Lupus Systemic Lupus Erythematosus

1
LupusSystemic Lupus Erythematosus

• Sarah Mouser

2
SLE

• A chronic multisystem inflammatory disorder that
  can affect various parts of the body esp the
  joints, kidney, skin, and blood.
• Its a disease of flares and remissions
• Autoimmune disease-attacks itself

3
Etiology

• 70-90 occur in women, but can occur in men.
• More common in African Americans Asians
• More than 16,000 new cases a year
• 5 million people worldwide
• 1.5 million in America

4
CAUSES

• No gene or gene group has been proven to cause
  Lupus
• Appears in certain families
• Unknown cause
• Some environmental factors such as UV rays,
  sulfa rays, some sun-sensitizing
  tetracyclines-Bactrim, penicillin-Amoxicillin
• Can be exaccerbated by emotional stress, cold,
  virus, exhaustion,
• Sex hormone Estrogen plays a part in it.

5
Forms of Lupus

• SLE (Systemic Lupus Erythematosus)
• CLE (Cutaneous Lupus Erythematosus)
• Drug-Induced Lupus Erythematosus

6
SLE

• Most common
• Inflammation of the kidneys
• Increased bp in the lungs
• Inflammation of blood vessels in brain
• Hardening of arteries

7
CLE

• Limited to the skin
• Raised, scaly and red, but not itchy, known as
  discoid rash bec of disk shaped lesions
• Butterfly rash

8
Drug-Induced Lupus

• Most often caused by hydralazine (used to treat
  HTN), procainamide (irregular heart rhythm),
  isoniazide (used to treat tuberculosis)
• More common in men

9
SLE

• -alterations in the immune system
• -Antinuclear antibodies, antibodies to DNA, and
  antihistones are all strongly associated with
  SLE.
• -abnormalities in both B cells and T cells
• -appearance of B cells thought to cause increase
  in production of antibodies to self
• -visceral lesions mediated by type III
  hypersensitivity

10
General Symptoms

• -extreme fatigue
• -malaise
• -fever
• -painful or swollen joints
• -known as the great imitator because it has
  symptoms similar to RA, blood disorders,
  fibromyalgia, diabetes, thyroid problems, Lyme
  disease, and many heart, lung, and muscle and
  bone disorders.

11
Prognosis

• -no cure for disease
• -80-90 can expect to live a normal life span
• -many people die from overwhelming infection and
  kidney failure
• Overall 5 yr survival rate with extended
  therapeutic options are 95

12
Diagnosis

• -difficult to diagnosis because it mimics
• -evolves over time
• -have abnormal lab tests
• -not one specific test
• 4 out of 11 of the criteria

13
Criteria

• -face rash
• -scaly, discoid rash
• -sun-related rash
• -mouth sores
• -joint pain in more than 2 joints
• -swelling around heart or lungs
• -kidney disease
• -seizures
• -low blood count
• -positive anti-nuclear antibody test
• -other positive blood tests

14
Overlapping Syndromes

• -5-30 have overlapping symptoms
• -likelihood of an overlap disease-15
• -Overlap Disease Approximate Rate of Occurrence
• Rheumatoid Arthritis 1Polymyositis-Dermatomyosit
  is 2Mixed Connective Tissue Disease
  3Scleroderma 4Sjogren's syndrome 5

15

• Myositis-muscle pain due to fatigue and high
  levels of cortisone
• Polymyositis-Dermatomyositis-muscle weakness due
  to muscle inflammation
• Scleradoma-thickened skin
• Mixed connective tissue disorder-lupus,
  polymyositis-dermatomyositis, and scleroderma.
• Sjogrens syndrome-dry eyes and mouth-caused by
  an accumulation of lymphocytes

16
Cardiovascular

• -very hard to know
• -pericardial effusion
• -myocarditis-inflammation-at risk due to
  immunosuppressives
• -increased risk for CAD, HTN from kidney disease
  or corticosteroid use, elevated cholesterol
  levels from corticosteroid use, type 2 diabetes
  from corticosteroid use
• -lupus-related anemia b/c body is not producing
  enough red blood cells, antibodies destroy the
  healthy blood cells-hemolytic anemia

17
cont

• -valvular disease
• -thrombophlebitis
• -serositis-inflammation of sacs around organs
• -vasculitis
• -Raynauds phenomenon- fingers turn white and/or
  blue when cold

18
GI system

• - dysphagia
• -nausea
• -vomiting
• -pancreatitis
• -elevated liver function tests
• -sometimes due to treatments such as NSAIDS,
  other times due to muscles not moving wastes
  through body

19
Pulmonary System

• -cough
• -dyspnea
• -pleurisy
• -pneumonitis

20
MS system

• -joint deformities
• -arthralgia-joint pain
• -morning stiffness
• -lupus arthritis, which can cause muscle atrophy

21
Skin

• -discoid lesions on sun-exposed skin
• -photosensitivity
• -butterfly rash
• -build-up of calcium deposits under the
  skin-Calcinosis
• -inflammation damages blood vessels in the
  skin-Cutaneous vasculitis lesions
• -alopecia-hair loss
• -ulcers in mouth-mucosal ulcerations
• -petechia

22
Calcinosis
23
Hematologic System

• -lupus-related anemia b/c body is not producing
  enough red blood cells, antibodies destroy the
  healthy blood cells-hemolytic anemia
• -thrombosis
• -thrombocytopenia
• -leukopenia
• -neutropenia
• Splenomegaly

24
Nervous System

• -neuropathy
• -stroke
• -seizures
• -cognitive function described as lupus fog due
  to feelings of confusion, fatigue, memory loss,
  difficulty expressing thoughts
• -lupus headache-twice as many headaches as
  general population

25
Renal System

• -lupus nephritis-inflammation of nephrons which
  can lead to ESRD
• -first sign edema of feet and hands, urine frothy
• -urinary tract infections
• -lupus cystitis-inflammation of lining of the
  bladder

26
LIVING WITH LUPUS

• -exercise is encouraged to strengthen bones and
  tone muscles
• -especially walking, swimming, bicycling,
• -limit if experiencing bone and/or joint pain
• -extreme fatigue (unknown why)
• -poor coping strategies, feelings of
  helplessness, lack of exercise
• -proper amount of rest

27
CONT

• -increased sensitivity to light
• -infections can occur more often due to
  immunosuppressive
• -most common infections are involved with the
  respiratory (lungs and heart) system, skin, and
  urinary tract also Candia (yeast) infections, and
  shingles
• -30 of people get fibromyalgia
• -depression

28
Treatments

• Corticosteroids, Antimalarial-Plaquenil, Aspirin,
  Immunosuppressive, Anticoagulants
• Treated by rheumatologist
• Treatment based on age, symptoms, health, and
  lifestyle.

29
INVESTIGATIONS

• -Monoclonal antibodies-interfere with action of
  cells involved with immune response
• -hormones
• -stem-cell transplant

30
Famous People with Lupus

• Seal-singer had non-SLE as a child
• Flannery OConnor-author
• October is official Lupus Awareness Month