INTRODUCTION

The preservation of health is easier than the cure of disease Anonymous

Systemic lupus erythematosus is a chronic inflammatory condition caused by

an autoimmune disease. An autoimmune disease occurs when the body's
tissues are attacked by its own immune system. Patients with lupus have
unusual antibodies in their blood that are targeted against their own body
tissues. Lupus can cause disease of the skin, heart, lungs, kidneys, joints,
and nervous system. When only the skin is involved, the condition is called
discoid lupus. When internal organs are involved, the condition is
called systemic lupus erythematosus (SLE). Anemia and Hypoalbuminemia
are both complications of SLE. Haematological abnormalities are common in
systemic lupus erythematosus. Anaemia is found in about 50% of patients,
with anaemia of chronic disease being the most common form. Impaired
erythropoietin response and presence of antibodies against erythropoietin
may contribute to the pathogenesis of this type of anaemia. Complications
such as Lupus nephritis is the most common cause of extended edema and
hypoalbuminemia in patients with systemic lupus erythematosus (SLE).
However, the same immune complex mechanisms which lead to renal
protein loss can also be active in the gastrointestinal tract, resulting in
severe hypoproteinemia through enteral protein loss.

In Manuel J. Santos Hospital there are a total of 5 cases in the year 2016.

Symptoms vary from person to person, and may come and go. Almost
everyone with SLE has joint pain and swelling. Some develop arthritis. SLE
often affects the joints of the fingers, hands, wrists, and knees. Other
common symptoms include: Chest pain when taking a deep breath, Fatigue,
Fever with no other cause, General discomfort, uneasiness, or ill feeling
(malaise). Hair loss, Mouth sores, Sensitivity to sunlight, Skin rash: A
"butterfly" rash in about half the people with SLE. The rash is most often
seen over the cheeks and bridge of the nose. It can be widespread. It gets
worse in sunlight., Swollen lymph nodes.

Other symptoms depend on which part of the body is affected: Brain and
nervous system: Headaches, numbness, tingling, seizures, vision problems,
and personality changes, Digestive tract: Abdominal pain, nausea, and
vomiting, Heart: Abnormal heart rhythms (arrhythmias), Lung: Coughing up
blood and difficulty breathing, Skin: Patchy skin color and fingers that change
color when cold (Raynaud phenomenon),Kidney: Swelling in the legs, weight
gain. Some people have only skin symptoms. This is called discoid lupus.

Lupus occurs when your immune system attacks healthy tissue in your body.
It's likely that lupus results from a combination of your genetics and your
environment. It appears that people with an inherited predisposition for lupus
may develop the disease when they come into contact with something in the
environment that can trigger lupus. The cause for lupus in most cases,
however, is unknown. Some potential triggers include: Sunlight. Exposure
to the UV rays of the sun may bring on lupus skin lesions or trigger an
internal response in susceptible people. Infections. Having an infection or
exposure to viruses can initiate lupus or cause a relapse in some people.
Medications. Lupus can be triggered by certain types of anti-seizure
medications, blood pressure medications and antibiotics. People who have
drug-induced lupus usually see their symptoms go away when they stop
taking the medication. Chemicals. Exposure to chlorinated pesticides and
crystalline silica. Other factors include dietary and lifestyle factors such as
eating foods containing canavine prestine and smoking.

Factors that may increase your risk of lupus include: 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 40. Race. Lupus is more
common in African-Americans, Hispanics and Asians. Family History. SLE
can be passed genetically, which means that first degree or second degree
relative has a higher chance of having SLE and also Presence of
Autoimmune Disorders.

Complications of SLE may include serious kidney damage, kidney failure,

hallucinations, memory problems, strokes, seizure, anemia, increased risk of
bleeding or blood clotting, inflammation of blood vessels (vasculitis),
inflammation of the chest cavity lining (pleurisy), inflammation of your heart
muscle, your arteries or heart membrane (pericarditis), also having SLE
makes you more prone to infections, cancer and avascular necrosis.

To be diagnosed with lupus, you must have 4 out of 11 common signs of the
disease. Nearly all people with lupus have a positive test for antinuclear
antibody (ANA). However, having a positive ANA alone does not mean you
have lupus. The health care provider will do a complete physical exam. You
may have a rash, arthritis, or edema in the ankles. There may be an
abnormal sound called a heart friction rub or pleural friction rub. Your
provider will also do a nervous system exam.

Tests used to diagnose SLE may include: Antinuclear antibody (ANA), CBC
with differential, Chest x-ray, Serum creatinine, Urinalysis. Other tests to
learn more about your SLE. Some of these are: Antinuclear antibody (ANA)
panel, Complement components (C3 and C4), Coombs test - direct,
Cryoglobulins, Erythrocyte Sedimentary Rate and CRP (C-reactive Protein),
Kidney function blood tests, Liver function blood tests, Rheumatoid factor,
Antiphospholipid antibodies and lupus anticoagulant test and Kidney biopsy.

There is no cure for SLE. The goal of treatment is to control symptoms.

Severe symptoms that involve the heart, lungs, kidneys, and other organs
often need treatment from specialists. Mild forms of the disease may be
treated with: NSAIDs for joint symptoms and pleurisy. Low doses of
corticosteroids, such as prednisone, for skin and arthritis symptoms.
Corticosteroid creams for skin rashes. Hydroxychloroquine, a drug also used
to treat malaria. Belimumab, a biologic drug, may be helpful in some people,

Treatments for more severe SLE may include: High-dose corticosteroids.

Immunosuppressive drugs (drugs which dampen or suppress the immune
system). These medicines are used if patient do not get better with
corticosteroids, or if symptoms get worse when corticosteroids are
discontinued. Blood thinners, such as Coumadin, for clotting disorders.
Prevention in patients with SLE includes: Wearing protective clothing,
sunglasses, and sunscreen when in the sun. Getting preventive heart care.
Staying up-to-date with immunizations. Having tests to screen for thinning of
the bones (osteoporosis). Avoiding tobacco and drink minimal amounts of
alcohol.

Because of more effective and aggressive treatment, the prognosis for SLE
has improved markedly over the past two decades. Treatment early in the
course of the illness improves long-term progress. About 85 - 95% of people
with lupus survive 10 years, and many people have a normal life span. SLE
that develops later in life is generally less serious than SLE that strikes in
childhood or young adulthood.
 DEFINITION OF TERMS

Albumin-a simple form of protein that is soluble in water and coagulable

by heat, such as that found in egg white, milk, and (in particular) blood
serum.

Antinuclear Antibody- test is used as a primary test to help evaluate a

person for autoimmune disorders that affect many tissues and organs
throughout the body (systemic) and is most often used as one of the tests
to help diagnose systemic lupus erythematosus (SLE).

Erythema Multiform- a skin condition of unknown cause; it is a type

of erythema possibly mediated by deposition of immune complexes
(mostly IgM-bound complexes) in the superficial microvasculature of the
skin and oral mucous membrane that usually follows an infection or drug
exposure.

Erythrocyte Sedimentary Rate (ESR)- a blood test that detects and

monitors inflammation in the body. It measures the rate at which red
blood cells (RBCs) in a test tube separate from blood serum over time,
becoming sediment in the bottom of the test tube.

Immune Complex- An immune complex, sometimes called an antigen-

antibody complex, is a molecule formed from the integral binding of an
antibody to a soluble antigen. The bound antigen and antibody act as a
unitary object, effectively an antigen of its own with a specific epitope.

Left Costophrenic Sulcus- the recess between the ribs and the lateral-
most portion of the diaphragm, partially occupied by the most caudal part
of the lung; seen on radiographs as the costophrenic angle.

Normocytic Normochromic Anemia- In normocytic normochromic

anemia, the red blood cell count is low but the hemoglobin remains
normal which translates to the size of the blood cells is still normal.

Peripheral Smear Evalutaion- A Peripheral Blood Smear Examination is

a procedure, which involves spreading a drop of blood thinly onto a glass
slide. It is then treated with a special stain and studied under a
microscope to examine the blood cells. A Blood Smear test gives
information on the number, shape, and general appearance of the blood
cells. It also helps diagnose a range of deficiencies, diseases, and
disorders involving blood cell production, function, and destruction.