SYSTEMIC LUPUS

ERYTHEMATOSUS (SLE)

BSN 3 -3 Group 2
 SYSTEMIC LUPUS
ERYTHEMATOSUS (SLE)
-is the most common type of lupus. SLE is an
autoimmune disease in which the immune system
attacks its own tissues,

-causing widespread inflammation and tissue

damage in the affected organs. It can affect the
joints, skin, brain, lungs, kidneys, and blood vessels.
 CLASSIC SIGNS AND
SYMPTOMS
·Extreme or Unexplained Fatigue
·Unexplained fever and pain
·Joint pain, stiffness and swelling
·Butterfly-shaped rash on the face that covers the cheeks and bridge of the
nose or rashes elsewhere on the body
·Skin lesions that appear or worsen with sun exposure
·Hair loss
·Reynaud’s Syndrome
·Shortness of breath
·Chest pain
·Dry eyes
·Headaches, confusion and memory loss
 PATHOPHYSIOLOGY
Systemic lupus erythematosus (SLE, or lupus) is a systemic autoimmune disease with
multi-organ inflammation. SLE is characterized by production of pathogenic
autoantibodies directed against nucleic acids and their binding proteins, reflecting a
global loss of self-tolerance. The loss of tolerance with subsequent immune
deregulation is a consequence of genetic factors, in the setting of environmental
triggers and stochastic events, with recent studies implicating over 30 genetic loci in
disease pathogenesis.
Aberrant innate immune responses play a significant role in the pathogenesis of SLE,
contributing both to tissue injury via release of inflammatory cytokines as well as to
aberrant activation of autoreactive T and B cells, with the latter leading to pathogenic
autoantibody production and resultant end-organ injury. Autoantigenic nucleic acids
and their binding proteins are required for self-antigen specific activation of autoreactive
lymphocytes. Autoantigens complexed with their cognate autoantibodies also directly
contribute to activation of innate immune cells via Fc receptor (FcR)-mediated uptake of
complexes with the nucleic acid component of these complexes upon endosomal
trafficking engaging intracellular Toll-like receptors (TLRs) with subsequent innate and B
cell activation.
ADAPTIVE IMMUNITY

The adaptive immune system, also known as the acquired immune system, or specific immune system is a subsystem of the
immune system that is composed of specialized, systemic cells and processes that eliminate pathogens or prevent their
growth.

INNATE IMMUNITY

Recruit immune cells to infection sites by producing chemical factors, including chemical mediators called cytokines. Activate
the complement cascade to identify bacteria, activate cells, and promote clearance of antibody complexes or dead cells.
Identify and remove foreign substances present in organs, tissues, blood and lymph, by specialized white blood cells. Activate
the adaptive immune system through antigen presentation.

AUTOANTIBODIES AS INITIATORS OF TISSUE INJURY IN SLE

The kidney is a primary site of tissue injury in murine and human lupus. Nephritis results from glomerular deposition of
immune complexes of autoantibodies and autoantigens, with engagement of FcRs on immune cells along with
complement fixation. These effector mechanisms initiate infiltration and activation of tissue-infiltrating macrophages
that promote the inflammatory response with resultant tissue injury.
 DIAGNOSTIC PROCEDURES WITH NURSING MANAGEMENT
Diagnostic and laboratory procedures are crucial in diagnosing SLE, assessing disease activity,
monitoring organ involvement, and guiding treatment decisions. Regular monitoring of procedures
enables healthcare providers to evaluate the effectiveness of interventions, make necessary
adjustments to the treatment plan, and detect potential complications or disease flares.

LABORATORY TESTS
BLOOD AND URINE TESTS MAY INCLUDE:
Complete blood count- This test measures the number of red blood cells, white blood cells and
platelets as well as the amount of hemoglobin, a protein in red blood cells. Results may indicate
you have anemia, which commonly occurs in lupus. A low white blood cell or platelet count may
occur in lupus as well.
Erythrocyte sedimentation rate- This blood test determines the rate at which red blood cells
settle to the bottom of a tube in an hour. A faster than normal rate may indicate a systemic
disease, such as lupus. The sedimentation rate isn't specific for any one disease. It may be
elevated if you have lupus, an infection, another inflammatory condition or cancer.
Kidney and liver assessment- Blood tests can assess how well your kidneys and liver are
functioning. Lupus can affect these organs.
Urinalysis- An examination of a sample of your urine may show an increased protein level or red
blood cells in the urine, which may occur if lupus has affected your kidneys.
Antinuclear antibody (ANA) test- A positive test for the presence of these antibodies — produced
by your immune system — indicates a stimulated immune system. While most people with
lupus have a positive antinuclear antibody (ANA) test, most people with a positive ANA do not
have lupus. If you test positive for ANA , your doctor may advise more-specific antibody testing.
Imaging tests- If your doctor suspects that lupus is affecting your lungs or heart, he or she may
suggest:
Chest X-ray- An image of your chest may reveal abnormal shadows that suggest fluid or
inflammation in your lungs.
Echocardiogram- This test uses sound waves to produce real-time images of your beating heart.
It can check for problems with your valves and other portions of your heart.
Biopsy- Lupus can harm your kidneys in many different ways, and treatments can vary,
depending on the type of damage that occurs. In some cases, it's necessary to test a small
sample of kidney tissue to determine what the best treatment might be. The sample can be
obtained with a needle or through a small incision.
Skin biopsy- is sometimes performed to confirm a diagnosis of lupus affecting the skin.
 NURSING MANAGEMENT
Nursing goals of a client with systemic lupus erythematosus (SLE) may
include relief of pain and discomfort, relief of fatigue, maintenance of skin
integrity, compliance with the prescribed medications, increased knowledge
regarding the disease, and absence of complications.

1. Assess and monitor the patient for signs and symptoms of disease activity.
2. Monitor patient’s renal function.
3. Assess patient’s skin condition.
4. Monitor medication adherence and side effects.
5. Provide psychological and emotional support.
 MEDICATIONS
Medications are often given to suppress immune system, treat existing inflammation and manage
symptoms such as pain. Monitor for GI discomfort or irritation when giving medications; prevent
constipation if opioids are given.
These are some of the common drugs used for treatment of SLE:
1. NSAID’S
Over-the-counter NSAIDs, such as ibuprofen and naproxen, help reduce mild pain and swelling in joints and
muscles
Mechanism of Action – Blocks prostaglandin synthesis through inhibition of cyclooxygenase enzymes,
producing anti-inflammatory, analgesic, and antipyretic effects.
Potential Adverse Effects: Gastrointestinal irritation and bleeding, renal toxicity, hepatic toxicity and
hypertension
2. Antimalarials
Medicines that prevent or treat malaria also treat joint pain, skin rashes, fatigue, and lung inflammation. Two
common antimalarial medicines are hydroxychloroquine (Plaquenil) and chloroquine phosphate (Aralen).
Mechanism of Action – Unclear; may interfere with T-cell activation and inhibits cytokine activity; also thought to
inhibit intracellular TLRs
Potential Adverse Effects: Macular damage, muscle weakness
3. Corticosteroids
Corticosteroids (prednisone) may help reduce swelling, tenderness, and pain. In high doses, they can calm the immune
system.
Sometimes just called “steroids,” come in different forms: pills, a shot, or a cream to apply to the skin. Lupus symptoms
usually respond very quickly to these powerful drugs.
Mechanism of Action- Multiple effects of immune system (e.g. blocking cytokines activation and inhibiting interleukins, Y-
interferon and tumor necrosis factor(x)
Potential Adverse Effects: Weight gain, hypertension, hyperglycemia, hyperlipidemia, osteoporosis, cataracts, edema,
hypokalemia, muscle weakness, growth suppression, increased risk of infection, glaucoma
4. Immunosuppressants
These medicines may be used in severe cases of lupus, when lupus affects major organs and other treatments do not work.
Mechanism of Action – Multiple suppressive effect of immune system (e.g., reduction of T-cell and B-cell proliferation; DNA
and RNA disruption)
Potential Adverse Effects: Myelosuppression, hepatotoxicity, renal dysfunction, infertility, increased risk of infection and
cancer.
5. Monoclonal Antibodies
Belimumab (brand name: Benlysta) the primary monoclonal antibody approved for the treatment of systemic lupus
erythematosus (SLE).
By inhibiting BLyS, belimumab helps reduce the production of autoantibodies and control the autoimmune response seen
in SLE.
Mechanism of Action – Block binding of BLyS to receptors in B cells. Inhibiting survival of B-cells and reducing B-cell
differentiation into immunoglobulin producing plasma cells.
Potential Adverse Effects: Nausea, diarrhea, pyrexia, nasopharyngitis, insomnia, extremity pain, depression, migraine,
gastroenteritis, infection (e.g, pneumonia, UTI, cellulitis, bronchitis)
 NURSING MANAGEMENT
1. Education: Provide patient education about SLE, its symptoms, and the importance of
medication adherence and self-care.
2. Symptom Management: Teach patients strategies to manage common symptoms like
fatigue, joint pain, and skin rashes, such as using heat or cold packs and maintaining a
balanced diet.
3. Medication Monitoring: Assist patients in understanding their medications, their potential
side effects, and the importance of following the prescribed regimen.
4. Sun Protection: Emphasize the need for sun protection, as UV light can trigger flares.
Encourage patients to use sunscreen, wear protective clothing, and limit sun exposure.
5. Regular Follow-up: Stress the importance of regular medical follow-up to monitor disease
progression, adjust treatment plans, and address any concerns.
 NURSING CARE PLAN FOR SYSTEMIC LUPUS ERYTHEMATOSUS

ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION

Subjective: Disturbed body image After 7 days of nursing Independent: After 7 days of nursing
related to presence of rash, interventions, the patient Encourage good To improve general interventions, the patient
“Namuwa ako nawong” as lesions, alopecia, and loss rash will be minimized and nutrition, sleep habits, health and help rash was minimized and
verbalized by the patient. of strength. prevented. and exercise, rest and prevent infection. prevented.
relaxation technique.
Suggests alternative To cover significant
Objective: hairstyles or wearing of areas of alopecia.
scarves or wigs
·Butterfly rash ·Encourage good oral To prevent oral
·Alopecia hygiene. ulcer.
·V/S taken as follows: Teach the patient
relaxation techniques To reduce emotional
T: 37.2 such as deep breathing, stress that may
P: 90 progressive muscle cause fatigue.
R: 19 relaxation, and imagery.
BP: 110/80 Avoid direct exposure to To reduce the
sunlight and encourage chance of
use of sunscreen and exacerbations.
wear protective clothing.
Advice to avoid Use of some drugs
pregnancy during the for treatment of SLE
time of disease. can cause sterility.
Collaborative:
Administer analgesics as To enhance pain
prescribed. relief.
THE END