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Lupus Systemic Lupus Erythematosus

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					Lupus
Systemic Lupus Erythematosus
Sarah Mouser

SLE
A chronic multisystem inflammatory disorder that can affect various parts of the body esp the joints, kidney, skin, and blood.  It‟s a disease of flares and remissions  Autoimmune disease-attacks itself
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Etiology
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70%-90% occur in women, but can occur in men. More common in African Americans & Asians More than 16,000 new cases a year 5 million people worldwide 1.5 million in America

CAUSES
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No gene or gene group has been proven to cause Lupus Appears in certain families Unknown cause Some environmental factors such as: UV rays, sulfa rays, some sun-sensitizing tetracyclinesBactrim, penicillin-Amoxicillin Can be exaccerbated by emotional stress, cold, virus, exhaustion, Sex hormone Estrogen plays a part in it.

Forms of Lupus
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SLE (Systemic Lupus Erythematosus) CLE (Cutaneous Lupus Erythematosus) Drug-Induced Lupus Erythematosus

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SLE
Most common  Inflammation of the kidneys  Increased bp in the lungs  Inflammation of blood vessels in brain  Hardening of arteries
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CLE
Limited to the skin  Raised, scaly and red, but not itchy, known as discoid rash bec of disk shaped lesions  Butterfly rash
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Drug-Induced Lupus
Most often caused by hydralazine (used to treat HTN), procainamide (irregular heart rhythm), isoniazide (used to treat tuberculosis)  More common in men
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SLE
-alterations in the immune system  -Antinuclear antibodies, antibodies to DNA, and antihistones are all strongly associated with SLE.  -abnormalities in both B cells and T cells  -appearance of B cells thought to cause increase in production of antibodies to self  -visceral lesions mediated by type III hypersensitivity
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General Symptoms
-extreme fatigue  -malaise  -fever  -painful or swollen joints  -known as the „great imitator‟ because it has symptoms similar to RA, blood disorders, fibromyalgia, diabetes, thyroid problems, Lyme disease, and many heart, lung, and muscle and bone disorders.
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Prognosis
-no cure for disease  -80-90% can expect to live a normal life span  -many people die from overwhelming infection and kidney failure  Overall 5 yr survival rate with extended therapeutic options are 95%
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Diagnosis
-difficult to diagnosis because it mimics  -evolves over time  -have abnormal lab tests  -not one specific test  4 out of 11 of the criteria
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Criteria
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-face rash -scaly, discoid rash -sun-related rash -mouth sores -joint pain in more than 2 joints -swelling around heart or lungs -kidney disease -seizures -low blood count -positive anti-nuclear antibody test -other positive blood tests

Overlapping Syndromes
-5%-30% have overlapping symptoms  -likelihood of an overlap disease-15%  -Overlap Disease Approximate Rate of Occurrence  Rheumatoid Arthritis 1% Polymyositis-Dermatomyositis 2% Mixed Connective Tissue Disease 3% Scleroderma 4% Sjogren's syndrome 5%
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Myositis-muscle pain due to fatigue and high levels of cortisone Polymyositis-Dermatomyositis-muscle weakness due to muscle inflammation Scleradoma-thickened skin Mixed connective tissue disorder-lupus, polymyositis-dermatomyositis, and scleroderma. Sjogren‟s syndrome-dry eyes and mouth-caused by an accumulation of lymphocytes

Cardiovascular
-very hard to know -pericardial effusion -myocarditis-inflammation-at risk due to immunosuppressives  -increased risk for CAD, HTN from kidney disease or corticosteroid use, elevated cholesterol levels from corticosteroid use, type 2 diabetes from corticosteroid use  -lupus-related anemia b/c body is not producing enough red blood cells, antibodies destroy the healthy blood cells-hemolytic anemia
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cont
-valvular disease  -thrombophlebitis  -serositis-inflammation of sacs around organs  -vasculitis  -Raynaud‟s phenomenon- fingers turn white and/or blue when cold
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GI system
- dysphagia  -nausea  -vomiting  -pancreatitis  -elevated liver function tests  -sometimes due to treatments such as NSAIDS, other times due to muscles not moving wastes through body
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Pulmonary System
-cough  -dyspnea  -pleurisy  -pneumonitis
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MS system
-joint deformities  -arthralgia-joint pain  -morning stiffness  -lupus arthritis, which can cause muscle atrophy
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Skin
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-discoid lesions on sun-exposed skin -photosensitivity -butterfly rash -build-up of calcium deposits under the skinCalcinosis -inflammation damages blood vessels in the skin-Cutaneous vasculitis lesions -alopecia-hair loss -ulcers in mouth-mucosal ulcerations -petechia

Calcinosis

Hematologic System
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-lupus-related anemia b/c body is not producing enough red blood cells, antibodies destroy the healthy blood cells-hemolytic anemia -thrombosis -thrombocytopenia -leukopenia -neutropenia Splenomegaly

Nervous System
-neuropathy  -stroke  -seizures  -cognitive function described as “lupus fog” due to feelings of confusion, fatigue, memory loss, & difficulty expressing thoughts  -lupus headache-twice as many headaches as general population
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Renal System
-lupus nephritis-inflammation of nephrons which can lead to ESRD  -first sign edema of feet and hands, urine frothy  -urinary tract infections  -lupus cystitis-inflammation of lining of the bladder
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LIVING WITH LUPUS
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-exercise is encouraged to strengthen bones and tone muscles -especially walking, swimming, bicycling, -limit if experiencing bone and/or joint pain -extreme fatigue (unknown why) -poor coping strategies, feelings of helplessness, lack of exercise -proper amount of rest

CONT
-increased sensitivity to light  -infections can occur more often due to immunosuppressive  -most common infections are involved with the respiratory (lungs and heart) system, skin, and urinary tract also Candia (yeast) infections, and shingles  -30% of people get fibromyalgia  -depression
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Treatments
Corticosteroids, Antimalarial-Plaquenil, Aspirin, Immunosuppressive, Anticoagulants  Treated by rheumatologist  Treatment based on age, symptoms, health, and lifestyle.
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INVESTIGATIONS
-Monoclonal antibodies-interfere with action of cells involved with immune response  -hormones  -stem-cell transplant
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Famous People with Lupus
Seal-singer had non-SLE as a child  Flannery O‟Connor-author  October is official Lupus Awareness Month
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