SYSTEMIC LUPUS ERYTHEMATOSUS

ICD-9: 710.0

Systemic lupus erythematosus (SLE) is a chronic, inflammatory connective-tissue disorder in which cells and tissues throughout the body are damaged by a variety of autoantibodies and immune complexes. The disease affects women eight times more often than men. It is most often diagnosed between ages 15 and 45.

Etiology

The cause of the autoimmune response that characterizes SLE is not known. Genetic factors, as well as environmental and hormonal factors, may predispose an individual to the disease. Stress, overexposure to ultraviolet light, immunization reactions, and pregnancy are events that may precipitate the condition. Certain drugs also have the capacity to induce an SLE-like syndrome.

Signs and Symptoms

Because SLE can affect any part of the body, a host of symptoms are possible, including weight loss, fatigue, and fever. One manifestation of the disease is the “butterfly rash”, which may be found on the face, neck, and scalp of about 50% of clients with SLE. Similar rashes may appear on other body surfaces, especially on exposed areas. There also may be photosensitivity of the skin, joint and muscle pain, joint deformities, nausea, vomiting, and diarrhea. Other signs and symptoms include oral or nasopharyngeal ulcerations, patchy alopecia, pleuritis or pericarditis, and Raynaud phenomenon. This disorder is exhibited by intermittent interruptions of blood supply to the fingers and toes, marked by severe pallor and accompanied by numbness, tingling, or severe pain.

Butterfly rash of systemic lupus erythematosus

FIGURE. Butterfly rash of systemic lupus erythematosus. (From Lazarus, GS, and Goldsmith, LA: Diagnosis of Skin Disease. FA Davis, Philadelphia, 1997, p. 230, with permission.)

Diagnostic Procedures

CBC with differential, ESR, serum electrophoresis, antinuclear antibody, anti-DNA, and lupus erythematosus (LE) tests may be done. LE cells (polymorphonuclear leukocytes) often are found in the bone marrow. The anti-DNA test, which detects a particular autoantibody, is the most specific test for diagnosing SLE, but it must be performed while the disease is in its active stage.

Treatment

The mild stage of the disease requires only antiinflammatory agents, including aspirin. Skin lesions require topical treatment such as corticosteroid creams. Corticosteroid drugs remain the treatment of choice to control SLE, both for acute generalized exacerbations and for exacerbations of the disease localized to vital organ systems. It is recommended that clients with photosensitivity wear protective clothing when in the sun and use an effective sunscreen agent.

Complementary Therapy

A whole-foods diet that avoids cow’s milk and beef products is recommended. Increasing intake of green, yellow, and orange vegetables and of fish oil and flaxseed oil is recommended. Supplementation with vitamins B12, B5, and C may be helpful.

CLIENT COMMUNICATION

Urge clients to get plenty of rest and to consider a low-sodium, low-protein diet. Heat packs may be used to relieve joint pain and stiffness. Teach clients how to observe for multiple organ involvement.

Prognosis

The prognosis for SLE improves with early detection and careful treatment, but it remains poor for those who develop cardiovascular, renal, or neurological complications or serious bacterial infections.

Prevention

There is no specific prevention for SLE.