Systemic Lupus Erythematosus

Systemic Lupus Erythematosus (SLE), or most people are referring to when they say “lupus.”, is an autoimmune disease in which a person's immune system attacks various organs or cells of the body, causing damage and dysfunction. Lupus is called a multisystem disease because it can affect many different tissues and organs in the body. Systemic lupus erythematosus is a long-term autoimmune disorder that may affect the skin, joints, kidneys, brain, and other organs. In this essay we will explain about the etiology (causes & factors), Nursing Care Plan (NCP), treatment, and medication.

SLE was first described in 1828. Its very name helps define the disease (Simon & Zieve, 2009):

• Systemic is used because the disease can affect organs and tissue throughout the body.
• Lupus is Latin for wolf. It refers to the rash that extends across the bridge of the nose and upper cheekbones and was thought to resemble a wolf bite. 
• Erythematosus is from the Greek word for red and refers to the color of the rash. 

          Some patients with lupus have very mild disease, which can be treated with simple medications, whereas others can have serious, life-threatening complications. Lupus is more common in women than men, and for reasons that are not precisely understood, its peak incidence is after puberty. Although SLE usually first affects people between the ages of 15 and 45 years, it can occur in childhood or later in life as well.
           Lupus is a complex disease, and its cause is unknown. Scientists are making progress in understanding lupus. In studies of identical twins—who are born with the exact same genes—when one twin has lupus, the other twin has a 24-percent chance of developing it. Other research found that an identical twin of a person with lupus has a threefold to tenfold greater risk of getting lupus than a nonidentical twin. Moreover, first-degree relatives (mother, father, brother, sister) of people with lupus have an eightfold to ninefold increased risk of having lupus compared with the general public. This and other research suggests that genetics plays an important role, but it also shows that genes alone do not determine who gets lupus, and that other factors play a role.

Although an identical twin is much more likely to have lupus if her identical sibling has lupus, the likelihood of developing the disease in the unaffected twin is not 100%. Despite the nearly identical genetic makeup of identical twins, the probability of the unaffected twin developing the disease if the other twin has it is around 30%-50% or less. This implies that environmental factors may help determine whether or not the disease develops in a person. Some of the factors scientists are studying include sunlight, stress, hormones, cigarette smoke, certain drugs, and infectious agents such as viruses. Recent research has confirmed that one virus, Epstein-Barr virus (EBV), which causes mononucleosis, is a cause of lupus in genetically susceptible people (NIAMS, 2011). Outside of random occurrences of lupus, certain drugs, toxins, and diets have been linked in its development. Sun exposure (ultraviolet light) is a known environmental agent that can worsen rashes of patients with lupus and sometimes trigger a flare of the entire disease.

        In the past, the drugs most frequently responsible for drug-induced lupus are procainamide (Procanbid), hydralazine (Apresoline), minocycline (Minocin), phenytoin (Dilantin), and isoniazid (Laniazid). However, newer medications have been associated with drug-induced lupus, such as the new biological agents (etanercept [Enbrel], infliximab [Remicade], and adalimumab [Humira]) used to treat rheumatoid arthritis. Generally, lupus that is caused by a drug exposure goes away once the drug is stopped.

            Many women with lupus note that symptoms may be worse after ovulation and better at the beginning of the menstrual period. Estrogen has been implicated in making the condition worse, and this problem is currently being studied. Nevertheless, as a result of recent research, we do know that women with lupus may take birth-control medications without risk of activating their disease. Women who have antiphospholipid antibodies (such as cardiolipin antibodies, lupus anticoagulant, and false-positive tests for syphilis/RPR) should not take estrogens or birth-control pills because of the risk of blood clotting. Pregnant mothers with antiphospholipid antibodies have an increased risk of miscarriage and premature birth. Treatments include aspirin and blood-thinning medications (anticoagulant; heparin or low molecular weight heparin, Lovenox).

            Pregnancy does not appear to worsen the long-term outcome of patients with lupus. On the other hand, active lupus tends to increase the risk of miscarriage and preterm birth. Babies of lupus mothers with the SSA antibody (anti-Ro antibody) can develop heart electrical abnormalities and a temporary skin rash (lupus neonatorum, also known as neonatal lupus). Pregnant mothers with lupus are monitored closely by obstetricians.

Giving the Nursing Care Plan (NCP) to people suffering from SLE ( Systemic Lupus Erythematosus.) is quite challenging because the symptoms and the diagnosis of them, is difficult to predict. There is a comprehensive and prolonged assessment procedure used to determine and assess their symptoms. These may include the medical history, a physical examination, laboratory tests, and a medical history that includes a period of relevant observations, possibly over several years. There are no single laboratory tests that can either prove or disprove this disease. Initial screening includes a complete blood count (CBC); liver and kidney screening panels; laboratory tests for specific autoantibodies (e.g., antinuclear antibodies [ANA]) such as anti-Ro, anti-La, anti-dsDNA, anti-Sm, anti-RNP, lupus anticoagulant, and anticardiolipin; an anti-phospholipid antibody test; urinalysis; blood chemistries; and erythrocyte sedimentation rate (ESR). The result of these tests will determine the evidence of existing symptoms which will reflect progress of the ongoing disease.

The treatment of Lupus embraces the whole aspect of human needs, such biological, psychological, and social. As a health professional, we have to meet all of the needs, necessary  to reduce the symptom of LUPUS. The biological needs will be fulfilled through prescribed medication. Although there are no medicines, known at this time, that can cure this disease, medication is required to control some of the symptoms, together with the specific manifestations. Some medicines which are used to control these symptoms are:  non-steroidal anti-inflammatory drugs (NSAIDs), antimalarials, corticosteroids, immunosuppressive, and intravenous immunoglobulin. Professional Health Care must determine the type and dose of the appropriate medicine. Drug history records are required so the professional can search for any allergies, hypersensitivities, and side effects. Treatment must also encompass physical and emotional rest, protection from direct sunlight, correct diet and nutrition, treatment of infection, surgery where necessary and immunization. On the matter of the psychosocial aspect, it should be noted that the individual emotional reaction of dealing with this disease can be overwhelming. Anger, grief, and depression are the common responses. The involvement and cooperation of the patient, their family, and access to relevant and available support systems could be quite beneficial in helping the patient to gain the necessary emotional control that will ultimately lead to a better understanding and prognosis. By allowing the patient and their family the time and freedom to move through different emotional phases without criticism and unrealistic expectation, may facilitate acceptance of this disease. A multidisciplinary approach from all concerned health professionals, including social workers, counselors and community resources, can play a significant role in helping the patient adjust to and deal with this disease.
 For conclusion, lupus is an autoimmune disease when the immune system attacks various organs or cells that make body getting dysfunction and damaged. The causes and the treatment of Lupus still unknown, but in some research, the etiology of this disease may be caused of genetic link, environmental factors, reversible drug-induced lupus, and association with pregnant and menstruation. 

References:

EnsZ, S. “Treatments for Lupus.” (2012). http://www.sclero.org/medical/symptoms/associated/lupus/treatments.html (diakses 21 April 2012)

Michelle. (1998). “Treatment of Systemic Lupus Erythematosus: An Update.” http://www.aafp.org/afp/1998/0601/p2753.html (diakses 21 April 2012)

Nasional Insitute of Arthritis and Muscoloskeletal and Skin Diseases (NIAMS). “Handout on Health:      Systemic             Lupus Erythematosus.” http://www.niams.nih.gov/Health_Info/Lupus/default.asp (Accessed on   2012, April 22^nd)

Shiel, William C. “Lupus (Systemic Lupus Erythematosus) (cont.).” http://www.emedicinehealth.com/lupus_systemic_lupus_erythematosus/page2_em.htm (Accessed on 2012, April 22^nd)

Simon, Harvey and Zieve, David. “Systemic lupus erythematosus.” http://adam.about.net/reports/Systemic-lupus-erythematosus.htm (Accessed on 2012, April 22^nd)

William C. Shiel Jr., MD, FACP, FACR. (2012). “Lupus (Systemic Lupus Erythematosus).” http://www.emedicinehealth.com/lupus_systemic_lupus_erythematosus/article_em.htm (Accessed on 2012, April 22nd)
National Institute of Arthritis and Musculoskeletal and Skin Disease. 2006. “Lupus Guide”. http://www.niams.nih.gov/Health_Info/Lupus/Lupus_Guide/chapter_1.asp (Acceses on 2012, 22nd of April)

Created by: Faiqa, Sopha, Tissa, Hadiah, Fadhila, Vera
Content editor: Mr. Allan Bush