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Systemic Lupus Eritematosus

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  • 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

  • Copyright 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

    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

  • Copyright 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

    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

  • Copyright 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

    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

  • Copyright 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

    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

  • Copyright 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

    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

  • Copyright 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

    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

  • Copyright 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

    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

  • Copyright 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

    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

  • Copyright 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved