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