Chapter 11: Systemic Lupus Erythematosus

Question 1

Systemic Lupus Erythematosus (SLE)

Answer 1

chronic multisystem inflammatory disorder
-characterized by an autoimmune anti body production that results in an inflammation of the connective tissue in various organs or systems in the body

Question 2

Pathophysiology

Answer 2

the immune system is composed of specialized cells that destroy invading organisms by phagocytosis and antibody and lymphocyte production; when foreign organisms or antigen enters the body, it is consumed by macrophages and then passed on to lymphokines, which present to the T and B lymphocytes; The B lymphocytes are activated, resulting in a production of increased number of circulating antibodies that target their specific antigen, the antigen-antibody complex either promotes destruction of the antigen or activates the normal inactive proteins in the complement system
>in SLE, the body fails to recognize its own proteins

Question 3

Clinical Manifestations result from what?

Answer 3

inflammation of the multiple organ systems, especially joints, skin, kidneys, nervous system, and serous membranes

Question 4

Risks With SLE

Answer 4

• when SLE complicates pregnancy, there is an increased risk of spontaneous abortion (SAB), PROM, PTL, preterm birth, stillbirth, and neonatal death
• maternal autoantibodies may cross the placenta and form immune complexes with fetal autoantigens, promoting fetal tissue destruction
• autoantibodies may initiate injury to fetal cardiac tissue, resulting in conduction disturbances that may be temporary or permanent

Question 5

Management

Answer 5

-immunosuppression of lupus flare with corticosteroid therapy, non-steroidal anti-inflammatory drugs, antimalarial agents, azathioprine, and careful fetal surveillance
>if disease flares during pregnancy, treatment must be implemented ASAP
>patient’s health is deemed FIRST PRIORITY
>offer support and remain alert for early indicators of SLE exacerbation
-educate family about plan of care, NEED for close surveillance, and effective family planning after birth

Question 6

SLE Exacerbation S/S

Answer 6

elicited on the patients history and physical examination, and a blood sample obtained for serological evaluation

• rise in the anti-dsDNA antibody titer and a decrease in complement
• onset of edema and hypertension can be indicative of active SLE-associated nephritis