In this post, we will continue our discussion of the clinical manifestations of Systemic Lupus Erythematosus.
While SLE can affect any eye structure, one of the most common manifestations is Keratoconjunctivitis Sicca, also known as Dry Eye Syndrome. This is a disease that involves both the tears and the ocular surface, and results in discomfort, visual disturbance, and tear film instability for the patient, and may result in permanent damage to the surface of the eye. Cotton wool spots, a retinal vasculopathy, are also a common manifestation of SLE in the eye. Other less-common manifestations include optic neuropathy, choroidopathy, episcleritis, scleritis, anterior uveitis and orbital tissue involvement. In addition, steroid-induced glaucoma and retinal toxicity due to antimalarial therapy are two conditions that may result from SLE medications.
Hematologic abnormalities are common in SLE, and anemia of chronic disease is the most common. Leukopenia is common in SLE patients and is typically seen in patients with an exacerbation of their disease. Neutropenia may also result from toxicity due to immunosuppressive medications. Mild thrombocytopenia is also a common hematologic abnormality, but typically no treatment is needed unless it becomes severe. Autoimmune hemolytic anemia is relatively rare, but can be severe requiring immediate therapy.
LYMPHADENOPATHY AND SPLENOMEGALY
Lymph node enlargement commonly occurs in association with active SLE, and usually involves the cervical, axillary and inguinal regions. It is important to remember, though, that lymph node enlargement may also be due to infection. Splenomegaly can also be observed among SLE patients, particularly with active disease.
Other Associated Conditions and Complications
A number of medical conditions that are related to either the underlying disease or the therapy prescribed to ease symptoms can occur in patients with SLE.
Antiphospholipid syndrome is a blood disorder that causes the body to attack the “normal” proteins in the blood that usually control blood clotting. As a result, blood clots are formed. The patient may suffer Deep Vein Thrombosis (DVT); blood clots in the arteries, leading to stroke or heart attack; and low platelet counts (thrombocytopenia). In patients who are pregnant, this may lead to miscarriage, fetal stoke and fetal demise.
Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues, and research has indicated that patients with SLE have a higher prevalence of fibromyalgia than the general population.
Also known as osteonecrosis, aseptic necrosis, and ischemic bone necrosis, avascular necrosis is a condition that occurs when there is loss of blood to the bone. This can ultimately cause bone death and collapse. In SLE patients, both the underlying disease process and the medications used (mainly steroids) may cause this to occur.
Osteoporosis is a common complication of SLE. It occurs when bones weaken and are more likely to break. This weakness may be due to medication prescribed for the SLE more so than the SLE disease process itself.
Serious infections, especially of the skin, respiratory, and urinary systems, develop in up to 50% of SLE patients. Most of these are due to bacteria, but research has indicated that the majority of deaths of patients with SLE are due to opportunistic infections, including fungal infection, that occur as a result of immunosuppressive therapy. Immunosuppressive therapy includes the use of steroids.
OTHER AUTOIMMUNE DISEASES
There is an increased prevalence of thyroid disease and Myasthenia Gravis among patients with SLE. It is notable that there is a high prevalence of autoimmune diseases among families of patients with SLE.
Any woman who has SLE and becomes pregnant should be treated as a very high-risk pregnancy because there is a serious risk of a disease exacerbation and miscarriage. With monitoring and medical advances, today research has indicated that careful monitoring and ongoing treatment of pregnant women with SLE results in 75-80% of the pregnancies being carried to term. For comparison, in women without the disease, 85-90% are carried to term. It is important to know that pregnant women with SLE are more likely to develop pregnancy induced hypertension, diabetes, hyperglycemia and renal complications, especially those on steroids, and they should be monitored closely.
In our next post, Clinical Practice Update: Systemic Lupus Erythematosus IV, we will discuss the Nursing Interventions for the patient with 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 for the Correctional Nurse.