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SYSTEMIC LUPUS ERYTHEMATOSUS

Systemic lupus erythematosus (SLE)

-is a chronic, inflammatory autoimmune collagen disease resulting from disturbed immune regulation that causes an exaggerated production of autoantibodies

Clinical Manifestation Onset is insidious or acute. SLE can go undiagnosed for many years. The clinical course is one of exacerbations and remissions Classic symptoms: Fever, fatigue, weight loss, and possibly arthritis, pleurisy Musculoskeletal system: Arthralgia and arthritis (synovitis) are common presenting features. Joint swelling, tenderness and pain on movement are common, accompanied by morning stiffness. Integumentary system: several types are seen (eg, subacute cutaneous lupus erythematosus [SCLE], discoid lupus erythematosus [DLE]. Butterfly rash across the bridge of the nose and cheeks and may be precursor to systemic involvement. Lesions worsen during exacerbations (flares) and may be provoked by sunlight or artificial ultraviolet light. Oral ulcers may involve buccal mucosa or hard palate. Cardiovascular system: Pericarditis is the most common clinical cardiac manifestations. Women with SLE are also at risk of early atherosclerosis. Papular erythematosus, and purpuric lesions may occur on fingertips, elbows, toes and extensor surfaces of forearms or lateral sides of hands and may progress to necrosis. Varied and frequent neuropsychiatric presentations, generally demonstrated by subtle changes in behaviour or cognitive ability.

ASSESSMENT AND DIAGNOSTIC FINDINGS Complete history Physical Examination Blood tests

No single laboratory test confirms SLE. Blood testing reveals moderate to severe anemia, Thrombocytopenia, leukocytosis, or leukopenia, and positive anti-nuclear antibodies. Other test supports but do not confirm diagnosis.

MEDICAL MANAGEMENT Treatment includes management of acute and chronic disease. Goals of treatment include preventing progressive loss of organ function, reducing the likelihood of acute disease, minimizing disease related disabilities, and preventing complications from therapy. Monitoring is performed to assess disease activity and therapeutic effectiveness.

PHARMACOLOGIC THERAPY Nonsteroidal anti-inflammatory drugs (NSAIDs) are used with corticosteroids to minimize corticosteroids requirements Corticosteroids are used topically for cutaneous manifestations IV administration of corticosteroids is an alternative to traditional high dose aral use Cutaneous, musculoskeletal and mild systemic features of SLE are are managed with antimalarial drugs Immunosuppressive agents are generally reserved for the ost serious forms of SLE that have not responded to conservative therapies.

NURSING MANAGEMENT The nursing care of patient with SLE is generally the same as that for the patient with rheumatic disease. the primary nursing diagnoses address fatigue, impaired skin integrity disturbed body image and deficient knowledge. Be sensitive to psychological reactions of the patient due to changes and the unpredictable course of SLE; encourage participation in support groups, which can provide disease information, daily management tips and social support. Teach patient to avoid sun and ultraviolet light exposure or protect themselves with sunscreen clothing.

Because of the increased risk of involvement of multiple organ system s, teach patient the importance of routine periodic screening as well as health promotion activities. Refer to dietician if necessary Instruct the patient about the importance of continuing prescribed medications, and address the changes and the potential side effects that are likely to occur with their use. Remind the patient of the importance of monitoring because of the increased risk of systemic involvement, including renal and cardiovascular effects.