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Maidhof, W. & Hilas, O. (2012). Lupus: An overview of the Disease And Management Options. (Vol. 37 No. 4, p. 240-246).
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LUPUS: An Overview of the Disease And Management Options

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LUPUS: An Overview of the Disease And Management Options

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DEFINATION
Lupus is a chronic inflammatory autoimmune disease with a wide range of clinical presentation resulting from its effect on the multiple organ systems.

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Neonatal and Pediatric lupus erythematosus (NLE): A rare form of lupus observed in newborns. Result from maternal autoantibodies passing through the placenta.
Discoid lupus erythematosus (DLE): A chronic scarring and atrophic photosensitivity dermatosis, which may progress to Systemic lupus erythematosus or may occur in patient with Systemic lupus erythematosus.
Drug-induced lupus (DIL): Occurs after exposure to a medication, causing an autoimmune response.
Systemic lupus erythematosus (SLE): A chronic disease that affects various organ systems, primarily as a consequence of the formation and deposition of autoantibodies and immune complexes, leading to eventual organ damage.

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PATHOPHYSIOLOGY OF SYSTEMIC LUPUS ERYTHEMATOSUS

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PATHOPHYSIOLOGY OF SYSTEMIC LUPUS ERYTHEMATOSUS

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During the process of cellular death, pieces of cellular materials are formed on the surface of the dying cell. Antigens that are normally absent on the surface of the cellular material, but  embedded within, are now present on the cell surface. Hyperactive B cells; resulting from T-cell and antigen stimulation, increase the production of anti-bodies against antigens that are exposed on the surface of apoptotic cells. The presence of hyperactive B cells leading to the production of autoantibodies, in conjuction with the impaired removal of apoptotic cellular material, results in the formation of immune complexes. These immune complexes induce inflammatory reactions, causing the tissue inflammation and damage associated with Systemic lupus erythematosus

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The cause of Systemic lupus erythematosus remains unknown, but decades of research shows that genetic, hormonal, immunological, and environmental factors play a role in the development of systemic lupus erythematosus.

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General signs and symptoms: fever, fatigue, and weight loss.
Signs and symptoms involving the skin: red rash on the nose and cheeks ("butterfly" rash), alopecia, Reynaud's phenomenon, and sores in the mouth or nose.
Musculoskeletal: arthralgias, myalgias, and arthritis.
Pulmonary: painful breathing, coughing, and shortness of breath. Pleural effusion and pulmonary hypertension have also been reported.
Cardiovascular: pericarditis, myocarditis, endocarditis, and coronary artery disease.
Gastrointestinal: nausea, vomiting, and abdominal pain.
Hematological changes: anemia, leukopenia, or thrombocytopenia.
CNS: headaches, depression, anxiety, seizures, stroke, or cognitive impairment.
Renal involvement: diminished kidney function, which may result in elevated serum creatinine levels and proteinuria.

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The diagnosis of systemic lupus erythematosus is based on:
Signs and symptoms: if a patient displays four or more of the signs and symptoms, either simultaneously or at different time points.
Laboratory testing: Anti-nuclear antibodies (ANA) testing, a complete blood count (CBC) with differential, a complete metabolic profile, a urinalysis to determine the creatinine clearance and the presence of proteinuria or active sediment. The testing of complement levels (C3 and C4) as potential makers during systemic lupus erythematosus flares.
Diagnostic testing: Radiography, renal ultrasound, chest radiography, and electrocardiography

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NSAIDs: Treat mild-to-moderate lupus. Used to alleviate musculoskeletal pain, swelling, and aches. Eg. salicylates
Antimalarial agents: Treat mild-to-moderate lupus. Effective in treating various signs and symptoms of lupus and preventing subsequent flares. Eg Hydroxychloroquine
Corticosteroids: Treat mild-to-moderate lupus. These agents decrease the swelling and pain associated with inflammation, which can occur in a lupus flares.  High-dose corticosteroids are used to control disease progression. Eg prednisone
Immunosuppressive Agents: Treat severe lupus. They are used when it is necessary to induce and maintain remission and to reduce flares or relapses. Eg Cyclophosphamide
Monoclonal Antibodies (Belimumab): Belimumab is a human monoclonal antibody for the treatment of lupus. Belimumab inhibits the activation of B-cell lymphocytes by interfering with a protein necessary for B-cell activity.
Rituximab: A genetically engineered monoclonal antibody directed against CD20 antigen.
Stem-cell transplantation: Introduction of healthy cells into the body in order to help rebuild the immune system

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a. Encourage exercise as tolerated.
b. Advice patient on proper diet and nutrition.
c. Encourage smoking cessation.
d. Teach patient how to manage comorbid conditions.
e.Encourage the use of sun protection.
f. Educate patient on appropriate immunizations

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1. The single best definition of systemic lupus erythematosus is that it is:
A.  a disease in which, anti-DNA autoantibodies are present.
B. a type of type III hypersensitivity
C. a disease that often affect the kidney
D. a disease that often affect the skin.

2. Which of the following are among the most common symptom of new cases or recurrent active SLE flares?
A. peptic ulcer
B. pleuritis
C. fatigue and weight loss
D. cranial neuropathy

3. Which of the following skin manifestations is the most common associated with SLE?
A. Raynaud phenomenon
B. Malar rash
C. Alopecia
D. Livedo reticularis

4. The nurse is assigned to care for a client admitted to the hospital with a diagnosis of systemic lupus erythematosus (SLE). The nurse review the health care provider's prescriptions. Which of the following medications would the nurse expect to be prescribed?
A.  Antibiotic
B. Antidiarrheal
C. Corticosteroid
D. Opioid analgesic

5. Which type of lupus occurs after exposure to a medication, that can cause autoimmune response?
A. Discoid lupus
B.Drug-induced lupus
C. Systemic lupus
D. Neonatal and pediatric lupus

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Maidhof, W. & Hilas, O. (2012). Lupus: An overview of the Disease And Management Options. (Vol. 37 No. 4, p. 240-246).