Systemic Lupus Erythematous
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Transcript Systemic Lupus Erythematous
Systemic Lupus
Erythematosus
Iris Zink, CRNP
Objectives
Discuss pathophysiology of SLE and its
various presentations
Discuss impact of SLE on patient’s
health
Discuss the criteria for diagnosis of
SLE, and interpretation of lab tests
Discuss the interventions and standard
therapies for treatment of SLE
The Great Imitator
SLE: Definition
Lupus is a systemic autoimmune disease in which
the body loses tolerance to self:
•Can affect virtually any organ in the body and initial
symptoms are often nonspecific, making it very difficult to
diagnose
•Most commonly seen in women of childbearing age but 10%
of patients are men
•Average time of two years from onset of symptoms to
diagnosis
(Cevera, Medicine, 1993; Font, Semin Arthritis Rheum, 2004)
Shoua
Judy
Nakia
SLE Prevalence
Prevalence:
40-50 cases per 100,000
people
Approximately 750,000 cases in U.S.
today
Much more common in developed
countries and in urban areas
15-20% diagnosed during childhood
(Schur, Epidemology and pathogenesis of SLE. Up to date v. 14.2; Petri. SLE. Current
Rheumatology, Chapter 19)
Epidemiology: Race, Gender
and Age
More prevalent in African Americans,
Caribbean populations, Hispanics and
Asians
Female > Male
Most common between 20-40 year olds
How is SLE diagnosed?
Labs
Symptomatology
Patients
must meet 4/11 criteria
1.Malar Rash
2.Discoid Rash
3. Photosensitivity
4.Mucocutaneous Ulcers
5. Arthritis
6. Serositis
7. Renal Disorder
8. Neurologic Disorder
Neuropsychiatric
Systemic Lupus Erythematosus (NPSLE)
(95 vs 80%)
CNS (diffuse & central)
Acute confusional state
Psychosis
Anxiety
Depressive disorders
Cognitive dysfunction *
Seizures
CVA
Chorea
Myelopathy
Demyelinating syndrome
Headaches *
PNS
Brunner, H & Klein-Gitelman, M; Rheumatologist Vol 3:3, March 2009
Neuropathies
Acute inflammatory
demyelination
9. Hematologic 10. Immunologic
Leukopenia
Thrombocytopenia
Lymphopenia
Anti- DNA
ANA Interpretation
1:40
1:80
1:160
1:320
1:640
1:1280
1:2560
Lab Tests
ANA
ENA Ro SSA
La SSB
DNA
Sm
RNP
Jo-1
Histone
Scl-70
Antiphospholipid
antibody
Lupus Anticoagulant
Complement
Symptoms
•
Fever and fatigue 42%
•
Alopecia 18%
•
Lupus Nephritis 40-60%
Causes of Death
Death from renal disease is most common in
first 3-5 years
Patients who survive the first 5 years of
disease die from CVD at a much younger age
than disease free individuals
Women with SLE ages 35-44 have MI’s 50
times that of age matched controls
Quality of Life
90 patients SLE
Significantly worse QOL vs.
– age matched controls
– HTN, diabetes, or MI
Lupus lower than patients with CHF
re: physical function, bodily pain, general health
30%
25%
20%
15%
10%
5%
0%
Jolly, J Rheumatol 2005
AA
Hispanic
Caucasian
Treatment
Only FDA approved medications
• Plaquenil (hydroxychloroquine)
• Aspirin
• Steroids (prednisone)
Nephritis
Nephritis
• Medications for Lupus Nepritis
• Cyclophosphamide (Cytoxan)
• Mycophenolate Mofetil (CellCept)
DAMP AS RHINO
Discoid rash
ANA +
Malar rash
Photosensitivity
Arthritis
Serositis (pleural, pericardial)
Renal involvement
Hematologic abnormality
Immunologic abnormality
Neurologic abnormality (seizures, psychosis)
Oral/ nasal ulcer
www.medicalnemonics.com
References
Cervera, R., Khamashta, M. A., Font, J. (2003). Morbidity and mortality in SLE during a
10 yr period. Medicine (Baltimore), 82, 299-308.
Ho, A., Barr, S. G., Magder, L. S. (2001). A decrease in complement is associated with
increased renal and hematologic activity in patients with SLE. Arthritis Rheum, 44, 23502357.
Hochberg, M .C. (1997). Updating the ACR revised criteria for the classification of SLE
[letter]. Arthritis Rheum, 40, 1725.
Jolly, M. (2005). How does quality of life of patients with SLE compare with that of
other common chronic illnesses? J Rheumatol, 32, 1706-8.
Petri, M. (2004). SLE. In Imboden, J., Hellman, D. & Stone, J. (Eds.) Current
Rheumatology. Chapter 19. Retrieved 9/29/06 from www.accessmedicine.com.
Petri, M. Systemic Lupus Erythematosus 2006 update. (2006). J Clin Rheum 2006, 12,
37-40.
Tan, E. M., Cohen, A. S., Fries, J. F., et al. (1992). The 1992 revised criteria for the
classification of SLE. Arthritis Rheum, 25, 1271-7.
Schur, P. H. (2006). Epidemiology and pathogenesis of SLE. Up to date v.14.2. Retrieved
09/27/06 from www.uptodateonline.com.
Schur, P. H. (2006). Hematologic manifestations of SLE in adults. Up to Date v.14.2.
Retrieved 10/23/06 from www.uptodateonline.com.
Summary
Due to variety of symptoms, must know
entire history
Great imposter
Refer to Rheumatology if SLE
suspected
In SLE watch closely as things change
fast and CVD is a real concern
Monitor for QOL issues
Resources for Patients
www.clinicaltrials.gov
http://www.lupus.org/newsite/index.html
http://www.lupus.org/webmodules/webarticlesnet/
templates/nwohio_home.aspx
LFA, Michigan & Northwest Ohio - Findlay,
OH 419-423-9313, Toll-free 888-335-8787
(within OH and MI only)
http://www.arthritis.org/
http://www.mayoclinic.com/