This post continues our discussion of the Clinical Manifestations of Systemic Lupus Erythematosus (SLE).
SKIN AND MUCOUS MEMBRANE INVOLVEMENT
Most SLE patients develop skin and mucous membrane lesions at some point in their disease process, although there is a great deal of variability in presentation. The most common lesion is a facial eruption that in known as the “butterfly” rash that heralds the onset of acute cutaneous lupus erythema (ACLE). This rash typically presents after sun exposure as an area of erythema over the cheeks and nose without involvement of the nasolabial folds. Some patients may develop discoid lesions, which are more inflammatory and usually result in scarring. Many patients develop oral and/or nasal ulcers that are usually painless, but may lead to nasal septal perforation.
A variety of vascular abnormalities can occur in patients with SLE.
Raynaud phenomenon — Raynaud phenomenon in SLE is a vasospastic process induced by cold or emotion that occurs in up to 50 percent of patients with SLE. Raynaud phenomenon is characterized by intermittent pallor of the distal portion of the extremities followed by cyanosis and erythroderma.
Vasculitis — Up to one third of the patients with SLE develop vasculitis, which may occur in all areas of the body. However, it is most commonly seen in the small vessels and often manifests as skin lesions, including palpable purpura, petechiae, papulonodular lesions, livedo reticularis, panniculitis, splinter hemorrhages, and superficial ulcerations
Although the specific cause has not been established, blood clots can occur in both the venous and the arterial circulatory systems.
Approximately 50% of the patients with SLE have renal involvement, which becomes a significant cause of morbidity and mortality. Thus, periodic screening for the presence of lupus nephritis with urinalyses, presence and amount of proteinuria, and estimation of the glomerular filtration rate is an important component of the chronic care treatment plan for SLE patients.
Gastrointestinal symptoms are common in SLE patients and are most often the result of an adverse medication reaction or infection (either viral or bacterial). Because the whole gastrointestinal tract may be affected, problems like esophagitis, intestinal pseudo-obstruction, lupus hepatitis, and acute pancreatitis may occur.
Pulmonary manifestations of SLE include pleuritis (with or without effusion), pneumonitis, interstitial lung disease, pulmonary hypertension, and alveolar hemorrhage. It is important to note that respiratory symptoms may also indicate an infection, particularly in patients on immunosuppressive therapy, or a blood clot of the lung.
Occurring in approximately 25 percent of patients at some point during their disease, pericarditis (with or without effusion) is the most common cardiac-related condition in patients with SLE. However, any part of the heart can be affected, including the pericardium, myocardium, valves, conduction system, and coronary arteries. Patients with SLE also have an increased risk of coronary artery disease.
There are a number of neurological and psychiatric conditions that are associated with SLE. They include cognitive dysfunction, organic brain syndromes, delirium, psychosis, seizures, headaches, and/or peripheral neuropathies. Other less common problems are movement disorders, cranial neuropathies, myelitis, and meningitis. The thromboembolic conditions mentioned previously may cause focal neurologic problems like stroke, seizures and diffuse cognitive defects. Psychosis may occur as the result of manifestations of the SLE itself, or to steroid treatment. Other psychiatric manifestations of SLE include depression, anxiety, and mania.
In our next post, Clinical Practice Update: Systemic Lupus Erythematosus III, we will continue the discussion of the clinical manifestations of Systemic Lupus Erythematosus.
Please share your experiences caring for patients with Systemic Lupus Erythematosus in our comments section.
This Clinical Update is based upon The Correctional Nurse Educator class entitled Systemic Lupus Erythematosus.