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Concepts of Immunology & Concepts of Immunology & Autoimmune DisordersAutoimmune Disorders

What is Immunity?What is Immunity?What is Immunity?What is Immunity?

OverviewOverview

Immunity OverviewImmunity OverviewImmunity OverviewImmunity Overview

• Immune System usually defends Immune System usually defends against bacterial or viral invaders against bacterial or viral invaders and plays a key role in controlling and plays a key role in controlling the growth of cancer cells.the growth of cancer cells.

• 2 components of the immune 2 components of the immune response:response:

1. ability to recognize a pathogen 1. ability to recognize a pathogen as foreignas foreign

2. ability to respond to eliminate 2. ability to respond to eliminate the pathogen.the pathogen.

Organs of the Immune Organs of the Immune SystemSystemOrgans of the Immune Organs of the Immune SystemSystem

Organization of the Immune Organization of the Immune SystemSystem

Organization of the Immune Organization of the Immune SystemSystem

• Not confined to one organ or Not confined to one organ or body partbody part

• Most immune cells originate in Most immune cells originate in the bone marrowthe bone marrow

• Mature immune cells are Mature immune cells are released into the circulating released into the circulating bloodblood

• Different types of WBCs play Different types of WBCs play different roles in the immune different roles in the immune and/or inflammatory processand/or inflammatory process

Immunity-DefensesImmunity-DefensesImmunity-DefensesImmunity-Defenses

– First-line DefensesFirst-line Defenses• Physical Barriers (skin, mucous Physical Barriers (skin, mucous

membranes)membranes)• Chemical Barriers (saliva pH)Chemical Barriers (saliva pH)• Normal Flora Normal Flora

– Second-line DefenseSecond-line Defense• Inflammatory ProcessInflammatory Process

Third Line DefenseThird Line Defense AntibodiesAntibodies

http://www.infections.bayer.com

Overview

ImmunityImmunityImmunityImmunity• Innate = natural immunityInnate = natural immunity

– Individual, racial, species, geneticIndividual, racial, species, genetic– Inherent & nonspecificInherent & nonspecific– E.g., across the placentaE.g., across the placenta

• Acquired = through contactAcquired = through contact– Passive: Temporary, via source outside Passive: Temporary, via source outside

the bodythe body– Active: Produced by own body. Provides Active: Produced by own body. Provides

longer-lasting immunity longer-lasting immunity

Types of Active ImmunityTypes of Active ImmunityTypes of Active ImmunityTypes of Active ImmunityHumoral immunity- Humoral immunity- found in peripheral bloodfound in peripheral blood

• B lymphocytes B lymphocytes that produce antibodiesthat produce antibodies– AnaphylaxisAnaphylaxis– Hay fever & asthmaHay fever & asthma– Bacterial diseasesBacterial diseases– Immune complex diseaseImmune complex disease

Cell –mediated- Cell –mediated- found in peripheral bloodfound in peripheral blood• T lymphocytes T lymphocytes (“T” for thymus)(“T” for thymus)• Important in protecting the body against Important in protecting the body against

infection by viruses, slow-growing bacteria infection by viruses, slow-growing bacteria and fungal infections. and fungal infections.

• Immunosurveillance, reacting to abnormal Immunosurveillance, reacting to abnormal clones of self cells, some of which are clones of self cells, some of which are malignant. malignant.

• Transplant rejectionTransplant rejection• Delayed hypersensitivity (TB reaction)Delayed hypersensitivity (TB reaction)

Immunity: Direct/ActiveImmunity: Direct/ActiveImmunity: Direct/ActiveImmunity: Direct/Active

• Humoral Immunity = Antibody Humoral Immunity = Antibody Mediated Immunity (AMI) Mediated Immunity (AMI)

• effector units are effector units are immunoglobulins (IgM, IgG, & immunoglobulins (IgM, IgG, & IgA) present in the peripheral IgA) present in the peripheral bloodblood

• Involves antigen-antibody Involves antigen-antibody interactionsinteractions

Antibody ClassificationAntibody ClassificationAntibody ClassificationAntibody Classification

• Serum proteins = Serum proteins = immunoglobulins or gamma immunoglobulins or gamma globulinsglobulins

• Produced by Produced by BB lymphocytes (B- lymphocytes (B-cells)cells)

• Destroy antigensDestroy antigens• 5 types: IgA, IgG, IgM, IgD, IgE5 types: IgA, IgG, IgM, IgD, IgE

Immunity: Direct/ActiveImmunity: Direct/ActiveImmunity: Direct/ActiveImmunity: Direct/Active

Cell-mediated immunityCell-mediated immunity: the effector : the effector units are cytotoxic units are cytotoxic T cells T cells that that circulate in peripheral blood and circulate in peripheral blood and present in peripheral lymphoid tissuespresent in peripheral lymphoid tissues

• Differentiates self from non-self cellsDifferentiates self from non-self cells– Cancer cellsCancer cells– Self cells infected by organismsSelf cells infected by organisms

• Prevent development of cancer & Prevent development of cancer & metastasismetastasis

Cells of the Immune SystemCells of the Immune SystemCells of the Immune SystemCells of the Immune System

Cells of the Immune System Cells of the Immune System OverviewOverview

Cells of the Immune System Cells of the Immune System OverviewOverview

– T-Cells = CD4+ and CD8 T-Cells = CD4+ and CD8 – NK = Natural Killer CellsNK = Natural Killer Cells– B Cells = B lymphocytesB Cells = B lymphocytes– Granulocytes or Polymorphonuclear Granulocytes or Polymorphonuclear

(PMN) Leukocytes = neutrophils, (PMN) Leukocytes = neutrophils, eosinophils and basophils eosinophils and basophils

– Macrophages = monocytes that have Macrophages = monocytes that have migrated from the bloodstream and migrated from the bloodstream and entered tissueentered tissue

Cells of the Immune System: T-Cells Cells of the Immune System: T-Cells Cells of the Immune System: T-Cells Cells of the Immune System: T-Cells

– CD4 + = helper T cell- coordinator of CD4 + = helper T cell- coordinator of immune regulation. immune regulation. • enhance immune responses by the enhance immune responses by the secretion of specialized factors that secretion of specialized factors that activate other white blood cells to activate other white blood cells to fight off infection. fight off infection.

– CD8 + = killer/suppressor T cell CD8 + = killer/suppressor T cell •kill certain tumor cells, viral-infected kill certain tumor cells, viral-infected cells and sometimes parasites. The cells and sometimes parasites. The CD8+ T cells are also important in CD8+ T cells are also important in down-regulation of immune responses. down-regulation of immune responses.

Cells of the Immune System: Natural Cells of the Immune System: Natural Killer Cells (NK) Killer Cells (NK)

Cells of the Immune System: Natural Cells of the Immune System: Natural Killer Cells (NK) Killer Cells (NK)

• kill certain tumors such as kill certain tumors such as melanomas, lymphomas and viral-melanomas, lymphomas and viral-infected cells, most notably herpes infected cells, most notably herpes and cytomegalovirus-infected cellsand cytomegalovirus-infected cells

• Produces cytokines which attract & Produces cytokines which attract & activate B-cells, macrophages & activate B-cells, macrophages & other cells of the immune systemother cells of the immune system

Cells of the Immune System: B CellsCells of the Immune System: B CellsCells of the Immune System: B CellsCells of the Immune System: B Cells

B Cells = B lymphocytesB Cells = B lymphocytes– Produce antibodies Produce antibodies

(immunoglobulins) in response to (immunoglobulins) in response to foreign proteins of bacteria, foreign proteins of bacteria, viruses, and tumor cells. viruses, and tumor cells.

Cells of the Immune System: Cells of the Immune System: Granulocytes Granulocytes

Cells of the Immune System: Cells of the Immune System: Granulocytes Granulocytes

• Granulocytes or Polymorphonuclear Granulocytes or Polymorphonuclear (PMN) Leukocytes(PMN) Leukocytes – neutrophilsneutrophils– eosinophilseosinophils– basophils basophils

• important in: important in: – phagocytosisphagocytosis– allergies allergies – inflammatory responseinflammatory response

Cells of the Immune System: Cells of the Immune System: MacrophagesMacrophages

Cells of the Immune System: Cells of the Immune System: MacrophagesMacrophages

• Monocytes that have migrated from the Monocytes that have migrated from the bloodstream and entered tissuebloodstream and entered tissue– scavengers or antigen-presenting cells scavengers or antigen-presenting cells

(APC) (APC) – pick up and ingest foreign materials pick up and ingest foreign materials

(phagocytic)(phagocytic)– present these antigens to T cells and B present these antigens to T cells and B

cellscells

HLAsHLAsHuman Leukocyte AntigensHuman Leukocyte Antigens

HLAsHLAsHuman Leukocyte AntigensHuman Leukocyte Antigens

• Specific tissue typeSpecific tissue type– Humans have about 40 that are specific Humans have about 40 that are specific

antigens determined by geneticsantigens determined by genetics

• Normal only for that individual – acts as Normal only for that individual – acts as antigen to anotherantigen to another

• Major role of HLA antigen is regulation of Major role of HLA antigen is regulation of the immune response, distinguishing self the immune response, distinguishing self from non-selffrom non-self

• Plays a major role in the rejection of Plays a major role in the rejection of transplanted tissues when donor and transplanted tissues when donor and recipient HLA antigens do not match.recipient HLA antigens do not match.

Purpose of Inflammation and Purpose of Inflammation and ImmunityImmunity

Purpose of Inflammation and Purpose of Inflammation and ImmunityImmunity

• PROTECTION PROTECTION – To neutralize, eliminate, or To neutralize, eliminate, or

destroy organisms that invade destroy organisms that invade the body. the body.

– differentiate between self and differentiate between self and foreign cells and eliminate dead foreign cells and eliminate dead cellscells

– stimulate and depress the stimulate and depress the immune response in a regulated immune response in a regulated fashionfashion

How do immune system cellsHow do immune system cells function? function?How do immune system cellsHow do immune system cells function? function?

• SELF TOLERANCESELF TOLERANCE– SelfSelf– Non self (foreign)Non self (foreign)

– T-cells, lymphocytes, T-cells, lymphocytes, macrophages and antigens macrophages and antigens recognize cancer cells as non-self recognize cancer cells as non-self and destroys themand destroys them

Examples of Non –Self Examples of Non –Self Proteins and CellsProteins and CellsExamples of Non –Self Examples of Non –Self Proteins and CellsProteins and Cells

• Infected or debilitated body Infected or debilitated body cellscells

• Self cells that have become Self cells that have become cancerouscancerous

• All invading cells and All invading cells and organismsorganisms

ViralProteins

InflammationInflammationInflammationInflammation

• Purpose: Purpose: – immediate protection against tissue immediate protection against tissue

injury & foreign proteins injury & foreign proteins – critical to health and well-being.critical to health and well-being.– causes visible symptoms causes visible symptoms – can rid body of harmful organismscan rid body of harmful organisms– Can serve as a warningCan serve as a warning– Helps stimulate AMI & CMIHelps stimulate AMI & CMI– Does not require recognition of selfDoes not require recognition of self

InflammationInflammationInflammationInflammation

• Problem: Problem: – tissue damage may result from tissue damage may result from

excessive inflammatory response.excessive inflammatory response.

Infection vs. InflammationInfection vs. InflammationInfection vs. InflammationInfection vs. Inflammation

• Infection Infection – usually accompanied by inflammationusually accompanied by inflammation

• Inflammation does not always Inflammation does not always mean that an infection is present—mean that an infection is present—can occur without invasion by can occur without invasion by organismsorganisms

Inflammatory ResponseInflammatory ResponseInflammatory ResponseInflammatory Response

• Transient vasoconstriction Transient vasoconstriction followed by vasodilation & followed by vasodilation & vascular permeabilityvascular permeability

• Leukocyte migration + release Leukocyte migration + release of chemical mediators of chemical mediators (histamine, bradykinin)(histamine, bradykinin)

• Systemic: Fever, malaise, Systemic: Fever, malaise, leukocytosisleukocytosis

5 Cardinal signs of inflammation5 Cardinal signs of inflammation5 Cardinal signs of inflammation5 Cardinal signs of inflammation

• Warmth Warmth • Redness Redness • Swelling Swelling • Pain Pain • Decreased functionDecreased function

Acute InflammationAcute InflammationAcute InflammationAcute Inflammation

• Acute lasts less than 2 weeksAcute lasts less than 2 weeks• Outcome managementOutcome management

– Minimize complications of edemaMinimize complications of edema– Reduce inflammatory responseReduce inflammatory response

• Anti-inflammatory agents, removal of Anti-inflammatory agents, removal of foreign bodyforeign body

– Monitor systemic responsesMonitor systemic responses• Temperature and leukocyte countTemperature and leukocyte count

– Control the effects of edemaControl the effects of edema• Rest, ice, compression, elevation (RICE)Rest, ice, compression, elevation (RICE)

Chronic InflammationChronic InflammationChronic InflammationChronic Inflammation

• Lasts months or yearsLasts months or years– Is not protective & can be Is not protective & can be

debilitatingdebilitating

• Outcome managementOutcome management– Identify source of problemIdentify source of problem– Promote “clean wound”Promote “clean wound”

• DDebridement, antibiotic or anti-ebridement, antibiotic or anti-inflammatory agentsinflammatory agents

*A chronically inflamed wound has *A chronically inflamed wound has purulent drainage and does not heal purulent drainage and does not heal completely.completely.

IMMUNOCOMPETENCEIMMUNOCOMPETENCEIMMUNOCOMPETENCEIMMUNOCOMPETENCE

• Immunity is NOT constant!Immunity is NOT constant!– Most efficient in 20s & 30sMost efficient in 20s & 30s– Effected by:Effected by:

• Nutritional statusNutritional status• EnvironmentEnvironment• DrugsDrugs• DiseaseDisease• AgingAging

Changes in Immune Function Changes in Immune Function Related to AgingRelated to AgingChanges in Immune Function Changes in Immune Function Related to AgingRelated to Aging

• Defect in neutrophil functionDefect in neutrophil function• Elevation of WBCs may not Elevation of WBCs may not

occuroccur• Ability to make new antibodies Ability to make new antibodies

declinesdeclines• # antibodies decreases# antibodies decreases• # T lymphocytes declines# T lymphocytes declines• in gastric acid secretion, in gastric acid secretion,

cough reflex, cilial actioncough reflex, cilial action

Immune System FailureImmune System FailureImmune System FailureImmune System Failure

• Inability recognize pathogen as foreignInability recognize pathogen as foreign• Inability mount a response to eliminate Inability mount a response to eliminate

the pathogenthe pathogen– Immature, old or weak immune systemImmature, old or weak immune system– Malnutrition or chronic illness may lead to Malnutrition or chronic illness may lead to

compromised immune systemcompromised immune system– Tumor cells too small to stimulate responseTumor cells too small to stimulate response– Tumor burden so great that it overwhelms the Tumor burden so great that it overwhelms the

immune systemimmune system– Abnormal cells may resemble normalAbnormal cells may resemble normal– Abnormal cells may protect themselvesAbnormal cells may protect themselves– Immunosuppressive drugsImmunosuppressive drugs

Apoptosis: programmed cell Apoptosis: programmed cell deathdeathApoptosis: programmed cell Apoptosis: programmed cell deathdeath

• Apoptosis: cell “suicide” results in Apoptosis: cell “suicide” results in cells rapidly shrinking; they are cells rapidly shrinking; they are then phagocytized; inflammation is then phagocytized; inflammation is not triggerednot triggered

• Failure of cells to dieFailure of cells to die• If cell does not die it may live long If cell does not die it may live long

enough to accumulate mutations; enough to accumulate mutations; divide uncontrollably and divide uncontrollably and metastasizemetastasize

AutoimmunityAutoimmunity

• Conditions in which immunologic self-tolerance has been disrupted with resultant damage to body tissues or cells normally recognized as self.

• AI disorders with muscle and joint involvement include: RA, scleroderma, and mixed connective tissue disease.

Rheumatic DisordersRheumatic DisordersRheumatic DisordersRheumatic Disorders

• Includes more than 100 Includes more than 100 disorders involving muscles & disorders involving muscles & jointsjoints

• All involve inflammation & All involve inflammation & degenerationdegeneration– Osteoarthritis/ Rheumatoid Osteoarthritis/ Rheumatoid

arthritisarthritis– Systemic lupus erythematosusSystemic lupus erythematosus– SclerodermaScleroderma

Rheumatoid ArthritisRheumatoid Arthritis

• Chronic, systemic autoimmune disorder• Major distinctive feature- chronic, symmetrical

and erosive inflammation of synovial tissue of joints.

• Occurs worldwide and affects all racial and ethnic groups.

• Can occur at any time of life, but incidence tends to increase with age, peaking in ages 40-60’s.

• Women affected 2-3X more often than men.

Pathophysiology of RAPathophysiology of RAPathophysiology of RAPathophysiology of RA• T- and B-cell proliferationT- and B-cell proliferation• Angiogenesis in synovial liningAngiogenesis in synovial lining

– Joint swelling & stiffnessJoint swelling & stiffness

• Neutrophils accumulate in synovial Neutrophils accumulate in synovial fluidfluid– Joint effusion, warmth, decreased Joint effusion, warmth, decreased

ROMROM

• Proceeds to degradation of Proceeds to degradation of cartilage by proteinase and cartilage by proteinase and subchondral bone invasionsubchondral bone invasion

RARA

• Symptoms include:– Fever– Anemia

- anorexia & weight loss- fatigue

- muscle aching- Raynaud’s phenomenon

- morning stiffness lasting 30-45 minutesJoint involvement: Hot, painful, swollen joints,

usually bilateral & symmetrical.

Begins in small joints of hands, wrists & feet.Knees, shoulders, hips, elbows, ankles, neck, TM joints then become involved as disease progresses.

Rheumatoid NodulesRheumatoid NodulesRheumatoid NodulesRheumatoid Nodules

• Approx. 25% will develop Approx. 25% will develop subcutaneous nodules which subcutaneous nodules which are non-tender, movableare non-tender, movable

• Located over bony prominences Located over bony prominences such as elbowsuch as elbow

• May disappear spontaneouslyMay disappear spontaneously• Associated with rapidly Associated with rapidly

destructive & progressive destructive & progressive diseasedisease

RA (cont)…RA (cont)…

• aa

Extra-articular Features of RA Extra-articular Features of RA Extra-articular Features of RA Extra-articular Features of RA

• ArteritisArteritis• ScleritisScleritis• PericarditisPericarditis• SplenomegalySplenomegaly• NeuropathyNeuropathy• Sjogren’s syndrome (dry eyes Sjogren’s syndrome (dry eyes

& mucous membranes)& mucous membranes)

Diagnosis of RADiagnosis of RADiagnosis of RADiagnosis of RA

• Positive rheumatoid factor in 3 Positive rheumatoid factor in 3 out of 4 patients but this alone out of 4 patients but this alone is not diagnostic is not diagnostic

• Elevated sed rateElevated sed rate• C-reactive protein & ANA may C-reactive protein & ANA may

be positivebe positive• Low RBCs, C4 complement Low RBCs, C4 complement

decreaseddecreased

Diagnosis of RADiagnosis of RADiagnosis of RADiagnosis of RA

• Arthrocentesis: Cloudy or dark Arthrocentesis: Cloudy or dark yellow synovial fluid with yellow synovial fluid with leukocytes, complementleukocytes, complement

• X-rays: Narrowed joint spaces, X-rays: Narrowed joint spaces, bony erosionsbony erosions

RA managementRA management

• Includes combination of: - medications - rest - exercise - joint protection - joint replacementPrimary goals: - pain reduction - reducing joint inflammation - maintaining or restoring joint function - controlling systemic involvement

RA pain managementRA pain management

• Most often achieved with medications

• Usually combination of NSAID’s or salicylates and oral corticosteroids

• Opioids avoided due to need for long-term pain control

Medications for RAMedications for RAMedications for RAMedications for RA• Disease-modifying Antirheumatic Disease-modifying Antirheumatic

Drugs (DMARDs)Drugs (DMARDs)– Antimalarials (Plaquenil, Aralen)Antimalarials (Plaquenil, Aralen)

• Anti-inflammatory actionAnti-inflammatory action

– Gold (Solganol)Gold (Solganol)• Inhibits B & T-cell activityInhibits B & T-cell activity

– AzulfadineAzulfadine• Inhibits angiogenesisInhibits angiogenesis

– PenicillaminePenicillamine• Anti-inflammatory; inhibits T-cell functionAnti-inflammatory; inhibits T-cell function

Medications for RAMedications for RAMedications for RAMedications for RA

• Methotrexate (Rheumatrex) is Methotrexate (Rheumatrex) is standard of txstandard of tx– Improves pain, swollen jointsImproves pain, swollen joints– Cyclosporine may be addedCyclosporine may be added

• Biologic response modifiersBiologic response modifiers– Enbrel, Remicade, HumiraEnbrel, Remicade, Humira

• Inhibit TNF-alpha (a cytokine)Inhibit TNF-alpha (a cytokine)

– KineretKineret• Inhibits interleukin-1 (another cytokine Inhibits interleukin-1 (another cytokine

which contributes to joint destruction)which contributes to joint destruction)

Immunosuppressant MedsImmunosuppressant MedsImmunosuppressant MedsImmunosuppressant Meds

• High-dose MTXHigh-dose MTX• CytoxanCytoxan• ImuranImuran• AravaArava• *Highly toxic, used for *Highly toxic, used for

advanced diseaseadvanced disease– S/E of anemia, bone marrow S/E of anemia, bone marrow

suppression, rashes, GI upsetsuppression, rashes, GI upset

Other Meds used in RAOther Meds used in RAOther Meds used in RAOther Meds used in RA

• Meds to help depression, Meds to help depression, chronic pain & sleepchronic pain & sleep– Elavil, Paxil, ZoloftElavil, Paxil, Zoloft

Prosorba ColumnProsorba ColumnProsorba ColumnProsorba Column

• Approved by FDA for severe RA Approved by FDA for severe RA that has not responded to that has not responded to DMARDsDMARDs– Protein A immuno-absorption Protein A immuno-absorption

column used for weekly 2-hour column used for weekly 2-hour apheresis treatments x 12 weeksapheresis treatments x 12 weeks• Binds IgGBinds IgG

Surgical managementSurgical managementSurgical managementSurgical management

• SynovectomySynovectomy• Arthrodesis (fusion of joint)Arthrodesis (fusion of joint)• Arthroplasty (joint Arthroplasty (joint

replacement)replacement)• Local injection of Local injection of

corticosteroidcorticosteroid

RA- protecting articular surfacesRA- protecting articular surfaces

• Joint protection and work simplification – important concerns

• Decreases fatigue and increases energy levels

• Improves coping abilities and sense of control– Examples:– Easy grip combs and brushes/large handles– Adaptable clothing

RA- therapeutic exerciseRA- therapeutic exercise

• Important treatment for RA• 3 types of exercises - ROM—to improve joint motion - strengthening- to preserve or improve

the muscles ability to perform work - endurance – i.e.. Bike riding, swimming,

golf, dancing

Heat and cold therapies help inflamed joints

RA- nursing managementRA- nursing management

• GOAL- promote a healthy, positive life with adaptation

• Focus on comfort, self-care, control and coping

• Adaptations for home necessary• Provide information on dealing with

chronic pain• RA patients need caring and

empathy from nurses

RA- nursing diagnosesRA- nursing diagnoses

• Chronic pain• Fatigue/sleep deprivation• Impaired physical mobility• Chronic low self esteem,

disturbed body image, hopelessness, powerless

• Risk for ineffective therapeutic regimen management

Connective Tissue DisordersConnective Tissue Disorders

• Systemic Lupus Erythematosus (SLE)

-multisystem, inflammatory disorder

- abnormalities of the immune system

- chronic condition - produces wide spread damage to

connective tissues, blood vessels and serous and mucous membranes

SLE- LupusSLE- Lupus

• Primarily disease of young women. • Peak incidence occurs between ages 15-40,

during childbearing years• Female-to- male ratio 10:1• Young black women majority group affected• Once considered fatal, now 85% of patients live

longer than 15 years after diagnosis• Most common causes of death: active lupus

nephritis, vascular events and infections

Lupus- Pathophysiology Lupus- Pathophysiology

• Exaggerated production of autoantibodies

• Combination of genetic, hormonal & environmental factors ?

• Drug-induced lupus– Apresoline, procainamide, INH, Thorazine,

some anti-seizure meds• Abnormal suppressor T-cell function• Immune complex deposits cause tissue

damage• Inflammation stimulates antigens, which

in turn stimulates additional antibodies • Sx can flare

Lupus- Clinical ManifestationsLupus- Clinical Manifestations• Fever• Fatigue and malaise, weight loss• Painful, swollen joints is common presentation

– Morning stiffness• Skin lesions- on scalp, ears, face and neck

– Discoid lupus: Skin involvement only• Skin rashes (butterfly rash over bridge of nose and

cheeks) occurs in more than 50%• Temporary loss of hair• Painless mouth ulcers• Vascular lesions/ pericarditis/ pleurisy• Photosensitivity• Can cause psychosis, convulsions, depression• Peripheral edema• Infections• Kidney involvement with hypertension• *Can effect any body system

Diagnosis of SLEDiagnosis of SLEDiagnosis of SLEDiagnosis of SLE

• AnemiaAnemia• ThrombocytopeniaThrombocytopenia• Increased or decreased WBCsIncreased or decreased WBCs• Positive ANA (antinuclear Positive ANA (antinuclear

antibodies)antibodies)– Additional autoantibodies can be Additional autoantibodies can be

tested if ANA is positive tested if ANA is positive

• Possibly hematuriaPossibly hematuria• *No single lab test confirms dx*No single lab test confirms dx

Lupus- Medical ManagementLupus- Medical Management

• Management based on organ systems involved• Commonly occurring conditions: - hypertension - infections - seizures - hyperlipidemia - osteoporosisGoals: - maintain skin integrity - promote healthy life style - reduce stress - proper nutrition - promote comfort - increase independence -maintain emotional well-being

Lupus- medication therapyLupus- medication therapy

• NSAID’s for pain• Corticosteroids (usually Prednisone) used

to control thrombocytopenic purpura, hemolytic anemia, myocarditis, seizures and nephritis

• Antimalarial drugs used for managing cutaneous manifestations and treating musculoskeletal manifestations

• Immunosuppressive agents (MTX) useful in managing arthritis and skin rashes

Lupus- dietary changesLupus- dietary changes

• Persons with lupus need to adjust their diet to help with hypertension and renal failure

• Reduce salt and fat intake• Reduce cholesterol intake• Also important to stop smoking to

reduce the risk of hypertension and coronary artery disease

Lupus- supportive careLupus- supportive care

• Physical rest• Emotional rest/ support groups• Diet and nutrition• Skin protection/ sunscreen• Education regarding need for

periodic screenings to assess organ involvement