Condition: Systemic Lupus Erythematosus (SLE)
Brief Overview: Systemic lupus erythematosus is a chronic autoimmune disease that can affect multiple organ systems, including the skin, joints, kidneys, brain, heart, and lungs. It is characterized by periods of remission and flare-ups, with a wide range of clinical manifestations.
Prevalence: SLE affects approximately 20-150 per 100,000 individuals, with a higher prevalence in women of childbearing age and certain ethnic groups, such as African Americans, Hispanics, and Asians.
Etiology: The exact cause is unknown but involves genetic, hormonal, and environmental factors that trigger an abnormal immune response, leading to widespread inflammation and tissue damage.
Risk Factors:
• Female sex (9:1 female-to-male ratio)
• Age (commonly diagnosed between 15-45 years)
• Genetic predisposition (e.g., HLA-DR2, HLA-DR3)
• Environmental triggers (e.g., UV light, infections, certain medications)
• Hormonal influences (e.g., estrogen)
Commonly Associated Conditions:
• Antiphospholipid syndrome
• Rheumatoid arthritis
• Sjögren’s syndrome
• Raynaud’s phenomenon
• Cardiovascular disease
Common Medications:
• Nonsteroidal anti-inflammatory drugs (NSAIDs) for mild symptoms
• Corticosteroids for controlling flares
• Hydroxychloroquine (a disease-modifying antirheumatic drug)
• Immunosuppressants (e.g., azathioprine, methotrexate, mycophenolate mofetil)
• Biologic agents (e.g., belimumab)
Common Labs, Imaging, and Tests:
• Antinuclear antibody (ANA) test (most sensitive test for SLE)
• Anti-dsDNA and anti-Smith antibodies (specific for SLE)
• Complement levels (C3, C4) to monitor disease activity
• Urinalysis to detect proteinuria or hematuria (kidney involvement)
• Imaging (e.g., chest X-ray, echocardiography) for organ involvement
Common Symptoms:
• Fatigue
• Joint pain and swelling
• Skin rashes, including the characteristic butterfly rash (malar rash)
• Photosensitivity
• Fever
• Oral or nasal ulcers
• Hair loss (alopecia)
• Raynaud’s phenomenon
Common Treatments:
• Hydroxychloroquine to manage symptoms and reduce flares
• Corticosteroids for acute inflammation
• Immunosuppressants for severe or refractory cases
• Lifestyle modifications (e.g., sun protection)
Physical Findings:
• Malar rash (erythematous rash on the cheeks and nose)
• Discoid lesions
• Joint tenderness or swelling (non-erosive arthritis)
• Pericardial or pleural rubs in cases of serositis
• Edema in nephritis
Potential Complications and Contraindications:
• Lupus nephritis leading to renal failure
• Cardiovascular disease (e.g., pericarditis, myocarditis)
• Neurological involvement (e.g., seizures, psychosis)
• Contraindications for immunosuppressants in active infections
General Health and Lifestyle Guidance:
• Avoid excessive sun exposure and use broad-spectrum sunscreen
• Maintain a healthy diet and exercise regularly to reduce cardiovascular risk
• Adhere to prescribed medications and attend regular follow-ups
• Monitor for signs of organ involvement or new symptoms
Suggested Questions to Ask Patients:
• Have you noticed any patterns or triggers for your symptoms?
• Do you experience unusual sensitivity to sunlight?
• Have you had any symptoms such as chest pain, shortness of breath, or blood in your urine?
Suggested Talking Points:
• Explain the chronic nature of lupus and the importance of monitoring for flares.
• Emphasize that effective treatments can manage symptoms and improve quality of life.
• Discuss the need for routine lab tests to monitor disease activity and organ function.
• Reassure patients that with proper care, complications can be minimized.
• Eat a whole foods diet. Make sure to eat foods high in omega 3 such as wild caught salmon. Add turmeric to foods.