FEVER JOINT PAIN RASH

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SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
WHAT IS SLE?

Systemic lupus erythematosus (SLE) is a

multisystem inflammatory autoimmune disease.
It is a complex disorder of multifactorial origin
resulting from interactions among genetic,
hormonal, environmental, and immunologic factors.
SLE typically affects the skin, joints, and serous
membranes (pleura, pericardium), along with the
renal, hematologic, and neurologic systems.
Most cases of SLE occur in women in their
childbearing years. Women are 10 times more
likely than men to develop SLE.

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SLE is an autoimmune disorder characterized by multisystem inflammation
with the generation of autoantibodies. Although the specific cause of SLE is
unknown, multiple factors are associated with the development of the
disease, including :
• Genetic
• Immunoregulatory
• Hormonal
• Environmental factors.

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Factors that may increase your risk of lupus include:
Your sex. Lupus is more common in women.
Age. Although lupus affects people of all ages, it's most often diagnosed
between the ages of 15 and 45.
Race. Lupus is more common in African Americans, Hispanics and Asian
Americans.
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SLE is a chronic inflammatory disease that can affect almost any organ
system, although it mainly involves the skin, joints, kidneys, blood cells, and
nervous system. Its presentation and course are highly variable, ranging
from indolent to fulminant.
Look Out for the Lupus Triad (in women of childbearing age):
1. Fever
2. Joint Pain
3. Rash

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The classic presentation of a triad of fever, joint pain, and rash in a woman of childbearing age
should prompt investigation into the diagnosis of SLE.
Patients may present with any of the following manifestations:
•Constitutional (eg, fatigue, fever, arthralgia, weight changes)
•Musculoskeletal (eg, arthralgia, arthropathy, myalgia, frank arthritis, avascular necrosis)
•Dermatologic (eg, malar rash, photosensitivity, discoid lupus)
•Renal (eg, acute or chronic kidney failure, acute nephritic disease)
•Neuropsychiatric (eg, seizure, psychosis)
•Pulmonary (eg, pleurisy, pleural effusion, pneumonitis, pulmonary hypertension, interstitial
lung disease)
•Gastrointestinal (eg, nausea, dyspepsia, abdominal pain)
•Cardiac (eg, pericarditis, myocarditis)
•Hematologic (eg, cytopenias such as leukopenia, lymphopenia, anemia, or thrombocytopenia)

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DIAGNOSIS (DIAGNOSTIC STUDIES)
The diagnosis of SLE is based on distinct criteria revealed through patient history, physical examination, and
laboratory findings

Blood Tests for Lupus

Antiphospholipid Antibodies (APLs)
Antinuclear Antibody (ANA)
 What it is: APLs are a type of antibody
 What it is: ANA is a type of antibody directed
directed against phospholipids.
against the cells' nuclei.
 Why the test is used: APLs are present in up
 Why the test is used: ANA is present in
to 60% of people with lupus. Their presence can
nearly everybody with active lupus. Doctors
help confirm a diagnosis.
often use the ANA test as a screening tool.

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DIAGNOSIS
Anti-Sm Anti-dsDNA
 What it is: Anti-Sm is an antibody directed  What it is: Anti-dsDNA is a protein directed
against Sm, a specific protein found in the cell against double-stranded DNA
nucleus.
 Why the test is used: Between 75% and 90%
 Why the test is used: . It's rarely found in of people with lupus have a positive anti-dsDNA
people without lupus. So a positive test can help test. Also, the test is very specific for lupus.
confirm a lupus diagnosis. Therefore, a positive test can be useful in
confirming a diagnosis. Also, the presence of
anti-dsDNA indicates a greater risk of lupus
nephritis, a kidney inflammation that occurs with
lupus. So a positive test can alert doctors to the
need to monitor the kidneys.

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DIAGNOSIS
Complement Erythrocyte Sedimentation Rate (ESR)
 What it is: Complement proteins are involved  What it is: : ESR measures the speed of red
in inflammation. The test can look for levels of blood cells moving toward the bottom of a test
specific complement proteins or for total tube. When inflammation is present, blood
complement. proteins stick together and fall and collect
more quickly as sediment.
 Why the test is used: ESR is used as a
marker of inflammation

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DIAGNOSIS
Complete Blood Cell Count (CBC) Chemistry Panel
 What it is: CBC is a test to measure levels of  What it is: A chemistry panel is a test to
different blood cells. assess kidney function and liver function. It also
 Why the test is used: Abnormalities in blood gives information on electrolytes, blood sugar,
cell counts, including white blood cells and red cholesterol, and triglyceride levels.
blood cells, may occur in people with lupus. This  Why the test is used: Abnormalities may
may be related to the lupus, lupus treatments, or indicate the development of complications from
infection. lupus.

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 Urine Tests for Lupus
DIAGNOSIS Besides blood tests used to diagnose and monitor lupus,
Glomerular Filtration Rate doctors use urine tests to diagnose and monitor the
effects of lupus on the kidneys. These tests include the
 What it is: : A glomerular filtration rate following:
measures how effective the kidneys are at
filtering the blood to eliminate waste products  Urine Protein/Microalbuminuria. These tests
measure the amount of protein (or albumin) in
urine. Even a small amount may indicate a risk for
kidney disease.
 Creatinine Clearance: This test measures how
effective the kidneys are at filtering the blood to
eliminate waste products. It is conducted on urine
collected over a 24-hour period.
 Urinalysis: Urinalysis can be used in screening for
kidney disease. The presence of protein, red blood
cells, white blood cells, and cellular casts may all
indicate kidney disease.

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MEDICATIONS
Antimalarial drugs
Anti-inflammatory drugs
 Some medications that treat malaria, such as
Over-the-counter anti-inflammatory drugs hydroxychloroquine and chloroquine, can also
include:
treat lupus. They might help with skin rashes,
 Acetaminophen mouth sores, and joint pain.
 Aspirin
Side effects of antimalarial drugs
 Ibuprofen
 Side effects, like stomach upset, tend to be rare
 Naproxen
and mild.
Side effects of anti-inflammatory drugs
 Sometimes, anti-inflammatories can irritate your
stomach, so take them with food or milk. NSAIDs,
especially at higher doses, raise your chances of a
heart attack or stroke.

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MEDICATIONS
Corticosteroids Immunosuppressive drugs
Lupus makes parts of your immune system overactive, so it  Like corticosteroids, these drugs curb your immune
attacks healthy tissue by mistake. Corticosteroids weaken this system, bring symptoms under control, and help
immune response. prevent long-term organ damage
Taken as a pill or IV, corticosteroids work fast to ease swelling,
warmth, and soreness in joints that are caused by Common immunosuppressive drugs for lupus include:
inflammation.They can also prevent long-term organ damage.
• Azathioprine (Imuran)
Side effects of corticosteroids
• Cyclophosphamide (Cytoxan)
Corticosteroids can have serious side effects like:
 • Higher chance of infections • Methotrexate (Rheumatrex)
 • Fragile bones or bone damage, especially in your hips Side effects of immunosuppressive drugs
 • Muscle weakness  Immunosuppressives can also have severe side
 • Diabetes effects. For example, they can make it hard for your
 • Cataracts
body to fight infections and raise your chances for some
kinds of cancer.

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NURSING MANAGEMENT

NURSING ASSESSMENT NURSING DIAGNOSES

 Subjective and objective data that should be Nursing diagnoses for the patient with SLE may
obtained from the patient with SLE. In particular, include, but are not limited to, the following:
evaluate the extent to which pain and fatigue
 • Fatigue related to chronic inflammation and
influence activities of daily living.
altered immunity
 • Impaired skin integrity related to
photosensitivity, skin rash, and alopecia
 • Impaired comfort related to illness-related
symptoms, treatment-related side effects, and
the potential for variable and unpredictable
progression of the disease

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NURSING MANAGEMENT
PLANNING NURSING IMPLEMENTATION
The overall goals are that the patient with SLE will: HEALTH PROMOTION. Education of
 (1) have satisfactory pain management, health professionals and the community should
 (2) adhere to the therapeutic regimen to achieve promote a clear understanding of the disease and
maximum symptom management, the need for early diagnosis and treatment.• Fatigue
related to chronic inflammation and altered
 (3) demonstrate awareness of and avoid activities
that exacerbate the disease, and immunity.

 (4) maintain optimal role function and a positive ACUTE INTERVENTION. As in the
self-image. majority of rheumatic diseases, the unpredictable
nature of SLE presents many challenges to the
patient and caregiver.

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NURSING IMPLEMENTATION

Nursing interventions include:

• Accurately recording the severity of symptoms and documenting the response to therapy.
• Specifically assess fever pattern, joint inflammation, limitation of motion, location and degree of discomfort,
and fatigue.
• Monitor the patient’s weight and fluid intake and output if corticosteroids are prescribed because of their
fluid-retention effect and the possibility of renal failure.
• Collection of 24-hour urine samples for protein and creatinine clearance may be ordered. Observe for signs
of bleeding that result from drug therapy, such as pallor, skin bruising, petechiae, or tarry stools.
• Carefully assess the neurologic status. Observe for visual disturbances, headaches, personality changes,
seizures, and forgetfulness. Psychosis may indicate CNS disease or may be an effect of corticosteroid
therapy.
• Irritation of the nerves of the extremities (peripheral neuropathy) may produce numbness, tingling, and
weakness of the hands and feet.
• Explain the nature of the disease, modes of therapy, and all diagnostic procedures. Emotional support for the
patient and family is also essential, especially during an exacerbation.

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AMBULATORY AND HOME CARE.

Help the patient understand that even strong adherence to the treatment plan is no guarantee against
exacerbations because the course of the disease is unpredictable. A variety of factors may increase disease
activity, such as fatigue, sun exposure, emotional stress, infection, drugs, and surgery.

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REFERENCES:
• Bartels, C. M. (2022, November 11). Systemic lupus erythematosus (SLE). Practice Essentials, Pathophysiology and Etiology, Pathophysiology. Retrieved November 18, 2022, from
https://emedicine.medscape.com/article/332244overview#:~:text=The%20classic%20presentation%20of%20a,into%20the%20diagnosis%20of%20SLE.&text=Patients%20may%20present%20with%
20any,fever%2C%20arthralgia%2C%20weight%20changes)
• Brown, D., Edwards, H., Buckley, T., & Aitken, R. L. (2020). Lewis's medical-surgical nursing: Assessment and management of clinical problems. Elsevier.

• https://simpletasks.org/wp-content/uploads/2014/05/Lupus-Online.pdf

• Khatri, M. (2021, October 21). How is lupus diagnosed? WebMD. Retrieved November 18, 2022, from https://www.webmd.com/lupus/laboratory-tests-used-diagnose-evaluate-sle

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THANK YOU