systemic lupus erythematosus (SLE), a chronic inflammatory disease affecting many systems of the body. It is an example of an autoimmune connective-tissue disorder. The pathophysiological characteristics of the disease include severe vasculitis, renal involvement, and lesions of the skin and nervous system. The primary cause of the disease has not been determined; viral infection or dysfunction of the immune system has been suggested. Adverse reaction to certain drugs also may cause a lupuslike syndrome. Four times more women than men have SLE. Also called disseminated lupus erythematosus. See also discoid lupus erythematosus. ▪ OBSERVATIONS: The initial manifestation is often arthritis. An erythematous rash (“butterfly rash”) over the nose and malar eminences, weakness, fatigue, and weight loss also are frequently seen early in the disease. Photosensitivity, fever, skin lesions on the neck, and alopecia where the skin lesions extend beyond the hairline may occur. The skin lesions may spread to the mucous membranes and other tissues of the body. They do not ulcerate but cause degeneration of the affected tissues. Depending on the organs involved, the patient also may have glomerulonephritis, pleuritis, pericarditis, peritonitis, neuritis, or anemia. Renal failure and severe neurological abnormalities are among the most serious manifestations of the disease. Diagnosis of SLE is made by subjective and objective findings based on physical examination and laboratory findings, including antinuclear antibody in the cerebrospinal fluid and a positive lupus erythematosus cell reaction in a lupus erythematosus preparation. Other laboratory examinations may be useful, depending on the organs, tissues, and systems affected by the disease. ▪ INTERVENTIONS: In many cases SLE may be controlled with corticosteroid medication administered systemically. Care and treatment vary with the severity and nature of the disease and the body systems that are affected. Topical steroids may be applied to the rash. Salicylates may be given to alleviate pain and swelling in the joints. Fatigue and stress are prevented, and all body surfaces are protected from direct sunlight. Antimalarial drugs are sometimes given to treat cutaneous lesions, but retinal damage may occur with prolonged use. ▪ PATIENT CARE CONSIDERATIONS: The timing, dosage, side effects, and toxic reactions to the medications are explained before discharge. The steroids must be taken exactly as prescribed, and, in the event that the patient cannot take them, the doctor is to be consulted promptly. The patient should carry an identification card bearing his or her diagnosis, a list of all medications and their dosage, and the doctor’s name and telephone number. As in any disease marked by chronic remission and exacerbation of many distressing symptoms, the patient may require extensive emotional and psychological support.
