovascular

Pericarditis is the most commoncardiac manifestation

Women who have SLE are also at risk

for early atherosclerosis


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Urinary

Serum creatinine levels and urinalysisare used in screening for renal

involvement

Early detection allows for prompttreatment so that renal damage can

be prevented

Renal involvement may lead tohypertension, which also requires

careful monitoring and management


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Central Nervous System

Central nervous involvement iswidespread, encompassing the entire

range of neurologic disease.

The varied and frequentneuropsychiatric presentations of SLE

are now widely recognized. These are

generally demonstrated by subtlechanges in behavior patterns or

cognitive ability.


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Endocrine

Sex hormone may play a role in SLEbecause 90% of the cases occur in

female and females with SLE have

reduced levels of androgens


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Respiratory

Chest pain caused by inflammation ofpleural membranes, fever, SOB and

hypoxemia


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Digestive

Ulcers may develop in the oral cavityand pharynx

Abdominal pain and vomiting may

occur No cause can be found

Inflammation of the pancreas

Occasionally enlargement of the liver


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Thank you

Systemic Lupus Erythematosus2

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