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Care of the Lupus Patient

Systemic Lupus Erythematosus

General Manifestations

Fatigue, fever, psychological and emotional effects.

Specific Manifestations

Dermatologic: Butterfly rash, photosensitivity, DLE, subcutaneous LE, mucosal ulcers, alopecia, pain and discomfort, pruritus, bruising.

Musculoskeletal: Arthralgias, arthritis, other joint complications.

Hematologic: Anemia, decreased WBC count, thrombocytopenia, lupus anticoagulants, false-positive VDRL, elevated ESR.

Cardiopulmonary: Pericarditis, myocarditis, myocardial infarction, vasculitis, pleurisy, valvular heart disease.

Renal: Asymptomatic microscopic renal involvement, renal failure, fluid and electrolyte imbalance, urinary tract infection.

Central Nervous System (CNS): General CNS symptomology, cranial neuropathies, cognitive impairment, mental changes, seizures.

Gastrointestinal: Anorexia, ascites, pancreatitis, mesenteric or intestinal vasculitis.

Ophthalmologic: Eyelid problems, conjunctivitis, cytoid bodies, dry eyes, glaucoma, cataracts, retinal pigmentation.

Other Key Issues

Pregnancy: Lupus flare, miscarriage or stillbirth, pregnancy-induced hypertension, neonatal lupus.

Infection: Increased risk of respiratory tract, urinary tract, and skin infections; opportunistic infections.

Nutrition: Weight changes; poor diet; appetite loss; problems with taking medications; increased risk of cardiovascular disease, diabetes, osteoporosis, and kidney disease.

Systems Potentially Affected by Lupus

Care of the Lupus Patient

General Manifestations of SLE


Fatigue is a nearly universal complaint of patients with SLE even when no other manifestations of the disease are present. The cause of this debilitating fatigue is not known. The patient should be evaluated for factors that may exacerbate fatigue, such as overexertion, insomnia, depression, stress, anemia, and other inflammatory diseases. Fatigue in SLE patients may be lessened by adequate rest, healthful diet, exercise, and attention to psychosocial factors.

Many patients with SLE experience changes in weight. At least one-half of patients report weight loss before being diagnosed with SLE. Weight loss in SLE patients may be attributed to a decreased appetite, side effects of medications, gastrointestinal problems, or fever. Weight gain can occur in some patients and may be due in part to prescribed medications, especially corticosteroids, or fluid retention from kidney disease.

Episodic fever is experienced by more than 80% of SLE patients, and there is no particular fever pattern. Although high fevers can occur during a lupus flare, low-grade fevers are more frequently seen. A complicating infection is often the cause of an elevated temperature in a patient with SLE. The patient's WBC count may be normal to elevated with an infection, but low with SLE alone. However, certain medications, such as immunosuppressives, will suppress the WBC even in the presence of fever. Therefore, it is important to rule out other causes of a fever, including an infection or a drug reaction. Urinary and respiratory infections are common in SLE patients.

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