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Systemic Lupus Erythematosus Case Study
Systemic Lupus Erythematosus
Systemic lupus erythematosus (SLE) is a chronic, life-long autoimmune disease that affects multiple tissues and organs in the body (Madhok and Wu, 2009). The primary tissues and organs affected by immune system dysfunction are the joints, kidneys, vessel walls, and skin. SLE is believed to be due to an interaction between genetic factors and environmental triggers. The disease is also more prevalent among women, which is consistent with the possibility that hormones play some role in disease etiology.
Of primary concern is lupus glomerulonephritis (Madhok and Wu, 2009). Other serious complications include cardiovascular and neuropsychiatric involvement. Most patients will experience arthritis or joint pain (84%), fever (52%), malar rash (58%), and photosensitivity (45%). Accordingly, a diagnosis of SLE will depend in part on a blood test for anti-nuclear antibodies (ANA) and presentation with rash, joint pain, fatigue, and/or low-grade fevers.
The pain in Vicki's knees, shoulders, and elbows is the result of inflammation, which is caused by an autoimmune reaction to cartilaginous tissue in the joints (A.D.A.M., 2013). The fever is most likely low grade and due to systemic inflammation and the frequent infections...
Inflammation is also the cause of the prototypical butterfly rash. The anemia could be the result of iron deficiency, possibly due to frequent menstruation or gastrointestinal bleeding; however hemolytic anemia is another possibility. Hemolytic anemia has been associated with very high serum levels of cardiolipin auto-antibodies. The hardening of the skin over the fingers is not a symptom of SLE, but of scleroderma, another autoimmune disease. Scleroderma is caused by excessive collagen deposition reminiscent of what happens during wound repair. SLE and scleroderma can co-occur.
Laboratory tests will probably reveal the following:
1. ANA titer above 1:40 (Gill, Quisell, Rocca, and Walters, 2003)
2. CBC revealing lower than normal RBC count, hemoglobin, and hematocrit indicating iron deficiency (Schrier, 2013) or a positive erythrocyte antibody screen consistent with a diagnosis of hemolytic anemia (ABSCM) (Mayo Medical Laboratories, 2013)
3. CBC with differential showing a low white blood cell count
Renal inflammation due to progressive SLE can be devastating. Close to 50% of SLE sufferers will experience nephritis due to the deposition of cellular debris generated by the autoimmune process (A.D.A.M., 2013).…
References
A.D.A.M. (2013, Mar. 14). Lupus in-depth report. Reviewed by H. Simon and D. Zieve. New York Times. Retrieved 7 Nov. 2013 from http://health.nytimes.com/health/guides/disease/systemic-lupus-erythematosus/print/html.
Gill, James M., Quisell, Anna M., Rocca, Peter V., and Walters, Dene T. (2003). Diagnosis of systemic lupus erythematosus. American Family Physician, 68, 2179-2186.
Hedberg, A., Kanapathippillai, P., Rekviq, O.P., and Fenton, K.A. (2013). SMW heparin prevents increased kidney expression of proinflammatory mediators in (NZBxNZW) F1 mice. Clinical & Developmental Immunology, published 17 Sep. 2013 online ahead of print. Available 9 Nov. 2013 from http://www.hindawi.com/journals/cdi/2013/791262/.
Madhok, Rajan and Wu, Olivia. (2009). Systemic lupus erythematosus. Clinical Evidence, 7(1123), 1-29.
Mayo Medical Laboratories. (2013). Test ID: ABSCM. Antibody screen, erythrocytes. Mayo Clinic. Retrieved 8 Nov. 2013 from http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8956.
Schrier, Stanley L. (2013). Patient information: Anemia caused by low iron (beyond the basics). Wolters Kluwer Health. Retrieved 8 Nov. 2013 from http://www.uptodate.com/contents/anemia-caused-by-low-iron-beyond-the-basics.
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The most common cause of death is infection due to immunosuppression, a result in turn of medications intended to manage the disease. Chances are worse for men and children than for women. After the age of 60, the disease tends to turn benign. The only marker of prognosis in lupus is the anti-ds DNA antibody test and the most sensitive is the Anti-Smith test (Wikipedia) The standard treatment for lupus
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