Systemic Lupus Erythematosus shams elmostabal family

1. Systemic Lupus Erythematosus
Safaa EID
Medical surgical and critical care
department

2. Definition
• is an autoimmune disease of the body's
connective tissues.
• Autoimmune means that the immune system
attacks the tissues of the body.
• attacks parts of the cell nucleus.
• between the ages of 15 and 40, although it
can show up at any age.

3. Pathogenesis
• A healthy immune system produces
proteins called antibodies and specific cells
called lymphocytes.
• that help fight and destroy viruses, bacteria,
and other foreign substances that invade the
body.

4. • In lupus, the immune system produces
antibodies against the body's healthy cells
and tissues.
• These antibodies, contribute to the
inflammation of various parts of the body
and can cause damage to organs and tissues.
• Lupus can affect
-joints, skin, kidneys, heart, lungs, blood
vessels, and brain.

5. Causes
• The exact causes is not known.
• Inherited genes, viruses, ultraviolet light,
and drugs may all play some role.
• Genetic factors increase the tendency of
developing autoimmune diseases

6. • female hormones play an important role in
the expression of SLE.
• a key enzyme's failure to dispose of dying
cells may contribute the development of
SLE.
• a genetic mutation
• Drug-induced lupus. ( hydralazine, beta-
blokers, isoniazid) .

7. There are several kinds of lupus:
• Discoid lupus
erythematosus is
• a chronic skin disorder
• red, raised rash appears
on the face, scalp, or
elsewhere
• The rash may last for
days or years .

8. • Sub acute cutaneous lupus erythematosus refers
to skin lesions that appear on parts of the body
exposed to sun. The lesions do not cause scarring.
• Drug-induced lupus is a form of lupus caused by
medications. Many different drugs can cause drug-
induced lupus
• Neonatal lupus is a rare disease that can occur in
newborn babies of women with SLE

9. • Sjögren's syndrome is an autoimmune
disorder in which immune cells attack and
destroy the excroin glands that produce
tears and saliva.
• Sjögren's syndrome is also associated with
rheumatic disorders such as rheumatoid
arthritis

10. Secondary sjogren’s syndrome
• Dry eyes
• Dry mouth

11. Clinical manifestations
• The symptoms of SLE come on in
waves, called flares or flare-ups. In
between flares, patients may have
almost no symptoms.
• general discomfort, extreme fatigue,
fever, and weight loss at some point.

12. “Common Symptoms of Lupus
• Painful or swollen joints and muscle pain
• Unexplained fever
• Red rashes, most commonly on the face
• Chest pain upon deep breathing
• Unusual loss of hair
• Pale or purple fingers or toes from cold or
stress .

13. • Sensitivity to the sun
• Swelling (edema) in legs or around eyes
• Swollen glands
• Extreme fatigue

14. • Malar rash:
• This is a "butterfly-
shaped" red rash over the
cheeks below the eyes and
across the bridge of the
nose.
• It may be a flat or a raised
rash.
• The rashes are made worse
by sun exposure.

15. • Raynaud’s
phenomenon
• is commonly found in
lupus.
• reaction of distal digits to
cold or emotion, in which
the skin colour changes
from white to blue to red)

16. • Maculopapular
eruption

17. • Vasculitic skin
lesion

18. • Alopecia

19. • Oral ulcer:
• Painless sores in the
nose or mouth need to
be observed and
documented by a
doctor.

20. Different symptoms in different
body systems :
• Kidneys
Inflammation of the kidneys (nephritis)
Lungs
Central nervous system:

21. • Blood vessels:
• Blood vessels may become inflamed
(vasculitis)
• Muscles and Bones:
• joint pain or inflammation.
• The pain can come and go, or it can be
long lasting.

22. • Blood:
• anemia, leucopenia (a decreased number
of white blood cells), or thrombocytopenia
(a decrease in the number of platelets in the
blood, which assist in clotting).
• Heart:
• (myocarditis and endocarditis) or the
membrane that surrounds it (pericarditis).

23. • Digestive System:
• Symptoms include abdominal pain, loss of
appetite, nausea, and sometimes vomiting.
• psychological and emotional effects
• such as grief, depression, and anger,
depression
• Pregnancy.
• However, the chances of miscarriage,
premature birth, and death of the baby in
the uterus are high.

24. Diagnostic studies
– Complete blood count (CBC)
– Erythrocyte sedimentation rate (ESR)
– Urinalysis
– Blood chemistries
– Antinuclear antibody test (ANA)
– Other autoantibody tests (anti-DNA)
• Skin biopsy
• Kidney biopsy

25. Treatment
• A conservative regimen of physical and
emotional rest is required
• protection from direct sunlight
• a healthful diet
• prompt treatment of infections
• pregnancy must be planned for times when
the disease is under control, and the patient is
on allowable medications.

26. Medications
1-NSAIDs:
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
such as ibuprofen and naproxen.
2- Antimalarials:
• (Plaquenil). It may be used alone or in
combination with other drugs
3- Corticosteroids:

27. 4- Immunosuppressives: For some patients
whose kidneys or central nervous system are
affected by lupus, such as cyclophosphamide
(Cytoxan)
- restrain the overactive immune system by
blocking the production of immune cells.

28. Other therapy
• Plasma exchange
• Intravenous Immunoglobulin
• Stem cell transplantation
• Immune therapy ( anti-IL10, anti-CD20,
and immune tolerance therapy)

29. Nursing care
• Minimize appearance of lesions.
• Alleviate discomfort
• Minimize fatigue.
• Maintain weight at optimal range
• Teach the patient to recognize fever and signs and
symptoms of infection.
• Maintain joint function and increase muscle
strength.

30. – Recognize anemia and develop a plan of
care
– Minimize episodes of bleeding.
– Minimize incidence of infection.
– Educate the patient about immunizations
– Educate patient nutritional status.

31. Thanks