Care of the Lupus Patient
Systemic Lupus Erythematosus
psychological and emotional effects.
Butterfly rash, photosensitivity, DLE, subcutaneous
LE, mucosal ulcers, alopecia, pain and discomfort, pruritus,
Arthralgias, arthritis, other joint
Anemia, decreased WBC count, thrombocytopenia,
lupus anticoagulants, false-positive VDRL, elevated ESR.
Pericarditis, myocarditis, myocardial infarction,
vasculitis, pleurisy, valvular heart disease.
Asymptomatic microscopic renal involvement, renal
failure, fluid and electrolyte imbalance, urinary tract infection.
Central Nervous System
General CNS symptomology,
cranial neuropathies, cognitive impairment, mental changes,
Anorexia, ascites, pancreatitis, mesenteric or
Eyelid problems, conjunctivitis, cytoid bodies, dry
eyes, glaucoma, cataracts, retinal pigmentation.
Lupus flare, miscarriage or stillbirth,
pregnancy-induced hypertension, neonatal lupus.
Increased risk of respiratory tract, urinary tract,
and skin infections; opportunistic infections.
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
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.