Systemic Lupus Erythematosus

Is a chronic multisystem autoimmune disorder of the connective tissue. Sometimes

referred to as a group of syndromes due to difrrenece of how it can manifest in
patienst.
Autoimmune disorders occur when the natural systems agaisnstdefenses disease
stat attacking itself. This is disorder is difficult to diagnose.

The patient can have periods of remissions and flare-ups.

Inflammation can be seen in the most areas of the body systems. As the bodys
immune response is lowered.

Lupus is known for autterfly rush on the face. They were first seen in the late 1800.
The discovery of the systemic involvement was first in the late 1800s.
Joint
s lymphatic system
Central nervous system
Neuromuscular
Circulatory system/invovlment
In the early 1900s, the butterfly rash was again seen in 20 patients who also had
systemic involvlement involving the lungs, heart, kidney and brain, which are known
as advanced lupus.
18 of those patients died in two years, whocih lead to the start of research in to this
disorder.

CAUSES
Lupus is multifactorial with no one specific cause. It can be combination of
genetics, enzyme deficiency, hormone deficiency, environmental, chemicals, oral
contraceptives, and over 100 linked drugs.

It can also be caused or aggravated from environmental effects such as:

Sunlight. Ultraviolet light,
Infections,
Epstein barr virus,
HCV,
Smoking
Even from
Pregnancy
Together, all of this play role in the development of symptoms.

Lupus is not contagious and is not spread from one person to another..

PATHOPHYSIOLOGY
It is suspected that Gene mutations lead to proliferation of the auto antibodies
leading to inflammation and blood vessel abnormalities. Eventually causing
problems in all systems.
The most widely studied and known about is the kidney concerning
glomerulonephritis. The gene mutations are so been researched, however, it seems
to cause the lymphocyte production to be abnormal. Specificly with increased T
cells. A B-CELL is part of the bodysdefence system to fight against antigens.
However in patients with lupus, for some reasons there is increase production of
abnormal B-CELLS. Which Instead of attacking antigens, they start attacking the
body, which is called autoimmune disorder.
Another contributing factor, is that additoiin to the production of abnormal B-CELLS,
there is also LOW APOPTOSIS of B-CELLS.
APOPTOSIS means a normal process in which a cell dies.
With increase production of abnormal B-CELLS and LOW APOPTOSIS, this causes an
increased amount of abnormal B-Cells.
This auto immune antibody are found in the LAB TEST called ANA DsDNA.

A patient may go a long time without knowing they have lupus due to the general
symptoms.
They may present with general tiredness, or aches and pains.
Proper diagnosis should be performed by a rheumatologist.
SYSTEMS that can be affected include the dermatological system or skin causing
rashes and lesions, The Musculuskeletal System causing pain and inflammation, the
pulmonary system causing pleurisy and or pleural effusion, The Cardiac System
causing mild carditis and or pericardidtis, The Vascular System causing anemia,
leukopenia, thrombocytopenia, and vascularitis. The Renal System causing
glomerulonephritis, acute kidney injury, and potentially kidneychronic disease, The
GastroIntestinal System causing abdominal pain, weight loss,anorexia and nausea,
and finally, The Nerurological System causing potential decrease levels of
consciousness, seizures and psychosis.

When studying you can use pneumonics SOAP, BRAIN, MD

To help you remember the chronical manifestations. They are not in order, but itll
help you remember the important signs and symptoms of the disease.
SOAP stands for: Serositis, Oral Ulcers, Arthritis, Photosensitivty
BRAIN stands for: Blood disorders, Renal Involvment, Antinurclear antibodies,
Immunologic Phenomenon, Neurologic Disorder
MD stands for: Malar (butterfly rash), and finally discoid rash.

TRANSMISSION AND RISK FACTORS

TRANSMISSION
There is a familial component to lupus which suggest the predisposition but it is not
a communicable disease.
The RISK FACTORS include:
- Female puberty to premenopausal age
- as The disease favors women to men 9 to 1.
- Lupus is more common in African-Americans, Asians and Hispanics

DIAGNOSIS
Many lab tests are done and lupus can mimic many other autoimmune disorders.
Some lab test used by rheumatologist can include:
-

AntiNuclear Antibody Testing this is done first which is usually high in lupus
but it can also be high in other disorders.
Other test can include
Erythrocyte Sedimentation Rate
Double stranded DNA antibody assay
ENA PANEL
Extracable nuclear antigens
Ches and Joint Xrays
CT SCANS can also help the diagnosis.
Also BIOPSIES of appropriate to organs may be necessary to confirm
diagnosis.

TREATMENT AND PREVENTION

there is no cure for lupus
The primary treatment is with medications and includes:
-

Immunosupressive Therapy with medication such as CELLCEPT, IMURAN,

AZZASAN, BENLYSTA to name a few
Other medication therapy includes CORTICOSTERIODS which can include:
PREDNISONE, SOLU-MEDROL (this medication can help reduce inflammation)
NONSTEROIDAL ANTI-INFLAMMATORY DRUGS / nsaids can also be used for
pain and inflammation. Names of this medication can include: ADVIL
IBUPROFEN, MOTRIN, ALEVE
ALSO placwinil can be used, this medication is an antimalrial which help
patients with swollen pain and skin problems
Other treatments can include a PLASMA EXCHANGE as stem cell
transplantation

PATIENT EDUCATION
1. Patient s are told to avoid direct sunlight , it can cause exacerbation in all
systems. If they must go in the sunlight though, instruct them to use atleast
30+ SPFsunscreen in addition to clothing.
2. Teach non pharmacological stress reduction thecniques. Also to tach to stay
active with mild exercise during times when there is no flare up to maintain
joint function and to keep mucle mass. Also teach osteoporosis prevention as
well as joint care proper exercise and possible supplementation with vitamins
such as LOCOSAMIN?

3. Instruct maintain a diet low in salt and fat and to avoid elevated blood
pressure
4. Overall, encourage eating healthy foods
5. And in caution about being around populations that are easily get sick
6. Also teach to avoid infection by washing hands frequently
7. And be vigilant in looking for the early sign and symtoms of infections
8. Encourage in full support in
9. Encourage communication with a psychologist or psychiatrist to help cope
with the stress as needed.
10.Also instruct your patient to prevent infectioin by staying up to date with
immunizations including the yearly flu shot and pap smear.
Now lets go to QUESTIONS

1. Which of these are risk factors for lupus? Select all that apply
a. Genetics
b. Being of European decent
c. Having a stepmother with lupus
d. Having a brother with lupus
e. Being in middle school
f. Being a male
2.