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https://www.youtube.com/watch?v=h eRWz1Qmu4Q 

Listen to his words and accent

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Chronic, autoimmune disease that can affect literally any body system

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Rarely presents the same in any two lupus patients

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Disruption in apoptosis
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Immune system generates auto-antibodies
Antibodies clump together and can latch on to any body system. Attacking cells DNA surrounding the antibody. No known cause
 No know treatment to cure the disease
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› Treatment is aimed at

reducing symptoms and balancing the body’s immune system to a functional level
› Genetic, epigenetic, hormonal, and other environmental factors associated with SLE

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250,000 Americans diagnosed with definite
SLE (NADWG).
90% in women of childbearing age
Incidence of SLE in black women 4x higher than that in white women

D.W. Is a 25-year-old married woman with three children under 5 years old. She came to her physician 7 months ago with vague complaints of intermittent fatigue, joint pain, low-grade fever, and unintentional weight loss. Her physician noted small, patchy areas of vitiligo and scaly rash across her nose, cheeks, back, and chest.

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Positive antinuclear antibody(ANA) titer

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Positive dsDNA(positive lupus erythematosus) 

Positive anti-Sm(anti-smooth muscle antibody)

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Elevated C-reactive protein(CRP) 

Elevated erythrocyte sedimentation rate (ESR)

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Decreased C3 and C4 serum complement Joint x-ray films demonstrated joint swelling without joint erosion. D.W was subsequently diagnosed with systemic lupus erythematosus (SLE).
She was initially treated with hydroxychloroquine
(Plaquenil) 400mg and Deltason (Prednisone) 20mg PO qdaily, bed rest, and ice packs.
› D.W responded well to treatment, the steroid was tapered and discontinued, and she was told she could report for follow-up every 6months, unless her symptoms became acute. D.W. Resumed her job in environmental services at a large geriatric facility.

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Positive antinuclear antibody (ANA) titer:
› Auto-antibodies are in the immune system

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Positive dsDNA (positive lupus erythematosus): › Auto-antibodies that target DNA
› Highly specific

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Positive anti-SM (smooth muscle antibody): › Presence of antibodies against smooth

muscle

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Elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)
› Measure of inflammation in the body

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Decreased C3 and C4 serum complement › Shows impending or current “flare” of

lupus symptoms

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11 criteria for SLE
› Established by

the American
Rheumatism
Association
› If individual display 4 or more of these criteria,
SLE diagnosis is highly suggested.

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Known as a “butterfly” rash
› D.W. displays scaly rash over cheeks, nose,

back and chest.

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Discoid skin rash
Photosensitivity
Two or more swollen/tender joints
› Shown both subjectively

and objectively

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Brain irritation
› Seizures or psychosis (lupus

cerebritis)

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Mucous membrane ulcers
Pleuritis or pericarditis

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Low blood counts
Kidney abnormalities
› Proteinuria

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Tests:
› dsDNA, anti-Sm, ANA
› ESR and CRP

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Coping and understanding of dx
Monitor pain and temp
Medication
administration and understanding Ways to live a normal and safe life dx. w/ SLE

Eighteen months after diagnosis, D.W. Seeks out her physician because of puffy hands and feet and increased fatigue. D.W.
Reports that she has been working longer hours because of the absence of two of her fellow workers.

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Laboratory Test Results (8 months after dx):
Sodium

129mmol/L

Norm =135-145

Potassium

4.2mmol/L

Norm=3.5-5.2

Chloride

119mmol/L

Norm=96-106

Total CO2

21mmol/L

Norm=20-29

BUN

34mg/dL

Norm=8-20

Creatinine

2.6mg/dL

Norm=0.6-1.1

Glucose

123mg/dL

<140

Urinalysis

2+ protein
1+ RBCs

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Elevated BUN and Creatinine
Proteinuria
and hematuria
Slightly
elevated sodium and chloride 
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Stabilize labs
Decrease swelling and fatigue Medication adjustment
Promote kidney function
Decrease risk of infection

6) The physician