Group 4 Systemic Lupus Erythematosus

1. Group 4 Systemic Lupus Erythematosus Cassidy Summers Tricia Molett Summer Lashley Kelly Winship

2. Systemic Lupus Erythematosus • Chronic autoimmune disease • Most common form of lupus • Autoantibodies • produced by own immune system • recognize own DNA as foreign • Lupus “wolf”

3. Understanding the causes: • Unknown • Possible Factors: • genetics • environmental • hormonal • May explain why lupus occurs more frequently in females than in males • NOT infectious

4. Screening and Diagnosis: • Difficult • Usually takes months to even years • Requires a specialist • rheumatologist • Laboratory tests: • Antinuclear antibody (ANA) test that detects the presence of autoantibodies that attack your own cells • blood tests for anemia, low white-cell count, abnormalities in organ function • urinalysis • electrocardiogram or echocardiogram to check the heart • chest x-ray

5. Types of Lupus: • Cutaneous (skin) lupus • primarily affects the skin but may involve the hair and mucous membranes • also commonly called discoid lupus • Systemiclupus erythematosus (SLE) • affects any system in the body • Drug-induced lupus erythematosus (DILE) • Side effect of long term use of certain medications • Symptoms overlap with those of SLE • Neonatal lupus • very rare • acquired from the passage of maternal autoantibodies

6. Statistics about Lupus: • ~ 90% diagnosed individuals are women • ~ 70% suffer from systemic form • ~ 50% a major organ affected • ~ 1,500,000 Americans have a form of lupus • Lupus is three times more prevalent among African Americans, Hispanics, Asians, and Native Americans

7. Eleven Criteria Used for the Diagnosis of Lupus: • Malar Rash • Rash over cheeks • Discoid Rash • Red raised patches (hives) • Photosensitivity • Reaction to sunlight • Oral Ulcers • Ulcers in nose or mouth • Arthritis • Two or more joints • Serositis • Pleuritis or pericarditis

8. Eleven Criteria cont… • Renal Disorder • Excessive protein in the urine • Neurologic Disorder • Seizures • Hematologic Disorder • Hemolytic anemia or leukopenia • Antinuclear Antibody • Positive test • Immunologic Disorder • Positive anti-double stranded anti-DNA test

9. Why organs are attacked: • Due to autoantibodies • Also referred to as anti-nuclear antibodies • Antibodies produced by the immune system • Attack the RNA and DNA in the nucleus of own cells

10. General Information on Lupus • can continuously develop new complications • cannot change from one affected organ system to another • complications can vary from patient to patient • it is not infectious or contagious • can help to develop another autoimmune disease • in menstruation complications worsen after ovulation become become better at beginning of menstruation period

11. General Complications with Lupus Flare – inflammation of joint and/or muscle Exacerbation – a worsening condition Remission – disease free activity -- total remission -- partial remission Allergic State – produces an antibody to substances like drugs, pollen, and grass Fatal – overwhelming infection and kidney failure cancer causing – can carry added risk only when received certain chemotherapy drugs

12. Systems Affected Musculoskeletal system -- avascular necrosis -- muscle inflammation Kidney system Nervous system -- seizures -- nerve paralysis -- severe depression -- psychosis -- strokes Blood and Lymph system -- anemia -- thrombocytopenia -- leucopenia

13. Systems Affected Stomach, Intestines, Liver, and Associated Organs -- ulcers -- abdominal pains Skin and Hair -- rash and alopecia Heart and Blood Vessels -- pericarditis -- arthrosclerosis -- spasms of the artery Lungs -- pleurisy, pneumonia, and pleural effusion Eyes -- rarely involved except for retina

14. When to go to the Hospital Fever greater than 102 degrees Fahrenheit Chest pain Sudden onset of unusual shortness of breath, weakness, or abdominal pain Severe headache Acute visual changes Inability to bear weight or move a swollen joint due to severe pain Rapid swelling of one or more extremities (arms, legs, feet, hands)

15. Lupus Treatment • Effective treatment can minimize symptoms, reduce inflammation, and maintain normal body functions. • Treatment is based on a patient’s specific needs. • One must consider which organs are involved and how serious it is. • If lupus does not effect one’s organs, 80-90% of patients can experience a normal lifespan.

16. The simplest of treatments include: 1- Anti-inflammatory drugs like Aspirin & Aleve 2- Anti- malaria drugs 3- Immunosuppressive medications 4- Corticosteroids

17. Breaking News Lupus often damages blood vessels of the lungs, causing pulmonary hypertension. Pulmonary hypertension leads to elevated endothelin levels, a vasoconstrictor. New Med: Sitaxsentan, an endothelin receptor antagonist

18. More on Steroids Corticosteroids relieve lupus symptoms fast. They are most helpful for: • pleurisy (inflammation around the lung) • pericarditis ( inflammation around the heart) If lupus is only affecting the joints and skin, corticosteroids can be avoided.

19. References: • The Lupus Foundation of America • http://www.lupus.org/ • Mayo Clinic • http://www.mayoclinic.com/invoke.cfm?id=DS00115 • Arthritis Foundation • http://www.arthritis.org/conditions/DiseaseCenter/lupus.asp • National Institute of Arthritis and Musculoskeletal and Skin Diseases • http://www.niams.nih.gov/hi/topics/lupus/slehandout/ • Systemic Lupus Erythematosus Ed. Lahita, R.G. San Diego, CA Academic Press, 2004.

20. Group 4 Cassidy Summers Summer Lashley Kelly Winship Tricia Molett