Systemic offer total care to the affected person.

Systemic Lupus Erythematous (SLE) or
simply known as lupus is a life-threatening
disease. Many might not recognize the extent to which someone with SLE is
affected daily. It is essential for healthcare experts to understand the
sickness method, along with the cause, symptoms, signs, and remedy of lupus. By
comprehending all of this, healthcare professionals can help with reporting
signs and symptoms to the patient’s specialist to reach an accurate analysis.
It is not just vital to comprehend lupus to reach an analysis, but to offer
total care to the affected person.

Lupus is a rheumatic sickness
characterized by autoantibodies that attacks healthy tissues, immune complex
formation, harming various organs. The disease can have negative effects on the
skin, kidneys, joints, blood cells and the brain. (Teitel, A.D.,2013). The
principal cause of lupus is unknown; patients can also present with a few years
of signs and symptoms (D’Cruz, DP. S.L.E 587– 590).

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Patients with
SLE may experience symptoms including: chest pain when taking a deep breath, hair
loss, skin rash, sensitivity to sunlight, fever, general discomfort, fatigue, uneasiness
among others. Four out of the first eight common symptoms
must be present in order to

be diagnosed with SLE (Teitel,
A.D., 2013.). Lymphadenopathy is a particularly common symptom of SLE.
Approximately, 23-34% of all patients report experiencing lymphadenopathy
(Shrestha, D., et al., 2013). In order to determine if a patient does in fact
have SLE several tests are performed to reach a definitive diagnosis. These
tests include the following: antibody tests including antinuclear antibody
panel, complete blood count, chest x-ray, kidney biopsy, urinalysis,
antithyroglobulin antibody, antithroid microsomal antibody, complement
components, Coombs’ test- direct, kidney and liver blood function tests, and
rheumatoid factor.

diseases, such as SLE, can be detected by the use of the antinuclear antibody
test. Antinuclear antibodies are present in people whose immune system is
fighting his or her own immune system. This test is used to determine the
“strength of the antibodies by measuring how many times the person’s blood must
be diluted to get a sample that is free of antibodies” (Teitel, A.D., 2013).
The Antithroglobulin antibody test is completed to assist in detecting possible
thyroid problems; because these particular antibodies, can lead to the
obliteration of the thyroid gland (Topiwala, S., 2012). The Antithyroid
microsomal antibody and complement components (C3 and C4) tests are used to
diagnose autoimmune disorders. The Coombs’ test is used to detect antibodies
that can potentially destroy red blood cells, therefore causing anemia
(Vorvick, L. J., 2012). Cryoglobulins is performed to detect cryoglobulins
which are linked with disorders that affect the skin, joints, kidneys, and
nervous system (Teitel, A. D., 2013. Cryoglobulins).

Erythrocyte Sedimentation
Rate (ESR) is a test that is ordered to determine a “sed rate” of a person
having unexplained fevers, certain types of arthritis, muscle symptoms or other
vague symptoms that cannot be explained. This test is also used to determine if
a disease is becoming more active or flaring up (Dugdale, D.C., 2011).
Rheumatoid factor is used to assist in determining whether the patient has
rheumatoid arthritis or sjogren syndrome, which may be secondary to SLE
(Starkebaum, G.A., 2013). Once the results of the test are determined the next
phase is treatment.  Because SLE is an
autoimmune disease and the cause is unknown there is no cure. It is important
to treat the symptoms; to do this a variety of medications with various side
effects are necessary. The most common medications used in treatment are the steroids
Plaquenil Cytoxan , Imuran, Rheumatrex, prednisone, Benlysta , CellCept and Rituxan
(Lupus Health Center, 2014). Topical steroids are used to treat rashes by
direct application. When concerning SLE low doses of steroid creams and tablets
can be effective. Larger doses of steroids may be prescribed when internal
organs are endangered. 

The downfall of steroids in larger doses
is that they cause side effects such as weight gain, thinning skin which can
bruise easily, muscle weakness, stretch marks across the body and acne – this
is known as Cushing’s syndrome and weakening of the bones (Corticosteroids-
Side effects, 2013). Plaquenil is a biological response modifier, antimalarial,
and disease modifying rheumatic drug that is used to keep mild lupus related
problems under control, as well as preventing flare ups. It is contraindicated
in people with known hypersensitivity to retinal or visual field changes
associated with quinoline compounds, psoriasis, porphyria, G6PD deficiency, and
long term therapy in children. Plaquenil should be used cautiously in treatment
of people with hepatic disease, alcoholism, use with hepatotoxic drugs, impaired
renal function, porphoria, metabolic acidosis, patients with tendency to
dermatitis, and pregnancy. Adverse effects include: fatigue, vertigo, headache,
mood or mental changes, anxiety, retinopathy, blurred vision, difficulty
focusing, anorexia, nausea, vomiting, diarrhea, abdominal cramps, weight loss,
thrombocytopenia, bleaching or loss of hair, unusual pigmentation of skin or
inside of mouth, skin rash, and/or itching. It is important to administer antacids
and laxative by at least four hours because drugs containing aluminum and
magnesium decrease the absorption of Plaquenil (Wilson, B.A., Shannon, M.T.,
& Shields, K.M., 2013). 

                     Imuran (azathioprine) is
an immunosuppressant, disease-modifying rheumatic drug that is used for SLE,
lupus nephritis, psoriatic arthritis, ulcerative colitis, nephrotic syndrome,
and other inflammatory and immunologic diseases. Imuran is contraindicated in
patients with hypersensitivity at azathioprine of mercaptopurine, have a
clinically active infection, immunization of patient of close family members
with live virus vaccines, anuria, pancreatitis, patients previously treated
with alkylating agents, concurrent radiation therapy, development of GI
toxicity to drug, pregnancy, and lactation. Adverse effects include: nausea,
anorexia, esophagitis, diarrhea, bone marrow depression, thrombocytopenia,
leukopenia, anemia, agranulocytosis, secondary infection, and/or alopecia.
Allopurinol increases the effects and toxicity of Imuran by reducing metabolism
of the active metabolite. Allopurinol should be decreased by one third or one
fourth (Wilson, B.A., et al., 2013).Rheumatrex is an antineoplastic, antimetabolite,
immunosuppressant disease-modifying antirheumatic drug that is used for
psoriatic arthritis, SLE, and polymyositis. Rheumatrex is contraindicated in
patients with hepatic and renal insufficiency, alcohol, ultraviolet exposure to
psoriatic lesions, preexisting blood dyscrasias, men and women in childbearing age,
pregnancy and lactation. Side effects of

Rheumatrex include: headache,
drowsiness, hepatotoxicity, ulcerative stomatitis, glossitis and gingivitis (Wilson,
B.A., et al., 2013).

It is
important to be able to differentiate between the symptoms of the disease
process and symptoms of the adverse effects. If the patient is not responding
to the prescribed treatment the medications should be adjusted or discontinued
all together. Many times it is difficult finding the correct medication regimen
for the patient, however it is necessary. The prognosis of SLE has improved in
the recent years. “Survival of SLE patients has improved in the last 60 years,
from a 5-year survival approximately 50% in the 1950s to more than 95% in the
2000s” (Ugarte-Gil, M. , & Alarcon, G., 2013). Older age at diagnosis,
poverty higher levels of disease activity, higher levels of damage, male
gender, and African-American race/ethnicity are among several factors that are
associated with SLE mortality rates (Ugarte-Gil, M. , & Alarcon, G., 2013).

 Not only should healthcare professionals
understand the signs and symptoms and treatment of SLE, but society as a whole should
as well. Majority of the time it is a family member or close friend that may
notice changes in a patient. We also must remember when a patient, friend, or
family member states that they are in pain we must further examine the details
of the pain. We are unable to feel the pain and we must not ignore the
subjective data our patients are providing because it may lead to a greater
problem such as SLE.  


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