Systemic Lupus Erythematosus Safaa EID Medical surgical and critical care department
Definition• is an autoimmune disease of the bodys connective tissues.• Autoimmune means that the immune system attacks the tissues of the body.• attacks parts of the cell nucleus.• between the ages of 15 and 40, although it can show up at any age.
Pathogenesis• A healthy immune system produces proteins called antibodies and specific cells called lymphocytes.• that help fight and destroy viruses, bacteria, and other foreign substances that invade the body.
• In lupus, the immune system produces antibodies against the bodys healthy cells and tissues.• These antibodies, contribute to the inflammation of various parts of the body and can cause damage to organs and tissues.• Lupus can affect-joints, skin, kidneys, heart, lungs, blood vessels, and brain.
Causes • The exact causes is not known.• Inherited genes, viruses, ultraviolet light, and drugs may all play some role.• Genetic factors increase the tendency of developing autoimmune diseases
• female hormones play an important role in the expression of SLE.• a key enzymes failure to dispose of dying cells may contribute the development of SLE.• a genetic mutation• Drug-induced lupus. ( hydralazine, beta- blokers, isoniazid) .
There are several kinds of lupus:• Discoid lupus erythematosus is• a chronic skin disorder• red, raised rash appears on the face, scalp, or elsewhere• The rash may last for days or years .
• Sub acute cutaneous lupus erythematosus refers to skin lesions that appear on parts of the body exposed to sun. The lesions do not cause scarring.• Drug-induced lupus is a form of lupus caused by medications. Many different drugs can cause drug- induced lupus• Neonatal lupus is a rare disease that can occur in newborn babies of women with SLE
• Sjögrens syndrome is an autoimmune disorder in which immune cells attack and destroy the excroin glands that produce tears and saliva.• Sjögrens syndrome is also associated with rheumatic disorders such as rheumatoid arthritis
Clinical manifestations• The symptoms of SLE come on in waves, called flares or flare-ups. In between flares, patients may have almost no symptoms.• general discomfort, extreme fatigue, fever, and weight loss at some point.
“Common Symptoms of Lupus• Painful or swollen joints and muscle pain• Unexplained fever• Red rashes, most commonly on the face• Chest pain upon deep breathing• Unusual loss of hair• Pale or purple fingers or toes from cold or stress .
• Sensitivity to the sun• Swelling (edema) in legs or around eyes• Swollen glands• Extreme fatigue
• Malar rash:• This is a "butterfly- shaped" red rash over the cheeks below the eyes and across the bridge of the nose.• It may be a flat or a raised rash.• The rashes are made worse by sun exposure.
• Raynaud’s phenomenon• is commonly found in lupus.• reaction of distal digits to cold or emotion, in which the skin colour changes from white to blue to red)
• Oral ulcer:• Painless sores in the nose or mouth need to be observed and documented by a doctor.
Different symptoms in different body systems :• KidneysInflammation of the kidneys (nephritis)LungsCentral nervous system:
• Blood vessels:• Blood vessels may become inflamed (vasculitis)• Muscles and Bones:• joint pain or inflammation.• The pain can come and go, or it can be long lasting.
• Blood:• anemia, leucopenia (a decreased number of white blood cells), or thrombocytopenia (a decrease in the number of platelets in the blood, which assist in clotting).• Heart:• (myocarditis and endocarditis) or the membrane that surrounds it (pericarditis).
• Digestive System:• Symptoms include abdominal pain, loss of appetite, nausea, and sometimes vomiting.• psychological and emotional effects• such as grief, depression, and anger, depression• Pregnancy.• However, the chances of miscarriage, premature birth, and death of the baby in the uterus are high.
Treatment• A conservative regimen of physical and emotional rest is required• protection from direct sunlight• a healthful diet• prompt treatment of infections• pregnancy must be planned for times when the disease is under control, and the patient is on allowable medications.
Medications1-NSAIDs:• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen.2- Antimalarials:• (Plaquenil). It may be used alone or in combination with other drugs3- Corticosteroids:
4- Immunosuppressives: For some patientswhose kidneys or central nervous system are affected by lupus, such as cyclophosphamide (Cytoxan)- restrain the overactive immune system by blocking the production of immune cells.
Other therapy• Plasma exchange• Intravenous Immunoglobulin• Stem cell transplantation• Immune therapy ( anti-IL10, anti-CD20, and immune tolerance therapy)
Nursing care • Minimize appearance of lesions. • Alleviate discomfort • Minimize fatigue. • Maintain weight at optimal range• Teach the patient to recognize fever and signs and symptoms of infection. • Maintain joint function and increase muscle strength.
– Recognize anemia and develop a plan of care– Minimize episodes of bleeding.– Minimize incidence of infection.– Educate the patient about immunizations– Educate patient nutritional status.