systemic lupus p.pdf

Systemic Lupus Erythematosus (SLE) Systemic Lupus Erythematosus (SLE) - Chronic, progressive autoimmune disorder ○ Progressive loss of tissue integrity through excessive inflammation and overactive immunity. ○ Exacerbations/remissions → Sun exposure exacerbates symptoms ○ Similar to RA → both affect...

Systemic Lupus Erythematosus (SLE) Systemic Lupus Erythematosus (SLE) - Chronic, progressive autoimmune disorder ○ Progressive loss of tissue integrity through excessive inflammation and overactive immunity. ○ Exacerbations/remissions → Sun exposure exacerbates symptoms ○ Similar to RA → both affects joints and has symmetrical symptoms (ex: pain in both wrists as opposed to one) ○ About 1,600,000 people in North America have SLE Pathophysiology: ○ Inflammation and immune cells precipitate and deposit cells in organs affected → cause vasculitis which lessens blood flow to organs ○ Affects multiple tissues and organs → can do permanent organ damage Risk Factors: FAFA I ○ Strong genetic connection (Family history) ○ Female 9:1 ○ Starts usually between ages of 15-45 ○ African American and Hispanic 2-3 times more likely to get than Caucasian women ○ Infection, injury, drugs, hormones, exposure to environmental substances, such as UV rays (tanning beds) can be a trigger Concepts Affected: ○ Immunity ○ Inflammation ○ Pain ○ Fatigue ○ Reproduction Impact on people ○ SLE affects multiple systems: Other: Mouth and nose ulcers Hair loss High fever Abnormal headache Severe abdominal pain Lungs: Pleuritis - Inflammation of pleura. Causes sharp chest pain (pleuritic pain) that worsens during breathing Pleura - two large, thin layers of tissue that separate your lungs from your chest wall Pneumonitis - lung inflammation Pulmonary emboli - A condition in which one or more arteries in the lungs become blocked by a blood clot. Pulmonary hemorrhage - the extravasation of blood into the alveoli, that is, bleeding into the lower respiratory tract Kidneys → Hematuria - Blood in urine Skin → Butterfly rash and red patches Heart: Endocarditis - inflammation of the inside lining of the heart chambers and heart valves (endocardium) Atherosclerosis Inflammation of the fibrous sac Blood: Anemia HTN Muscle and Joints: Pain Arthritis Aches ○ Maternal Problems: Preterm delivery Increased preeclampsia Increased miscarriages Fetal Problems: ○ Preterm Births ○ Stillbirths ○ IUGR (Intrauterine growth restriction) Signs and Symptoms BLA MAMA FS ○ Early Signs: Butterfly rash or other rash/skin changes (Malar Rash) Low grade fever Alopecia - Hair loss Myositis - rare group of diseases characterized by inflamed muscles, which can cause prolonged muscle fatigue and weakness Arthritis - inflammation or swelling of one or more joints Muscle aches usually bilateral Arthralgia - joint pain Fatigue, weakness Sun or light sensitivity KMS CLM (clam) PantoRS (panthers) ○ Late Signs: Kidney changes → proteinuria, lupus nephritis Moderate/severe pain (exacerbations/remissions) Cardiac change → pericarditis (inflammation) Lung involvement → pleural effusions Musculoskeletal Manifestations Polyarthritis Pancytopenia - low counts RBCs, WBCs, and platelets Anemia - low RBCs. Thrombocytopenia - low platelets Lymphopenia - low lymphocytes (WBCs) Raynaud’s Phenomenon - smaller arteries that supply blood to the skin constrict excessively in response to cold, limiting blood supply to the affected area. Sjogren’s Syndrome - An immune system disorder characterized by dry eyes and dry mouth. Seizures Interventions: X-Ray, CBC… C-U X-Ray, CBC, ESR, Antibodies, Creatine, Urinalysis ○ Secondary Prevention: No single lab test definitive Xray only if a joint is involved Complete Blood Count (CBC) → elevated WBC’s ESR (Sed Rate) → Elevated ESR Antibody tests: Rheumatoid Factor Anti-dsDNA → found in 30% of pts with SLE Anti-ssDNA (Anti‐Single-Stranded DNA Test) Antinuclear Antibodies (ANA) - Antibodies that target the nucleus of healthy cells. ○ 97 % of patients have elevated ANA’s, but the test is not specific. Creatinine → high creatinine indicates kidney problems. Urinalysis → Blood and urine tests to see if kidney involvement or involvement of other major organs. Tertiary Prevention: LP CSF | Meds ○ Lessen sun exposure → No tanning beds/clothing that covers/sunscreen/skin care ○ Pain control ○ Fatigue management → Exercise and rest periods/no exercise during flares ○ Consult with OB/GYN for high-risk pregnancy care ○ Stress management for patient and family ○ Pharmacology (see below) Medications for SLE ○ NSAIDS/DMARDS - Control inflammation/suppress immune system Methotrexate ○ ANTIMALARIALS: Hydroxychloroquine - immunomodulating and anticlotting effects Decreases skin lesions because it decreases UV ray absorption Implications: ○ Toxicity → Can cause retinitis that can lead to loss of central vision/irreversible Perform frequent eye exams ○ Immunomodulators: Monoclonal antibodies = “-mab” Janus kinase inhibitors - inhibits the activity of one or more of the Janus kinase family of enzymes, thereby interfering with the JAK-STAT signaling pathway in lymphocytes (inhibits JAK/STAT pathway which controls inflammation) CORTICOSTEROIDS - Control inflammation and suppress immune system ○ Example = Prednisone