1. Systemic Lupus Erythematosus (SLE) Cheryl McConnell RN, MSN

2. 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 1:200 will develop lupus Usual onset is during childbearing age Possible hormonal link 8 – 10 times more prevalent in women

3. 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

4. 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

5. 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

6. 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

7. Diagnostic Criteria Must have four of the following eleven symptoms or findings: Malar rashDiscoid lupus Mouth soresPhotosensitivity ArthritisAbnormal UA SerositisNeurologic disorder + ANAHematologic disorder Immunologic Disorder

8. 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

9. 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 invasion— leading to Myositis).  Muscle pain

10. 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

11. Signs and Symptoms of Lupus Respiratory –Pleural effusions Results in restrictive and obstructive changes –Dyspnea –Hypoventilation

12. Signs and Symptoms of Lupus Cardiac PericarditisRaynaud’s Disease TachycardiaLack of circulation Painto hands and feet Myocardial ischemia Chest Pain Cardiac Dysrrhythmias

13. Signs and Symptoms of Lupus Neurological –Psychoses –Paresis –Seizures –Headaches –Strokes –Peripheral neuropathies –http://www.mtio.com/lupus/lal_7.htmhttp://www.mtio.com/lupus/lal_7.htm

14. 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

15. 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

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

17. 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

18. Lupus Support The National Lupus Foundation –www.lupus.org