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Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease in which the immune system will attack any part of the body. Affected structures can include the skin, joints, blood vessels, and the kidneys. (Magill’s Medical Guide, Beattie, 2013).

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Multiple types of lupus exist, including drug-induced and discoid lupus. Drug-induced lupus occurs via prescription medications, while discoid lupus affects the skin. These types of lupus are different than SLE.

The cause of SLE is unknown, though a limited genetic component may be involved. Environmental factors may also contribute to lupus, including exposure to infection via the Epstein-Barr virus, UV light exposure, extreme stress, use of penicillin and sulfa drugs, and history of Celiac disease. (Beattie, 2013).  Lupus can develop, but often dissipates after discontinuation of the medication, after taking hydralazine, procainamide, isoniazid, and oral contraceptives. (Beattie, 2013).

The people affected most by lupus include Africans, American Indians, Asians, and Hispanics, all of whom have a three to four times greater chance of developing lupus compared to Caucasians. (Beattie, 2013) Men and women are both affected, but the incidence in women is twelve times greater than in men. (Beattie, 2013). 

The key physiologic issue associated with SLE is production of autoantibodies, in different quantities depending on the person. This causes symptoms to vary from person to person, which can make diagnosis very difficult. Typical symptoms of SLE include fever, tiredness, anemia, weight loss, feeling of numbing and coldness of the extremities (Raynaud’s phenomenon), and headaches. (Beattie, 2013). Most people with lupus experience joint pain, which is usually one of the first signs of the condition, though it is not constant and does not typically have permanent effects on joints.

Other clinical signs of lupus are malar rash (also known as butterfly rash), discoid skin rashes, red hands, fingers, and nails, and ulcerations of the mucous membranes in the nose and mouth. (Beattie, 2013). Photosensitivity can also occur. Additionally, patients with lupus can experience frequent lung sac and heart inflammation, which can lead to chest pain or discomfort after a deep breath. Life threatening conditions like bleeding into the lungs or heart failure rarely occur. Possible neurologic issues include headaches, changes in personality, seizures, stroke, depression, and dementia. (Beattie, 2013). If the kidneys are involved, severe nephritis can develop slowly or rapidly and cause death. When the eyes are affected, blurred vision can occur and, in rare cases, retinitis can progress into blindness if left untreated.

Lupus is not easily diagnosed due to it having a variety of presentations and symptoms that may appear similar to other diseases and conditions. A single test for lupus does not exist, and multiple specialists are often required to perform a series of tests and produce a differential diagnosis in order to be properly diagnosed. The American College of Rheumatology has stated that a patient can be positively diagnosed with lupus if they have at least four of the following eleven signs and symptoms: malar/butterfly rash, discoid rash, photosensitivity, oral ulcers, serous tissue inflammation, renal disorders, neurologic disorders, hematologic disorders, immunologic disorders, and the presence of antinuclear antibodies. (Beattie, 2013).

At this time, no cure exists for lupus. Patients with lupus are treated to minimize inflammation and keep organ functions as normal as possible. Treatment varies from patient to patient depending on their symptoms and which organs are affected. Lifestyle alterations to reduce inflammation include maintaining a healthy diet, individually directed exercise programs, getting proper rest, and attending support groups. (Beattie, 2013). Patients with lupus are also advised to quit smoking and alcohol consumption, and to take proper amounts of calcium and Vitamin D. Overexposure to the sun and UV radiation can also cause skin rashes and cause flare-ups of certain diseases, which can be prevented by using sunscreens and wearing clothing that covers the skin.

Patients with lupus may experience symptoms indicative of an upcoming flare-up, including headaches, dizziness, upset stomach, fatigue, and rashes. (Beattie, 2013). Laboratory tests may also predict impending flare-ups, which can allow for earlier intervention to limit the extent of inflammation and amount of medication needed to treat the patient.

Medications used to treat patients with lupus include non-steroidal anti-inflammatory drugs, corticosteroids, antimalarial drugs, cytotoxic drugs, and immunosuppressants. (Beattie, 2013).

NSAIDs are utilized to limit muscle and joint inflammation. Effective NSAIDs include aspirin, ibuprofen, indomethacin, ketoprofen, and naproxen. While they are effective anti-inflammatories, NSAIDs can produce adverse effects to the kidney and liver. (Beattie, 2013). 

Corticosteroids are anti-inflammatory synthetic hormones that can also help relieve pain symptoms. They are very effective when lupus affects the organs. Hydrocortisone, methylprednisone, and prednisone are commonly used orally for systemic concerns, while topical corticosteroids can help with lupus-induced rashes. (Beattie, 2013). Corticosteroids can also be administered via injection in joints, muscles, or IV, particularly if a lupus case is severe. Long-term use of corticosteroids can have negative side effects like hypertension, increased possibility of infection, diabetes, acne, and osteoporosis. (Beattie, 2013). 

Antimalarial medications such as hydroxychloroquine, chloroquine, and quinicrine can protect against UV light, as well as reduce rashes, inflammation of serous tissues, and inflammation of joints. (Beattie, 2013). These medications can be used in combination with NSAIDs or corticosteroids to create maximal anti-inflammatory effect and to help decrease the dose of corticosteroids that a patient would otherwise need to take. (Beattie, 2013). A potential risk of taking antimalarial medications is retinal damage, which necessitates visits to the ophthalmologist.

Cytotoxic drugs and immunosuppressants are often used either with or instead of corticosteroids to keep the patient from experiencing the side effects from corticosteroids. The Food and Drug Administration does not approve cytotoxic drugs for treating SLE, but are still considered part of standard practice. (Beattie, 2013). Cytotoxic medications like cyclophosphamide and Imuran focus on autoantibodies, which helps reduce overactivity of the immune response in patients with SLE. (Beattie, 2013). These medications can treat lupus nephritis, deficiency of red and white blood cells, bleeding in the lungs, and vasculitis. Imuran is less effective than cyclophosphamide but also has less side effects. Methotrexate and cyclosporine are two additional cytotoxic medications that can treat lupus. Cytotoxic drugs are problematic due to potentially severe side effects, including heightened cancer risk, increased risk of infection, hair loss, and sterility. (Beattie, 2013).

Patients with lupus who are considering pregnancy need to be very cautious to attempt to conceive only when their symptoms are not present. Pregnancy will not increase risk of symptom flare-up, but constant evaluation by a physician is indicated to rule out and treat any problems as early as possible. Pregnant patients can take prednisone while pregnant because it will not enter the placenta, but cyclophosphamide should not be used. (Beattie, 2013).  

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