systemic lupus eritematosus
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Systemic Lupus EritematosusTRANSCRIPT
Copyright 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Systemic Lupus Systemic Lupus Erythematosus (SLE)Erythematosus (SLE)
Copyright 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Systemic Lupus Systemic Lupus Erythematosus (SLE)Erythematosus (SLE)
Chronic multisystem inflammatory Chronic multisystem inflammatory diseasedisease
Associated with abnormalities of Associated with abnormalities of immune systemimmune system
Results from interactions among Results from interactions among genetic, hormonal, environmental, genetic, hormonal, environmental, and immunologic factors and immunologic factors
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Systemic Lupus ErythematosusSystemic Lupus Erythematosus
Affects theAffects the SkinSkin JointsJoints Serous membranes Serous membranes Renal systemRenal system Hematologic systemHematologic system Neurologic systemNeurologic system
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Systemic Lupus ErythematosusSystemic Lupus Erythematosus
A variable diseaseA variable disease ChronicChronic UnpredictableUnpredictable Characterized by exacerbations & Characterized by exacerbations &
remissionsremissions
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IncidenceIncidence
SLE affects 2 to 8 persons per SLE affects 2 to 8 persons per 100,000 in United States100,000 in United States
Most cases occur in women of Most cases occur in women of childbearing yearschildbearing years
African, Asian, Hispanic, and Native African, Asian, Hispanic, and Native Americans three times more likely to Americans three times more likely to develop than whitesdevelop than whites
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EtiologyEtiology
Etiology is unknownEtiology is unknown Most probable causesMost probable causes
Genetic influenceGenetic influence HormonesHormones Environmental factorsEnvironmental factors Certain medicationsCertain medications
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PathophysiologyPathophysiology
Autoimmune reactions directed Autoimmune reactions directed against constituents of cell nucleus, against constituents of cell nucleus, DNADNA
Antibody response related to B and Antibody response related to B and T cell hyperactivityT cell hyperactivity
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Clinical ManifestationsClinical Manifestations
Ranges from a relatively mild Ranges from a relatively mild disorder to rapidly progressing, disorder to rapidly progressing, affecting many body systemsaffecting many body systems
Most commonly affects the Most commonly affects the skin/muscles, lining of lungs, heart, skin/muscles, lining of lungs, heart, nervous tissue, and kidneysnervous tissue, and kidneys
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Fig 65-9Fig 65-9
Clinical ManifestationsClinical Manifestations
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Clinical ManifestationsClinical Manifestations
Dermatologic Dermatologic Cutaneous vascular lesionsCutaneous vascular lesions Butterfly rashButterfly rash Oral/nasopharyngeal ulcersOral/nasopharyngeal ulcers AlopeciaAlopecia
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Dermatologic ManifestationsDermatologic Manifestations
Fig 65-10Fig 65-10
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Clinical ManifestationsClinical Manifestations
MusculoskeletalMusculoskeletal Polyarthralgia with morning stiffnessPolyarthralgia with morning stiffness ArthritisArthritis Swan neck fingersSwan neck fingers Ulnar deviationUlnar deviation Subluxation with hyperlaxity of jointsSubluxation with hyperlaxity of joints
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Swan Neck DeformitySwan Neck Deformity
Fig. 65-4 DFig. 65-4 D
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Clinical ManifestationsClinical Manifestations
CardiopulmonaryCardiopulmonary TachypneaTachypnea PleurisyPleurisy DysrhythmiasDysrhythmias Accelerated CADAccelerated CAD PericarditisPericarditis
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Clinical ManifestationsClinical Manifestations
RenalRenal Lupus nephritisLupus nephritis Ranging from mild proteinuria to Ranging from mild proteinuria to
glomerulonephritisglomerulonephritis Primary goal in treatment is slowing the Primary goal in treatment is slowing the
progressionprogression
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Clinical ManifestationsClinical Manifestations
Nervous systemNervous system Generalized/focal seizuresGeneralized/focal seizures Peripheral neuropathyPeripheral neuropathy Cognitive dysfunctionCognitive dysfunction DisorientationDisorientation Memory deficitsMemory deficits Psychiatric symptomsPsychiatric symptoms
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Clinical ManifestationsClinical Manifestations
HematologicHematologic Formation of antibodies against blood Formation of antibodies against blood
cellscells AnemiaAnemia LeukopeniaLeukopenia
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Clinical ManifestationsClinical Manifestations
Hematologic (contd)Hematologic (contd) ThrombocytopeniaThrombocytopenia CoagulopathyCoagulopathy Anti-phospholipid antibody syndromeAnti-phospholipid antibody syndrome
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Clinical ManifestationsClinical Manifestations
InfectionInfection IncreasedIncreased susceptibility to infections susceptibility to infections Fever should be considered seriousFever should be considered serious Infections such as pneumonia are a Infections such as pneumonia are a
common cause of deathcommon cause of death
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Diagnostic StudiesDiagnostic Studies
No specific testNo specific test SLE is diagnosed primarily on SLE is diagnosed primarily on
criteria relating to patient history, criteria relating to patient history, physical examination, and laboratory physical examination, and laboratory findingsfindings
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Diagnostic StudiesDiagnostic Studies
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Diagnostic StudiesDiagnostic Studies
Antinuclear antibodiesAntinuclear antibodies ANA and other antibodies indicate ANA and other antibodies indicate
autoimmune diseaseautoimmune disease Anti-DNA and anti-Smith antibody tests Anti-DNA and anti-Smith antibody tests
most specific for SLEmost specific for SLE LE prep can be positive with other LE prep can be positive with other
rheumatoid diseasesrheumatoid diseases ESR & CRP are indicative of inflammatory ESR & CRP are indicative of inflammatory
activityactivity
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Diagnostic TestsDiagnostic Tests
CBC for hematologic problemsCBC for hematologic problems UA for lupus nephritisUA for lupus nephritis X-rays of affected jointsX-rays of affected joints Chest x-ray for pulmonary problemsChest x-ray for pulmonary problems ECG for cardiac problemsECG for cardiac problems
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Collaborative CareCollaborative Care
Prognosis is improved withPrognosis is improved with Earlier diagnosisEarlier diagnosis Earlier and better treatment regimensEarlier and better treatment regimens Careful monitoring for organ Careful monitoring for organ
involvementinvolvement
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Collaborative CareCollaborative Care
Drug therapyDrug therapy NSAIDsNSAIDs Antimalarial drugsAntimalarial drugs Steroid-sparing drugsSteroid-sparing drugs CorticosteroidsCorticosteroids Immunosuppressive drugsImmunosuppressive drugs
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Nursing ManagementNursing ManagementNursing AssessmentNursing Assessment
Assess patients physical, Assess patients physical, psychologic, and sociocultural psychologic, and sociocultural problems with long-term problems with long-term management of SLEmanagement of SLE
Assess pain and fatigue dailyAssess pain and fatigue daily
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