Systemic Lupus Erythematosus (SLE)

• Systemic Lupus Erythematosus (SLE) is a chronic, autoimmune inflammatory disease that can affect various body organs
• SLE is characterized by periods of remission and exacerbation (flares)

Pathophysiology and Etiology

• SLE involves the formation of autoantibodies and immune complexes that target the body's own tissues
• Genetic, hormonal, and environmental factors contribute to SLE development
• Exposure to sunlight, infections, and certain medications can trigger SLE in susceptible individuals

Clinical Manifestations

• SLE symptoms vary widely among individuals
• Common symptoms include fatigue, fever, joint pain, stiffness, and swelling
• A characteristic "butterfly" rash may appear on the face
• Other skin manifestations include discoid lesions and photosensitivity
• SLE can affect the kidneys, leading to lupus nephritis
• Cardiovascular involvement may result in pericarditis or myocarditis
• Pulmonary manifestations include pleuritis and pneumonitis
• Neurological symptoms can range from headaches to seizures and cognitive dysfunction
• Hematologic abnormalities may include anemia, leukopenia, and thrombocytopenia

Diagnosis

• Diagnosing SLE can be challenging due to its diverse presentation
• The American College of Rheumatology (ACR) criteria and Systemic Lupus International Collaborating Clinics (SLICC) criteria are used for classification
• Diagnostic tests include:
  • Antinuclear antibody (ANA) test: Highly sensitive but not specific for SLE
  • Anti-double-stranded DNA (anti-dsDNA) antibody test: More specific for SLE
  • Anti-Smith (anti-Sm) antibody test: Specific for SLE
  • Complement levels (C3, C4): Often decreased during SLE flares
  • Complete blood count (CBC): May reveal anemia, leukopenia, or thrombocytopenia
  • Urinalysis: To assess for kidney involvement
  • Kidney biopsy: To evaluate the extent of lupus nephritis
  • Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP): Markers of inflammation

Treatment and Management

• There is no cure for SLE; treatment focuses on symptom management and preventing organ damage
• Medications commonly used in SLE management include:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): For mild joint pain and inflammation
  • Antimalarial drugs (e.g., hydroxychloroquine): For skin and joint symptoms
  • Corticosteroids (e.g., prednisone): For flares and severe manifestations
  • Immunosuppressants (e.g., methotrexate, azathioprine, cyclophosphamide, mycophenolate mofetil): To suppress the immune system
  • Biologic agents (e.g., belimumab): To target specific immune system components
• Lifestyle modifications, such as sun protection, regular exercise, and stress management, are also important

Nursing Management

• Assess and monitor disease activity, including symptoms, lab values, and medication side effects
• Educate patients and families about SLE, its management, and the importance of adherence to treatment
• Provide support and counseling to help patients cope with the chronic nature of the disease
• Encourage patients to maintain a healthy lifestyle, including a balanced diet and regular exercise
• Emphasize the importance of sun protection to prevent flares
• Monitor for signs and symptoms of complications, such as infection, kidney damage, and cardiovascular disease
• Coordinate care with other healthcare professionals, such as rheumatologists, nephrologists, and cardiologists
• Administer medications as prescribed and monitor for adverse effects
• Teach patients about self-management strategies, such as recognizing early signs of flares and adjusting medications as needed under medical supervision

Potential Complications

• Lupus nephritis: Kidney inflammation that can lead to kidney failure
• Cardiovascular disease: Increased risk of heart attack and stroke
• Pulmonary complications: Pleuritis, pneumonitis, and pulmonary hypertension
• Neuropsychiatric complications: Seizures, cognitive dysfunction, and mood disorders
• Infections: Increased susceptibility due to immunosuppression
• Osteoporosis: Increased risk due to corticosteroid use
• Blood clots: Increased risk of venous and arterial thrombosis
• Pregnancy complications: Increased risk of miscarriage, preterm birth, and preeclampsia