Patho + Triggers
Three common environmental factors known to trigger exacerbations or "flares" in clients with SLE.
Ultraviolet (UV) light/sun exposure, emotional or physical stress, infection, Smoking
The classic red, raised, erythematous skin lesion across the bridge of the nose and cheeks that spares the nasolabial folds.
Malar "Butterfly" Rash
The specific demographic group representing approximately 90% of all diagnosed SLE cases due to estrogen-mediated immune responses
Females of childbearing age (ages 15 to 45)
The disease-modifying antimalarial drug prescribed to virtually all SLE clients to reduce flares, control fatigue, and improve long-term survival
Hydroxychloroquine (Plaquenil)
Key photoprotection education given to clients to prevent ultraviolet-induced skin and systemic flares
Use broad-spectrum sunscreen (SPF 30+ daily), wear protective long clothing/hats, and avoid direct sun during peak hours (10 AM to 4 PM)
Name the different types of lupus
Systemic, Discoid, Drug-Induced, Neonatal (not a true form of lupus)
Episodic vasospasm of small arteries in the digits in response to cold or stress, causing fingers to turn white, blue, and then red.
Raynaud's Phenomenon
The term for the overall blood cell deficit frequently caused by autoantibody destruction of bone marrow cells in SLE.
Pancytopenia
The crucial baseline and ongoing annual health exam required for clients taking Hydroxychloroquine due to the risk of irreversible drug toxicity
Ophthalmologic / Retinal Exam
Baseline EKG
How many criteria must be present to diagnose Lupus?
4 out of 11
The two autoantibody tests that are highly specific for Systemic Lupus Erythematosus (unlike ANA, which is sensitive but non-specific).
Anti-double-stranded DNA (anti-dsDNA) and Anti-Smith (anti-Sm) antibodies
Most common first signs and symptoms?
low grade fever, muscle weakness, fatigue
What lab testing would be expected for this patient?
BUN, Creatinine, ESR, CRP, Urinalysis (hematuria, RBC casts, proteinuria), Coagulation studies
Teaching for Immunosuppressants (Methotrexate)
No Live vaccinations
Infection Risk
Important family planning instruction for female clients with SLE regarding the safest timing for pregnancy.
Delay pregnancy until the disease has been in complete remission for at least 6 months
Pre plan pregnancy with HCP
Autoimmune complexes tend to be attracted to?
Glomeruli in the Kidneys
Leading cause of death from SLE
Lupus Nephritis
The most common cardiac complication of SLE, presenting with sharp chest pain?
Pericarditis
pain improves with leaning forward
Drug expected for DLE, rash or discoid lesions
Topical Corticosteroids
Avoid these - risk of increased hypercoagulable state
Oral Contraceptives
Skin manifestations occur in what % of Lupus patients?
30-40%
Occurs in most 90% patients (also seen in RA). Extreme fatigue, arthralgia, myalgia?
Polyarthritis
A severe musculoskeletal complication involving the femoral head, commonly caused by long-term high-dose corticosteroid therapy required for lupus management.
Osteonecrosis of the Hip
First drug approved in 50 years specifically for SLE. Biologic response modifier (not a steroid), given with other SLE medications
Belimumab
Because of the renal involvement, what are some other common medications you would expect to be ordered?
Diuretics, BP Meds