Major Characteristics of Lupus - Research Paper Example

? Lupus Lupus is a complex autoimmune disorder affecting numerous bodily systems (Bernknopf, Rowley, & Bailey, . The disease can manifest in clusters of symptoms that have been described as specific syndromes (Zandman-Goddard, Solomon, Rosman, Peeva, & Shoenfeld, 2012). Although there is no cure for the disease, the symptoms caused by lupus can be treated with medications (Bernkopf et al., 2011). There may be an environmentally imposed aspect of the disease in some patients that develop lupus (Zandman-Goddard et al., 2012). Knowing the cause of a disease can increase our ability to understand and therefore treat the disease. Unfortunately, this is not possible with lupus. The exact cause of lupus is unknown, and while it is posited that there may be a genetic factor involved, no specific gene related to lupus has been identified (Lupus Foundation of America, 2012). Individuals with family members who have lupus or another autoimmune disorder are more likely to develop lupus, and twin studies show increased likelihood of developing lupus in one twin when the other has it (Lupus Foundation of America, 2012). Certain ethnic backgrounds demonstrate a greater frequency of lupus, including African, Native American, Asian, Hispanic/Latino, Native Hawaiian, and Pacific Island ethnicities (Lupus Foundation of America, 2012). Although anyone can get the disease, research shows that lupus appears in these populations more frequently than in others. The environmental aspect of lupus is related to the disease’s initial appearance, as well as the flare-ups the disease causes. For the disease to surface or flare up, there is exposure to some environmental catalyst that sets off a disease process (Lupus Foundation of America, 2012). One such environmental attribute is ultraviolet light (Lupus Foundation of America, 2012). Ultraviolet light exposure from the natural rays of the sun or from fluorescent lighting can trigger lupus, as can drugs that increase photosensitivity including sulfa drugs and tetracycline drugs (Lupus Foundation of America, 2012). Penicillin drugs have also been identified as having triggering qualities for lupus (Lupus Foundation of America, 2012). Other environmental factors include virus, exhaustion, illness, emotional stress, and physical strain such as surgery or childbirth (Lupus Foundation of America, 2012). It is also believed that the hormone estrogen is implicated in lupus, as the symptoms of the disease often first manifest during pregnancy or childbirth and can flare up with the menstrual cycle (Lupus Foundation of America, 2012). Despite the identification of these common factors in the backgrounds of individuals who develop lupus, science has yet to pinpoint a cause or cure for the disease. Anyone can get lupus and it does not appear to manifest more in any geographic location than another (Lupus Foundation of America, 2012). Scientists do not believe the disease is caused by anything in the diet of the sufferer, and cannot definitively state whether pollution could play a role (Lupus Foundation of America, 2012). Some studies have linked lupus with cigarette smoking, vitamin D deficiency, and vaccines, but have still been unable to attribute cause to any one of these (Zandman-Goddard et al., 2012). According to the present epidemiological data available on the disease, systemic lupus erythematosus usually appears in adult women aged twenty to forty years (Bernknopf et al., 2011). Its prevalence ranges from 14.6 to 68 cases per 100,000 population (Bernknopf et al., 2011). It appears in African American women as many as three to four times as frequently as in Caucasian women (Bernknopf et al., 2011). Only 15-20% of lupus cases are diagnosed during childhood (Livingston, Bonner, & Pope, 2011). There are a variety of symptoms that a person with lupus may describe during their first bout of lupus. Fever, fatigue, and weight loss are common complaints (Bernknopf et al., 2011). The symptoms of lupus can also appear on the skin in the form of a rash or in the mouth as an ulcer (Livingston et al., 2011). The majority of sufferers have joint problems such as arthritis or tendinitis, and some have cardiovascular, respiratory, ophthalmic, or gastrointestinal symptoms (Bernknopf et al., 2011). Older patients are more likely to have lung disease and neuropsychiatric symptoms than younger patients with lupus (Bernknopf et al., 2011). The complex nature of the disease is evident in the variety of symptoms and combinations of symptoms it can present. Lupus can affect many bodily systems. Cardiopulmonary symptoms can include pericarditis, myocarditis, endocarditis, and coronary artery disease, and blood related problems can include leukopenia, anemia, neutropenia, thrombocytopenia, and thrombosis (Lupus Foundation of America, 2012). In the circulatory system, capillaries can become inflamed; the lungs and pulmonary system are at risk for pleuritis, pneumonitis, and pulmonary emboli (Lupus Foundation of America, 2012). In the gastrointestinal system, gastroesophageal reflux disease, ulcerative colitis, crohn’s disease, peritonitis, ascites, and liver problems have been attributed to lupus (Lupus Foundation of America, 2012). The description “lupus arthritis” describes the specific constellation of joint-related symptoms associated with the disease, including swelling, stiffness, tenderness and warmth, as well as a tendency for symptoms to be worse in the morning and to improve throughout the day (Lupus Foundation of America, 2012). Skin symptoms are extremely common, and are seen in two-thirds of lupus patients (Lupus Foundation of America, 2012). “Lupus” is a very general umbrella term that describes a whole host of disease types. Beneath that umbrella, there are four subcategories of the disease: systemic lupus erythematosus, cutaneous lupus, drug-induced lupus, and neonatal lupus (Lupus Foundation of America, 2012). Systemic lupus erythematosus is the disease that most people are referring to when they say “lupus” (Lupus Foundation of America, 2012). This form of the disease ranges in severity and in the body systems it affects (Lupus Foundation of America, 2012). Some possible manifestations of systemic lupus erythematosus include nephritis, pulmonary hypotension, and coronary artery disease (Lupus Foundation of America, 2012). In cutaneous lupus the disease affects the skin (Zandman-Goddard et al., 2012). Cutaneous lupus is the second most common manifestation of the disease, causing skin lesions and photosensitivity (Zandman-Goddard et al., 2012). Hair loss and changes in the skin’s pigmentation also occur in cutaneous lupus (Lupus Foundation of America, 2012). Cutaneous lupus comes in several forms, including discoid lupus, in which lesions are round and disc-shaped (Lupus Foundation of America, 2012). Another form is subacute cutaneous lupus, in which red, scaly, ring-shaped lesions are seen (Lupus Foundation of America, 2012). Finally, acute cutaneous lupus is the skin condition evident during a flare up of lupus (Lupus Foundation of America, 2012). As its name implies, this form of the disease is limited to skin effects, but 10% of cutaneous lupus sufferers will eventually develop systemic lupus erythematosus (Lupus Foundation of America, 2012). In drug-induced lupus, the disease symptoms surface while taking a certain medication and remit once the medication is stopped (Zandman-Goddard, 2012). This form of lupus appears mostly in the older population and develops after prolonged use of a medication (Zandman-Goddard, 2012). Drug-induced lupus is diagnosed under the circumstance that no prior lupus symptomatology was evident and that symptoms remit with the stopping of the medication (Zandman-Goddard, 2012). The more than eighty drugs that are identified as having lupus inducing qualities include some drugs for hypertension and arrhythmia, antipsychotics, anticonvulsants, diuretics, statins, biologics, and drugs to treat infection, thyroid disease, and inflammatory conditions (Zandman-Goddard, 2012). Not everyone who takes these medications will develop drug-induced lupus (Lupus Foundation of America, 2012). Finally, neonatal lupus is a relatively rare form of the disease (Lupus Foundation of America, 2012). In this case, a mother who has lupus transmits the disease to her fetus during pregnancy (Lupus Foundation of America, 2012). Symptoms of neonatal lupus include a skin rash, liver abnormalities, and low blood cell count (Lupus Foundation of America, 2012). Fortunately, the at-risk fetus can be identified by a physician and can be treated at birth or even before (Lupus Foundation of America, 2012). Additionally, some infants completely clear the disease within months of birth and no longer show any symptoms at all (Lupus Foundation of America, 2012). The goal of lupus treatment is to decrease symptoms and increase the patient’s quality of life, functioning, and duration of time between flare-ups. To treat the inflammation that is commonly a feature of lupus, nonsteroidal anti-inflammatory drugs are commonly prescribed (Lupus Foundation of America, 2012). Aspirin and acetaminophen can also be helpful (Lupus Foundation of America, 2012). Corticosteroid drugs are commonly prescribed to lessen the body’s immune response and provide relief from joint swelling and other inflammatory features of the disease (Lupus Foundation of America, 2012). These drugs can reduce the patient’s discomfort during a flare-up and may also be used between flare-ups as a preventative measure (Lupus Foundation of America, 2012). Antimalarial drugs are used in lupus to decrease the body’s production of autoantibodies (Lupus Foundation of America, 2012). Whereas corticosteroids and nonsteroidal anti-inflammatory drugs can have immediate effects, antimalarials can take months before an improvement of symptoms is achieved (Lupus Foundation of America, 2012). Rashes, oral ulcers, and joint pain are lupus symptoms that can be treated using antimalarials (Lupus Foundation of America, 2012). Autoimmune suppressors such as methotrexate can also be prescribed for symptoms related to inflammation and excess autoimmune activity (Lupus Foundation of America, 2012). Depending on the individual patient’s constellation of symptoms, a staggering variety of medications may be required to treat symptoms and prevent flare-ups. Occasionally, physicians will also have to treat symptoms that are exacerbated by medication use, including conditions such as osteoporosis (Lupus Foundation of America, 2012). Understanding lupus, its symptoms, its treatment, and how a patient might present with this disease is crucial for nurses. This disease is common enough that any nurse could care for a patient with lupus, either during a flare-up or during a lesser phase of symptomatology. These factors make lupus a very important topic for this course, as all students should gain a thorough awareness of the diseases that may be encountered during a professional career. Especially in the case of lupus, which is so complicated and has such a wide variety of possible symptoms, the student must take extra care to examine the characteristics of the disease. Furthermore, grasping the implications of the medications used for treating the disease is also crucial for the nurse, since so many side effects and complications could surface. What I gained from undertaking this study was a vast appreciation for the complexity of lupus. It seems to be a very frustrating and unpredictable disease for its sufferers, and seems like it would be just as frustrating to the physicians who encounter patients with lupus. In studying its symptoms, I continually thought how easily the disease could be misdiagnosed and the symptoms attributed to some other disorder. I learned that lupus most commonly presents in a certain age group and ethnicity of women, but that it could really appear in anyone, and – in the case of drug induced lupus – can even go away. It can affect several or only one of the body’s systems, and can range in severity from mild discomfort to extreme impairment. It seems that this disease is as unique as the individual in which it surfaces. Clearly, lupus is a disease that causes distress and discomfort. However, with proper medical attention and medications, symptoms can be controlled, quality of life increased, and flare-ups can be prevented. WORD COUNT 1870 References Bernknopf, A., Rowley, K., & Bailey, T. (2011). A review of systemic lupus erythematosus and current treatment options. Formulary, 46(5), 178–194. Livingston, B., Bonner, A., & Pope, J. (2011). Differences in clinical manifestations between childhood-onset lupus and adult-onset lupus: a meta-analysis. Lupus, 20(13), 1345–1355. Lupus Foundation of America. (2012). Lupus. Retrieved 10 July 2012 from http://www.lupus.org/newsite/index.html. Zandman-Goddard, G., Solomon, M., Rosman, Z., Peeva, E., & Shoenfeld, Y. (2012). Environment and lupus-related diseases. Lupus, 21(3), 241–250. Read More