1.
Systemic Lupus
Erythematosus (SLE)
By:
Mr. M. Sivananda Reddy

2.
Incidence
• About 90% of all cases occur in women
• Most cases occur in women of childbearing years
• At the age of 30 years the ratio of women to men is
10:1
• African, Asian, Hispanic, and Native Americans
three times more likely to develop than whites

3.
Etiology
• Auto immune
• Etiology is unknown
• Most probable causes:
– Genetic influence
– Hormones
– Environmental factors- UV B rays, infections with
CMV, HCV, smoking
– Certain medications- Trimethoprim,
Sulphamethaxozole

4.
Pathophysiology
• Autoimmune reactions directed against constituents of
cell nucleus, DNA
• Antibody response related to B and
T cell hyperactivity which is stimulated by the Estrogen
• The antigen antibody complexes that are developed will
be in the circulation and blocks the microvasculature
and the spaces

5.
Clinical Manifestations
• Ranges from a relatively mild disorder to rapidly
progressing, affecting many body systems
• Most commonly affects the skin/muscles, lining
of lungs, heart, nervous tissue, and kidneys

6.
• Dermatologic:
– Cutaneous vascular lesions
– Butterfly rash
– Oral/nasopharyngeal ulcers
– Alopecia

7.
Butterfly Rash / Malar Rash

8.
• Musculoskeletal
–Polyarthralgia with morning stiffness
–Arthritis
• Swan neck fingers
• Ulnar deviation
• Subluxation with hyperlaxity of joints

9.
Swan Neck Deformity

10.
Ulnar deviation:

11.
• Cardiopulmonary
– Tachypnea
– Pleuritis
– Dysrhythmias
– Accelerated CAD
– Pericarditis

12.
• Renal
– Lupus nephritis
• Ranging from mild proteinuria to glomerulonephritis

13.
• Nervous system
– Generalized/focal seizures
– Peripheral neuropathy
– Cognitive dysfunction
• Disorientation
• Memory deficits
• Psychiatric symptoms

14.
• Hematologic
– Formation of antibodies against blood cells
– Anemia
– Leukopenia
– Thrombocytopenia
– Coagulopathy
– Anti-phospholipid antibody syndrome

15.
• Infection
– Increased susceptibility to infections
– Fever should be considered serious
– Infections such as pneumonia are a common cause
of death

16.
Diagnostic Studies

17.
• Antinuclear antibodies
– ANA and other antibodies indicate autoimmune
disease
– Anti-DNA and anti-Smith antibody tests most
specific for SLE
– ESR & CRP are indicative of inflammatory
activity.

18.
• CBC for hematologic problems
• Ultrasound Abdomen for lupus nephritis
• X-rays of affected joints
• Chest x-ray for pulmonary problems
• ECG for cardiac problems

19.
Treatment
• Drug therapy
–NSAIDs- Acetaminophen
–Antimalarial drugs- Hydroxychloroquine
–Corticosteroids- Prednisone
–Immunosuppressive drugs

20.
Nursing Management
Nursing Diagnoses
• Fatigue
• Acute pain
• Impaired skin integrity
• Ineffective therapeutic regimen management
• Body image disturbance

21.
Nursing Interventions
– Observe for
• Fever pattern
• Joint inflammation
• Limitation of motion
• Location and degree of discomfort
• Fatigability

22.
– Monitor weight and I&O
– Collect 24-hour urine sample
– Assess neurological status
– Explain nature of disease
– Provide support

23.
• Ambulatory and home care
– Reiterate that adherence to treatment does not
necessarily halt progression
– Minimize exposure to precipitating factors –
fatigue, sun, stress, infection, drugs
– Teach energy conservation and relaxation exercises
– Teach regarding ROM to prevent contractures

24.
• Psychosocial issues
– Counsel patient and family that SLE has good
prognosis
– Physical effects can lead to isolation, self-esteem,
and body image disturbances
– Assist patient in developing goals