Systemic Lupus Erythematosus SLE

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Systemic Lupus Erythematosus (SLE)

• Cheryl McConnell RN, MSN

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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 40
• In this age group 1200 will develop lupus
• Usual onset is during childbearing age
• Possible hormonal link
• 8 10 times more prevalent in women

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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

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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

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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

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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

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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

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Signs and Symptoms of Lupus

• Skin
• Dry, scaly, raised rash on face
• Appears to be in butterfly patternthe Bite of
  the Wolf.
• Individual round lesions
• Hair
• Hair loss
• Change in texture

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Signs and Symptoms of Lupus

• Musculoskeletal
• 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
  invasionleading to Myositis).
• Muscle pain

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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

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Signs and Symptoms of Lupus

• Respiratory
• Pleural effusions
• Results in restrictive and obstructive changes
• Dyspnea
• Hypoventilation

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Signs and Symptoms of Lupus

• Cardiac
• Pericarditis Raynauds Disease
• Tachycardia Lack of circulation
• Pain to hands and feet
• Myocardial ischemia
• Chest Pain
• Cardiac Dysrrhythmias

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Signs and Symptoms of Lupus

• Neurological
• Psychoses
• Paresis
• Seizures
• Headaches
• Strokes
• Peripheral neuropathies
• http//www.mtio.com/lupus/lal_7.htm

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Signs and Symptoms of Lupus

• GI Tract
• Abdominal pain
• Mesenteric arteritis
• Pancreatitis
• Ulcers
• Liver enlargement
• Spleenomegaly

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Signs and Symptoms of Lupus

• Sexual Dysfunction
• Pain
• Fatigue/weakness
• Self esteem
• Decreased desire

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Signs and Symptoms of Lupus

• Systemic
• Fever
• Generalized weakness
• Fatigue
• Anorexia
• Weight loss

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Signs and Symptoms of Lupus

• Psychosocial
• Dealing with illness
• Fear of death chronic
• Lack of socialization
• Body image changes
• Rash
• Medication related

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Treatment

• Medications
• Topical steroids for lesions
• Plaquenil (hydroxychloroquine) Can damage retina
• Steroids
• Immunosuppressives
• Anticoagulants if needed

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Treatment

• Skin protection
• Avoid sunlight
• Mild soaps
• Cosmetic cover-ups
• Daily inspection
• Hair loss
• Mild shampoo
• No chemicals

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Patient teaching

• May need repeated hospitalizations
• Recognize signs of exacerbation
• Coping strategies
• Need for continued medical follow up
• Healthy lifestyle
• Lupus support group

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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

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Lupus Support

• The National Lupus Foundation
• www.lupus.org