Understanding Lupus: Types, Symptoms, and Autoimmunity

• Lupus is a chronic autoimmune disease affecting the skin, joints, kidneys, heart, lungs, and brain.
• In lupus, the immune system attacks its own tissues and organs, causing inflammation, pain, and damage.

Types of Lupus

• Systemic Lupus Erythematosus (SLE) is the most common form, affecting multiple organs.
• Discoid Lupus Erythematosus (DLE) primarily affects the skin, causing a characteristic rash.
• Drug-Induced Lupus is triggered by certain medications.
• Neonatal Lupus is a rare condition affecting newborns of mothers with lupus.

Common Signs and Symptoms

• Fatigue is a very common symptom.
• Joint pain and swelling are frequent.
• A butterfly-shaped rash across the cheeks and nose is characteristic of SLE.
• Skin lesions that worsen with sun exposure may occur.
• Shortness of breath and chest pain may be present.
• Dry eyes can be a symptom.
• Headaches, confusion, and memory loss can occur in some cases.
• Fingers and toes turning white or blue in response to cold or stress (Raynaud's phenomenon) can occur.

Diagnosis

• Diagnosis is based on a combination of factors.
• A review of symptoms is the first step.
• A physical examination is required.
• Blood tests are required.
• Urine tests are required.
• An antinuclear antibody (ANA) test is commonly used.
• Other tests that may be performed include: anti-dsDNA, anti-Sm, and antiphospholipid antibodies.

Treatment

• There is no cure for lupus, though treatment helps manage symptoms and prevent organ damage.
• Medications used include:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation.
  • Corticosteroids to reduce inflammation.
  • Antimalarial drugs (e.g., hydroxychloroquine) for skin and joint problems.
  • Immunosuppressants for severe cases.
  • Biologics to target specific parts of the immune system.

Nursing Interventions

• Assess the patient's pain level and administer pain medications as prescribed.
• Monitor for signs of organ involvement (e.g., kidney, heart, lungs).
• Teach patients about the importance of sun protection, including wearing protective clothing and using sunscreen.
• Encourage regular exercise and physical therapy to maintain joint mobility and muscle strength.
• Provide emotional support and education about the disease.
• Lupus can cause fatigue and impact a patients life.
• Encourage rest periods.
• Help patients identify activities they can still participate in.
• Encourage support groups or counseling services, as needed.
• Encourage a balanced and nutritious diet.
• Limit sodium intake, especially if the patient has kidney involvement or is taking corticosteroids.

Potential Complications

• Kidney damage (lupus nephritis): Monitor kidney function and urine output.
• Cardiovascular problems: Assess for chest pain, shortness of breath, and edema.
• Lung disease: Monitor for cough, shortness of breath, and pleuritic chest pain.
• Anemia and increased risk of infections: Monitor complete blood counts.
• Increased risk of blood clots (antiphospholipid syndrome): Assess for signs of deep vein thrombosis or pulmonary embolism.

Key Points for NCLEX

• Lupus is a chronic autoimmune disease with varied symptoms.
• There is no cure, focus on symptom management and preventing organ damage.
• Sun protection is crucial.
• Monitor for organ involvement and complications.
• Provide education and support to patients and their families.