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Characteristics/Clinical Presentation
Pathology
Histological changes within the body occur as a result of immunological changes or immunolgical attack associated with deposits of immune complexes within various tissues of the body.
SLE can affect many organs of the body, but it rarely affects them all. The following list includes common signs and symptoms of SLE in order of the most ...to least prevalent. All of the below symptoms might not be present at the initial diagnosis of SLE, but as the disease progresses more of a person’s organ systems become involved.
•“Constitutional symptoms (fever, malaise, fatigue, weight loss): most commonly fatigue and a low-grade fever
•Achy joints (arthralgia)
•Arthritis (inflamed joints)
This image illustrates the typical distribution pattern of the butterfly (malar) rash that can be a characteristic of SLE. This picture was included courtesy of: http://images.google.com/.
•Skin rashes
•Pulmonary involvement (symptoms include: chest pain, difficulty breathing, and cough)
•Anemia
•Kidney involvement (lupus nephritis)
•Sensitivity to the sun or light (photosensitivity)
•Hair loss
•Raynaud’s phenomenon
•CNS involvement (seizures, headaches, peripheral neuropathy, cranial neuropathy, cerebrovascular accidents, organic brain syndrome, psychosis)
•Mouth, nose, or vaginal ulcers”[1]
•The most common signs and symptoms of SLE in children and adolescents are: "fever, fatigue, weight loss, arthritis, rash, and renal disease."[5]
Associated Co-morbidities
•About 30% of people diagnosed with SLE are also diagnosed with fibromyalgia.[2]
•Atherosclerosis[6] [7]
•Lupus Nephritis- leads to End Stage Renal Disease (ESRD)
•Anemia[8]
•Some types of cancers (especially non-Hodgkin's lymphoma and lung cancer) [7][9] [10]
•Infections
•Hypertension
•Dyslipidemia
•Diabetes Mellitus
•Osteoporosis
•Avascular Necrosis [7]
Causes
There is no known cause of SLE, but research states that the interaction between a person's genetic make-up, immune system, hormonal balance, and environment could potentially cause SLE. At this time, autoimmunity is thought to be the primary causative factor of SLE.
There are certain factors that can predispose a patient to SLE including:
•Heredity- There is a high prevalence of SLE in first-degree relatives. The immune abnormalities associated with SLE can be triggered by both internal and external factors.
•Stress- It has been determined that stress can provoke changes in the neuroendocrine system causing changes in the function of immune system cells.
•Bacterial or viral infection- The Epstein-Barr virus has been found to be a risk factor for the development of SLE.
•Sunlight or UV exposure
•Immunizations
•Pregnancy- The evidence about whether or not pregnancy can cause exacerbations of SLE is very inconclusive because some studies state that pregnancy does affect the course of SLE, while others state that it has no affect on the course of the disease.
•Abnormal levels of estrogen
•Certain drugs- Drugs such as hydralazin, anticonvulsants, penicillin, sulfa drugs, and oral contraceptives can change the cellular responsiveness and immunogenicity of self-antigens and therefore make a person more susceptible to SLE.[1]
Systemic Involvement
There are many visceral systems can be affected from SLE, but the extent of the body's involvement differs from person to person. Some people diagnosed with SLE have only few visceral systems involved, while others have numerous systems that have been affected by the disease.
Musculoskeletal System:
This image was included courtesy of www.google.images.com
•Arthritis- typically affects hand, wrists, and knees
•Arthralgia
•Tenosynovitis
•Tendon ruptures
•Swan-neck deformity
•Ulnar drift
Cardiopulmonary/
•Pleuritis
•Pericarditis
•Dyspnea
•Hypertension
•Myocarditis
•Endocarditis
•Tachycarditis
•Pneumonitis
•Vasculitis
1.Small Vessels Purpura
2.Large Vessels Papular Lesions
3.Arterial Thrombosis
Central Nervous System:
•Emotional instability
•Psychosis
•Seizures
•Cerebrovascular accidents
This illustration was included courtesy of http://www.medicinenet.com/.
•Cranial neuropathy
•Peripheral neuropathy
•Organic brain syndrome
Renal System:
•Glomerulonephritis
-inflammatory disease of the kidneys
•Hematuria
•Proteinuria
•Kidney failure[1]
Cutaneous System:
•Calcinosis
•Cutaneous vasculitis
•Hair loss
•Raynaud's phenomenon
•Mucosal ulcers
•Petechiae
Blood Disorders:
•Anemia
•Thrombocytopenia
•Leukopenia
•Neutropenia
•Thrombosis
Gastrointestinal System:
This picture was included courtesy of http://www.health.com/
•Ulcers--Throat & Mouth
•Ulcerative colitis/Crohn's disease
•Peritonitis
•Ascites
•Pancreatitis
•Peptic ulcers
•Autoimmune Hepatitis [11]
Medical Management (current best evidence)
The medical management for SLE is primarily drug therapy and is based upon the patients symptoms and systemic involvement. In addition to drug therapy, prevention is also very important when dealing with SLE. For patients with photosensitivities, flare-ups can be reduced if patients are cautious about the amount of sunlight or UV light that they are exposed to. Patients with SLE are also encouraged to lead a healthy lifestyle that includes: smoking cessation, controlling alcohol consumption, weight management, and regular exercise.[1][7] Exercise is beneficial for patients with SLE because it decreases their muscle weakness while simultaneously increases their muscle endurance. Patients with SLE are also encouraged to participate in support groups, ensure they are taking the correct dosages and amounts of medications, and ensure they visit medical professionals regularly.[1]
New Therapies
Topical Therapy/Medication
NSAIDS
Hormonal Intervention
Immunosupressant Therapy
IV Gamma Globulin
Apheresis
Stem-Cell Transplantation
Biological Therapy[12]
Physical Therapy Management (current best evidence)
Physical therapists can play an important role for patients with SLE during and between exacerbations. The patient's need for physical therapy will vary greatly depending on the systems involved.
•Education: It is essential for patients with skin lesions to have appropriate education on the best way to care for their skin and to ensure they do not experience additional skin breakdown.
•Aerobic Exercise: One of the most common impairments that patients with SLE experience is generalized fatigue that can limit their activities throughout the day.[1] In a study by Tench et al., it was determined that graded aerobic exercise programs are more successful than relaxation techniques in decreasing the fatigue levels of patients with SLE. Aerobic activity caused many of the participants with SLE to feel "much better" or "very much better" at the conclusion of the study. The aerobic exercise program consisted of 30-50 minutes of aerobic activity (walking/swimming/cycling) with a heart rate corresponding to 60% of the patient's peak oxygen consumption.[13] Another study, completed by Ramsey- Goldman et al., concluded that both aerobic exercise and range of motion/muscle strengthening exercises can increase the energy level, cardiovascular fitness, functional status, and muscle strength in patients with SLE. In this study, the patients completed aerobic exercise for 20-30 minutes at 70-80% of their maximum heart rate. The patients who completed range of motion and muscle strengthening activities met 3 times a week for 50 minutes sessions.[14]
•Energy Conservation: Physical therapists can educate patients on appropriate energy conservation techniques and the best ways to protect joints that are susceptible to damage.
•Additionally, physical therapists and patients with SLE should be aware of signs and symptoms that suggest a progression of SLE including those associated with avascular necrosis, kidney involvement, and neurological involvement.[1]
Alternative/Holistic Management (current best evidence)
Sometimes used in addition to medical treatment, alternative treatments are used to treat symptoms caused by SLE. These alternative treatments include:
•Homeopathy
This picture depicts acupuncture therapy that can be used to decrease pain. It was included courtesy of www.googleimages.com.
•Chiropractic
•Traditional Chinese medicines (acupuncture and Tai Chi)
•Ayurveda
•Naturopathy
•Massage therapy
•Meditation
•Biofeedback- In conjunction with medication, biofeedback has been shown to decrease a patient's pain and stress levels
•Herbs and Supplements
•Acupuncture- Some research reveals that acupuncture can decrease a patient's arthritis pain[11]
Pathology
Histological changes within the body occur as a result of immunological changes or immunolgical attack associated with deposits of immune complexes within various tissues of the body.
SLE can affect many organs of the body, but it rarely affects them all. The following list includes common signs and symptoms of SLE in order of the most ...to least prevalent. All of the below symptoms might not be present at the initial diagnosis of SLE, but as the disease progresses more of a person’s organ systems become involved.
•“Constitutional symptoms (fever, malaise, fatigue, weight loss): most commonly fatigue and a low-grade fever
•Achy joints (arthralgia)
•Arthritis (inflamed joints)
This image illustrates the typical distribution pattern of the butterfly (malar) rash that can be a characteristic of SLE. This picture was included courtesy of: http://images.google.com/.
•Skin rashes
•Pulmonary involvement (symptoms include: chest pain, difficulty breathing, and cough)
•Anemia
•Kidney involvement (lupus nephritis)
•Sensitivity to the sun or light (photosensitivity)
•Hair loss
•Raynaud’s phenomenon
•CNS involvement (seizures, headaches, peripheral neuropathy, cranial neuropathy, cerebrovascular accidents, organic brain syndrome, psychosis)
•Mouth, nose, or vaginal ulcers”[1]
•The most common signs and symptoms of SLE in children and adolescents are: "fever, fatigue, weight loss, arthritis, rash, and renal disease."[5]
Associated Co-morbidities
•About 30% of people diagnosed with SLE are also diagnosed with fibromyalgia.[2]
•Atherosclerosis[6] [7]
•Lupus Nephritis- leads to End Stage Renal Disease (ESRD)
•Anemia[8]
•Some types of cancers (especially non-Hodgkin's lymphoma and lung cancer) [7][9] [10]
•Infections
•Hypertension
•Dyslipidemia
•Diabetes Mellitus
•Osteoporosis
•Avascular Necrosis [7]
Causes
There is no known cause of SLE, but research states that the interaction between a person's genetic make-up, immune system, hormonal balance, and environment could potentially cause SLE. At this time, autoimmunity is thought to be the primary causative factor of SLE.
There are certain factors that can predispose a patient to SLE including:
•Heredity- There is a high prevalence of SLE in first-degree relatives. The immune abnormalities associated with SLE can be triggered by both internal and external factors.
•Stress- It has been determined that stress can provoke changes in the neuroendocrine system causing changes in the function of immune system cells.
•Bacterial or viral infection- The Epstein-Barr virus has been found to be a risk factor for the development of SLE.
•Sunlight or UV exposure
•Immunizations
•Pregnancy- The evidence about whether or not pregnancy can cause exacerbations of SLE is very inconclusive because some studies state that pregnancy does affect the course of SLE, while others state that it has no affect on the course of the disease.
•Abnormal levels of estrogen
•Certain drugs- Drugs such as hydralazin, anticonvulsants, penicillin, sulfa drugs, and oral contraceptives can change the cellular responsiveness and immunogenicity of self-antigens and therefore make a person more susceptible to SLE.[1]
Systemic Involvement
There are many visceral systems can be affected from SLE, but the extent of the body's involvement differs from person to person. Some people diagnosed with SLE have only few visceral systems involved, while others have numerous systems that have been affected by the disease.
Musculoskeletal System:
This image was included courtesy of www.google.images.com
•Arthritis- typically affects hand, wrists, and knees
•Arthralgia
•Tenosynovitis
•Tendon ruptures
•Swan-neck deformity
•Ulnar drift
Cardiopulmonary/
•Pleuritis
•Pericarditis
•Dyspnea
•Hypertension
•Myocarditis
•Endocarditis
•Tachycarditis
•Pneumonitis
•Vasculitis
1.Small Vessels Purpura
2.Large Vessels Papular Lesions
3.Arterial Thrombosis
Central Nervous System:
•Emotional instability
•Psychosis
•Seizures
•Cerebrovascular accidents
This illustration was included courtesy of http://www.medicinenet.com/.
•Cranial neuropathy
•Peripheral neuropathy
•Organic brain syndrome
Renal System:
•Glomerulonephritis
-inflammatory disease of the kidneys
•Hematuria
•Proteinuria
•Kidney failure[1]
Cutaneous System:
•Calcinosis
•Cutaneous vasculitis
•Hair loss
•Raynaud's phenomenon
•Mucosal ulcers
•Petechiae
Blood Disorders:
•Anemia
•Thrombocytopenia
•Leukopenia
•Neutropenia
•Thrombosis
Gastrointestinal System:
This picture was included courtesy of http://www.health.com/
•Ulcers--Throat & Mouth
•Ulcerative colitis/Crohn's disease
•Peritonitis
•Ascites
•Pancreatitis
•Peptic ulcers
•Autoimmune Hepatitis [11]
Medical Management (current best evidence)
The medical management for SLE is primarily drug therapy and is based upon the patients symptoms and systemic involvement. In addition to drug therapy, prevention is also very important when dealing with SLE. For patients with photosensitivities, flare-ups can be reduced if patients are cautious about the amount of sunlight or UV light that they are exposed to. Patients with SLE are also encouraged to lead a healthy lifestyle that includes: smoking cessation, controlling alcohol consumption, weight management, and regular exercise.[1][7] Exercise is beneficial for patients with SLE because it decreases their muscle weakness while simultaneously increases their muscle endurance. Patients with SLE are also encouraged to participate in support groups, ensure they are taking the correct dosages and amounts of medications, and ensure they visit medical professionals regularly.[1]
New Therapies
Topical Therapy/Medication
NSAIDS
Hormonal Intervention
Immunosupressant Therapy
IV Gamma Globulin
Apheresis
Stem-Cell Transplantation
Biological Therapy[12]
Physical Therapy Management (current best evidence)
Physical therapists can play an important role for patients with SLE during and between exacerbations. The patient's need for physical therapy will vary greatly depending on the systems involved.
•Education: It is essential for patients with skin lesions to have appropriate education on the best way to care for their skin and to ensure they do not experience additional skin breakdown.
•Aerobic Exercise: One of the most common impairments that patients with SLE experience is generalized fatigue that can limit their activities throughout the day.[1] In a study by Tench et al., it was determined that graded aerobic exercise programs are more successful than relaxation techniques in decreasing the fatigue levels of patients with SLE. Aerobic activity caused many of the participants with SLE to feel "much better" or "very much better" at the conclusion of the study. The aerobic exercise program consisted of 30-50 minutes of aerobic activity (walking/swimming/cycling) with a heart rate corresponding to 60% of the patient's peak oxygen consumption.[13] Another study, completed by Ramsey- Goldman et al., concluded that both aerobic exercise and range of motion/muscle strengthening exercises can increase the energy level, cardiovascular fitness, functional status, and muscle strength in patients with SLE. In this study, the patients completed aerobic exercise for 20-30 minutes at 70-80% of their maximum heart rate. The patients who completed range of motion and muscle strengthening activities met 3 times a week for 50 minutes sessions.[14]
•Energy Conservation: Physical therapists can educate patients on appropriate energy conservation techniques and the best ways to protect joints that are susceptible to damage.
•Additionally, physical therapists and patients with SLE should be aware of signs and symptoms that suggest a progression of SLE including those associated with avascular necrosis, kidney involvement, and neurological involvement.[1]
Alternative/Holistic Management (current best evidence)
Sometimes used in addition to medical treatment, alternative treatments are used to treat symptoms caused by SLE. These alternative treatments include:
•Homeopathy
This picture depicts acupuncture therapy that can be used to decrease pain. It was included courtesy of www.googleimages.com.
•Chiropractic
•Traditional Chinese medicines (acupuncture and Tai Chi)
•Ayurveda
•Naturopathy
•Massage therapy
•Meditation
•Biofeedback- In conjunction with medication, biofeedback has been shown to decrease a patient's pain and stress levels
•Herbs and Supplements
•Acupuncture- Some research reveals that acupuncture can decrease a patient's arthritis pain[11]
