Epidemiology of Lupus

Epidemiology of Lupus

• Affects fewer than 25 people per 100,000 in North America, South America, Europe, and Asia.
• Prevalence varies by sex, ethnicity, geography, and age.
• Female-to-male ratio is 3:1 in children, 15:1 in childbearing years.
• African American females are almost four times more likely to develop SLE than European American females.
• SLE less frequent in Black populations in Africa, Asians, and African Caribbeans.
• Hispanic Americans have a higher prevalence than European Americans in the US.
• 65% of patients are diagnosed between ages 16 and 55.
• Prognosis for renal disease is poorer in African Americans and Mexican Americans than European Americans.
• Lower education levels and socioeconomic status correlate with poorer disease control.
• Males more likely than females to have renal disease, skin manifestations, lab abnormalities, neurological involvement, thrombosis, CVD, and vasculitis.
• Females more likely to have Raynaud's phenomenon, photosensitivity, and mucosal ulceration.
• Family history of SLE increases risk.
• Genes predispose to SLE.

Pathophysiology of Lupus

• Chronic inflammatory disease affecting virtually any organ system.
• Exact cause unknown, like other autoimmune diseases.
• Multiple factors trigger disease: pregnancy, sunlight, illness, surgery, silica dust, medication allergies.
• Most manifestations due to antibodies and immune complexes deposited in tissues.

Clinical Manifestations of Lupus

• Diverse, vague symptoms not following a pattern, varying greatly between individuals.
• Includes fatigue, fever, myalgia, weight changes.
• Symptoms not always present, impacting diagnosis.
• Periods of remission and disease flares are common.

Diagnosis of Lupus

• No single test for diagnosis.
• Laboratory findings, combined with history and physical exam, support diagnosis.
• ACR and Systemic Lupus International Collaborating Clinics guidelines and criteria are used.
• 17 criteria (clinical and immunological) are defined.
• At least one clinical and one immunological criterion are needed for diagnosis.
• Symptoms may not meet all 4 criteria if sufficient other evidence exists for diagnosis.

Laboratory Testing for Lupus

• Tests confirm autoantibodies.
• Anti-nuclear antibodies (ANA) indicate autoimmune disease but do not confirm SLE (2% of healthy individuals are positive).
• Anti-dsDNA and Anti-Sm antibodies are highly specific for SLE.
• Antiphospholipid antibodies assessed for potential blood clots.
• CBC (for leukopenia, thrombocytopenia, anemia).
• Urinalysis (for protein, creatinine) to monitor for kidney disease.
• C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) for inflammation, not specific for SLE.

Radiographical Imaging for Lupus

• Used to diagnose features, rule out other causes.

Treatment of Lupus

Non-pharmacological Therapy

• Avoid prolonged sun exposure, use high SPF sunscreen daily.
• Healthy diet.
• Adequate rest and sleep.
• Regular exercise.
• Smoking cessation.

Pharmacological Therapy

• Antimalarials (e.g., hydroxychloroquine) commonly used to treat symptoms and prevent disease flares.
• Mechanism not fully understood but thought to affect complement-dependent antigen-antibody reactions
• Treats fatigue, skin & joint issues, and prevents organ damage (lupus nephritis).
• Side effects: abdominal pain, nausea (may resolve).
• NSAIDs (e.g., ibuprofen) for arthralgia, myalgia, headache, fever.
• Glucocorticoids for suppressing inflammation.
• Immunosuppressants (e.g., methotrexate) for severe inflammation not responding to NSAIDs or steroids.
• Belimumab (Benlysta): biological response modifier approved in 2011. Binds to BLyS, interferes with the inflammatory cascade, reducing immune response.

Common Lupus Medications (Specific Concerns)

• Plaquenil (hydroxychloroquine): Requires baseline and regular eye exams for retinal toxicity.
• NSAIDs: should be avoided in renal impairment due to prostaglandin inhibition.
• Allergy to sulfonamide antibiotics like trimethoprim-sulfamethoxazole (30% of SLE patients).

Surgical Interventions for Lupus

• Renal transplant for severe lupus nephritis.
• Joint replacement for avascular necrosis risk.

Complications of Lupus

• Renal failure, premature heart disease, interstitial lung disease, hypercoagulation, stroke, avascular necrosis of joints, increased infection risk, therapy toxicities

Nursing Management of Lupus

Assessment & Analysis

• Fatigue
• Difficulty concentrating
• Joint pain
• Rash
• Photosensitivity
• Oral/nasal ulcers
• Dry eyes/mouth
• Hypertension
• Leukopenia
• Thrombocytopenia
• Alopecia
• Chest pain

Nursing Diagnoses/Problems

• Fatigue
• Impaired skin integrity
• Altered self-image

Nursing Interventions

• Vital signs (especially hypertension, fever, decreased oxygen saturation)

• Thorough history/physical exam (including symptoms in 17 criteria)

• Monitor lab values (BUN/creatinine, urinalysis, CBC, CRP/ESR, coagulation).

• Administer analgesics, anti-inflammatory meds as directed.

• Administer medications for specific symptoms.

• Teaching (disease process, sun protection, energy conservation, activity prioritization, immunizations/live vaccines).

• Avoid oral contraceptives in some lupus cases with higher risk factors (migraines, Raynaud's, phlebitis, antiphospholipid antibodies)

• Referrals to specialists (pulmonologist, nephrologist, neurologist, cardiologist, dermatologist).

Evaluating Lupus Care Outcomes

• Medication compliance for disease control is key.
• Disease flares are expected with possible increased symptoms.
• Regular rheumatologist follow-up for disease monitoring and treatment adjustments.
• Well-managed lupus allows patients to maintain daily activities.