Systemic Lupus Erythematosus (SLE)
Cheryl McConnell RN, MSN
Lupus: Prevalence
1 in 700 (ages 15 -64) women have lupus 1 in 250 are African American Women
Asian and Native Americans = ↑ incidence
Usually affects women between 15 to 40In this age group 1:200 will develop lupusUsual onset is during childbearing age Possible hormonal link
8 – 10 times more prevalent in women
Types of Lupus
• SLE – Systemic– Chronic, progressive, inflammatory
connective tissue disorder that causes organ failure; potentially fatal with a 5-year survival rate of 85%
• Drug Induced Lupus– Procainimide– Hydralazine– INH
• DLE – Discoid – Affects only the skin
Pathophysiology of Lupus
• Autoimmune: Exact Mechanism Unknown– Viruses– Environmental chemicals– Genetic
• Antibodies “attack” healthy tissue
• Causes inflammation to the organ or to the vessels supplying blood to the organ– Deprives organs of arterial blood supply
Prognosis
• Potentially fatal disorder
• Increase in survival rate in last 20 years
• Now… 85% of clients survive at least 5 years– Leading cause of death are related to
infection
Diagnostics
• DLE = skin biopsy• Serum ANA, ESR, protein
electrophoresis, complement, immunoglobins
• Lupus cell prep (LE prep)• CBC• Electrolytes• Liver and cardiac enzymes• Coag studies• Anticardiolipin Antibodies
Diagnostic Criteria
• Must have four of the following eleven symptoms or findings:Malar rash Discoid lupus
Mouth sores Photosensitivity
Arthritis Abnormal UA
Serositis Neurologic disorder
+ ANA Hematologic disorder
Immunologic Disorder
Signs and Symptoms of Lupus• Skin:
– Dry, scaly, raised rash on face– Appears to be in butterfly
pattern—the “Bite of the Wolf.”– Individual round lesions
• Hair– Hair loss– Change in texture
Signs and Symptoms of LupusMusculoskeletal
Joints are affected causing painful mobility (Polyarthritis in 90% of SLE patients).
Joint inflammation Avascular necrosis – after
5 years of diagnosis Muscle atrophy (results
from autoimmune complex invasion—leading to Myositis).
Muscle pain
Sign and Symptoms of Lupus
• Renal– Lupus nephritis
• Changes in the glomeruli– Decreased urinary output– Proteinuria– Hematuria– Fluid retention– Leading cause of death– 50% of all lupus pts have
this
Signs and Symptoms of Lupus
• Respiratory– Pleural effusions
• Results in restrictive and obstructive changes
–Dyspnea–Hypoventilation
Signs and Symptoms of Lupus
• CardiacPericarditis Raynaud’s Disease
• Tachycardia Lack of circulation• Pain to hands
and feet• Myocardial ischemia
Chest Pain
Cardiac Dysrrhythmias
Signs and Symptoms of Lupus
• Neurological
–Psychoses
–Paresis
–Seizures
–Headaches
–Strokes
–Peripheral neuropathies– http://www.mtio.com/lupus/lal_7.htm
Signs and Symptoms of Lupus
• GI Tract– Abdominal pain
• Mesenteric arteritis• Pancreatitis• Ulcers• Liver enlargement• Spleenomegaly
• Sexual Dysfunction– Pain– Fatigue/weakness– Self esteem– Decreased desire
• Psychosocial– Dealing with illness– Fear of death chronic– Lack of socialization– Body image changes
• Rash• Medication related
• Systemic– Fever– Generalized weakness– Fatigue– Anorexia– Weight loss
Treatment
• Medications:– Topical steroids for
lesions– Plaquenil
(hydroxychloroquine) Can damage retina
– Steroids– Immunosuppressives– Anticoagulants if
needed
• Skin protection– Avoid sunlight– Mild soaps – Cosmetic cover-ups- Daily inspection
• Hair loss– Mild shampoo– No chemicals
Patient teaching
• May need repeated hospitalizations
• Recognize signs of exacerbation
• Coping strategies• Need for continued medical
follow up• Healthy lifestyle• Lupus support group
More Patient Teaching
• Energy conservation
• Sexual counseling
• Pregnancy aggravates the signs and symptoms– No pregnancy if patient has complications
involving cardiac, renal, or CNS– Has increased risk of miscarriage, stillbirth,
premature birth
Lupus Support
• The National Lupus Foundation
–www.lupus.org