Pathophysiology of Systemic Lupus Erythematosus

Pathophysiology of general Lupus Erythematosus demonstrationThis essay go out explore the pathophysiology relating to a call I attended while on per make up placement as a student technician. The initial call details were that it was a 45 yr old pistillate in pain. On our arrival the diligent was sat in a conduce and was breathing rapidly and had a rattling flushed face. After introducing ourselves and gaining the patient roles consent we then proceeded to take her staple fibre observations and take her fib. to the highest degree of her observations were within acceptable limits except her telephone line pressure was slightly high, she had a brocaded pulse at 120 beats per minute and slightly high temperature at 38 degrees Celsius. On questioning the patient had a localised pain score of 8/10 in her cover version and a pains in her joints and muscles with a pain score of 4/10. When questioned ab proscribed her medical history, she stated she had a condition called ge neral lupus erythematosus. This is not a condition I had heard of before I, therefore, questioned her much about it.Differential DiagnosisA 20 year-old women patient presented with fatigue, heart palpitations and anxiety. Reviewing the patients history revealed that she started experiencing anxiety, fatigue and heart palpitations approximately two years ago when she was still pregnant and she arranged to anticipate her own doctor. At that time her doctor stated that this was was receivable to stress. merely, her symptoms became worse after she had another child. She stated that before going into labour she experienced premature contractions, headaches, increased fatigue, and swelling of her legs. Her doctor advised her to lodge off work and hand over some bed rest. Shortly after giving birth to her troika child, the patient began experiencing several new symptoms. Her knees and ankles started swelling, she similarly developed sever pain in her knees, wrists, elbows, and fin gers. During the winter the patient started feeling painful and her peripheral joints became discolored whenever exposed to cold. She had recently been admitted to hospital in range for tests to be carried out and although she was still waiting for a definative outcome, a rhueamatology consultant she was under stated he was fairly authoritative that she had stemic lupus erythematosus.EpidemiologyAccording to several(prenominal)rs et al (2007) approximately five people in every ten thousand keep from general lupus erythematosus. Ninety percent of patients who are diagnosed with ashesic lupus erythematosus are female (GinzlerTayar 2012 Blank et al 2009). It nigh greenly develops in women aged between 20 and 40 although anyone of any gender and age thunder mug develop it at any time. With regards to ethnic origin systemic lupus erythematosus is more(prenominal) prevalent in those with Afro-caribean, Asian or Chinese ancestry. Although there is a possibility of having a geneti c pre-disposition to the disease only 3 of 100 children of those diagnosed with systemic lupus erythematosus go out go on to develop it. According to National Health and sustenance Examination Survey (2004) a survey in which it was observed that 100% of patients with System lupus erythematosus were receiving intercession.AetiologyAlthough there is no definate generate of systemic lupus erythematosus (Giannouli 2006), there is thought to be several factors increasing the likelihood of ontogenesis systemic lupus erythematous they include Genetics where members of the family have lupus this condition will often increase the childs chances of create it (Hemminki 2009). It is also thought it endorse also be triggered by environmental factors such as trauma, invisible rays and also emotional stress. Gender and hormones is thought to be the biggest factor affecting the chances of underdeveloped systemic lupus erythematous as it is proven that it closelyly affects women than men e specially when they are in menstrual periods or in their pregnancy, it is said to occur nine times more to women in comparison to men (GinzlerTayar 2012).PathophysiologySystem lupus erythematosus is an autoresistant disease. The auto repellent system is responsible for fighting foreign and often harmful bacteria in the homophile system. However with systemic lupus erythematosus the immune system will attack itself, the pathology of this disease is similar to that of rheumatoid arthritis and tooshie affect any get going of the body (GinzlerTayar 2012). Systemic lupus erythematosus whitethorn also occur in the form of periarticular innervation that affects the tendon sheaths, the illness causes the patient to experience coexisting fibromyalgia that takes to poor sleep, chronic disease, inactivity ,mood problems and clinical depression (Knott 2012).Patients who suffer from this condition have abnormalities when it comes to their immune system, this includes the B kiosk function, apoptosis and also the T cell function. Systemic lupus erythematous mostly attacks the blood vessels, the clamber, the heart, nervous system, liver, lungs and the kidneys (Knott 2012). Unfortunately when System lupus erythematous persists without rough-and-ready treatment it may result in serious complications such as stroke, heart inflammation, lung damage, blood clots and if the patient is female it may result in miscarriage or pregnancy complications. interrogation shows that the exact cause of immune deregulation is not yet clear but it may be as a result of interference of endogenous metabolism that affects the function of antigens in the human system (GinzlerTayar 2012).The abnormalities ca apply by System lupus erythematosus may vary from one ethnic group to another for instance East Asians who have this problem they have extra cytotoxic T lymphocyte antigen-4 while the white populations abnormalities is observed through having more Fc-Y receptors (Hemminki 2009) . For e ffective diagnosis of System lupus erythematosus it is of essence to deal with specific autoantibodies in order to treat the root cause of the disease (GinzlerTayar 2012).The symptoms of systemic lupus erythematosus will vary from patient to patient as the signs and symptoms displayed will depend on the body part or system that is being affected by the systemic lupus erythematosus (Arthritis Research UK 2014). However there are some generalised symptoms and these are about to be discussed.Dermatological symptoms caused by systemic lupus erythematosus could include rashes and in some cases a specific rash to the cheeks known as a fleet rash whoremaster be identified (Knott 2012). Another common issue for the majority of people with systemic lupus erythematosus find that they become much more sensitive to sunlight. It is also common for the blood vessels under the sputter in the joints to become inflamed and this can hire to poor circulation to these areas (this is called Raynaud s phenomenon)(GinzlerTayar 2012). Oral ulceration can sometimes occur for this very reason.Blood disorders have been known to develop especially in children, the most common being anaemia. Having anaemia would obviously cause lethargy and low mood (Giannouli 2006).Patients with systemic lupus erythematosus are much more at risk of developing cardiac issues than the general public as the disease often causes inflammation of the blood vessels within the heart, thus increasing the risk of developing atherosclerosis which in turn could lead to a myocardial infarction if one of the blood vessels was to become blocked(Blank et al 2009).If the kidneys were to become inflamed due to the systemic lupus erythematosus, this could cause symptoms including haematuria (blood in the urine). Also, if the kidneys become inflamed this could lead to the patient developing a kidney infection which will result in the patient having moderate to severe back pain (GinzlerTayar 2012).The most common issue f or patients suffering from systemic lupus erythematosus is to do with their joints (Somers et al 2007). Most people suffering from systemic lupus erythematosus will develop pain in their muscles, joints and peripheral joints such as joints in their hands and knees can often become inflamed. This can be due to a condition known as Osteonecrosis developing due to the systemic lupus erythematosus (Giannouli 2006). Osteonecrosis is a condition that develops when there is a reduced blood supply to the bones. Osteonecrosis will affect the bones ability to replace old bone with new bone and if an injury is prolong it may never be able to heal properly (Knott 2012).Most patients find that it is worse when they vex up in the morning and as this is a chronic condition, it can often feel breach in periods of remission and more painful during a relapse period (GinzlerTayar 2012).DiagnosisThe process involves the blood tests including antibody tests, urinalysis and a chest X-ray which is most ly overseen by Rheumatology Consultants whose area of specialisation is autoimmune diseases and also soft tissue treatment. Musculoskeletal symptoms are analysed when trying to diagnose System lupus erythematous and it can be manifested as arthritis or arthralgia in which the patient expresses it as stiffness and pain, when it occurs in System lupus erythematous it can be in the form of migratory or transient pain and it is difficult to be diagnosed since it may be present when the patient makes the appointment with a doctor only to be resolved in the process of evaluation(Ginzler Tayar 2012 and Knott 2012). Systemic lupus erythematosus caused fewer erosions or fixed deformities unlike rheumatoid arthritis which is much more degernerative to the joints (GinzlerTayar 2012). on that point is also the possibility of around 4% of the patients will suffer from myositis ( which is the inflamation of the muscle tissue) and this can be examined by taking a biopsy of muscle tissue (Giannou li 2006).Pharmacology and associated treatmentUnfortunately there is no heal for Systemic lupus erythematosus and the treatment plan is based on symptom fill-in as opposed to unionise treatment of the disease(GinzlerTayar 2012, Blank et al 2007, Knott 2012). Treatment of Systemic lupus erythematosus is very specific to the individual patient and it eer depends in manifestation of the symptoms, the disease severity and most centrally the specific organ affected(Giannouli 2006). In order to devise the most appropriate treatment plan the rheumatology consultant will perform a hail of diagnostic tests and depending on what the results are will influence the treatment plan (Giannouli 2006).Patients suffering from systemic lupus erythematosus will often need to take a group of medications called non-steroidal anti inflammatory doses (Knott 2012). This group of medications work by reducing the inflammation in the affected joints and hopefully reducing the amount of pain the patient i s in. Some common non-steroidal anti inflammatory drugs are ibuprofen, aspirin and diclofenac sodium (these are all available without a prescription from a pharmacy), the rheumatology consultant may recommend Naproxen or pirixicam in certain percentage (BNF 2014). With non-steroidal anti inflammatory drugs there is a risk that they may cause damage to the lining of the stomach and could even cause ulceration in the stomach when taken over long periods of time in high doses(Knott 2012).If the patient is taking frequent non-steroidal anti inflammatory drugs they may be prescribed a proton pump inhibitor medication in order to protect the stomach. These medications work by reducing the amount of panelling the stomach produced and thus protecting the lining of the stomach (Knott 2012). Common proton pump inhibitor medications include omperazole, lansoprazole, pantoprazole and esomeprazole (BNF 2014).A merely treratment that a rheumatology consultant may con caser is the use of a medi cation called hydroxychloroquine (Giannouli 2006). Hydroxychloroquine was primarily an anti-malarial drug however it has recently started being used to treat the symptoms of systemic lupus erythematosus and is a disease modifying anti-rheumatic drug (also known as DMARD)(Knott 2012). Hydroxychloroquine works by reducing the response from the immune system which is make the symptoms (this is probably the closest treatment to treating the cause as opposed to just the symptoms). It is used as a long term treatment to try and prevent relapses or break through ups of the disease (GinzlerTayar 2012).Corticosteroids may be used in severe systemic lupus erythematosus (GinzlerTayar 2012). They may be prescribed during relapses of the disease. Corticosteroids work by block off the normal function of the white blood cells and reducing the inflammation response(Knott 2012). However the negative aspect of this is that it leaves patients very vulnerable to infections(GinzlerTayar 2012). Other side effect could include the patients bones nice more fragile, the skin becoming thinner, hypertension and also weight gain. For this reason corticosteroids will only be used to treat flare ups at the minimum effective dose and then reduce the dose slowly as the symptoms ease. Corticosteroids used in the treatment of this disease are hydrocortisone and predniselone(BNF 2014).Often used in conjunction with corticosteroids during a relapse are a group of medications called immunosuppressants . These medications will work by reducing the action of the immune system and will be used when the immune system is attacking a healthy part of the patients body(Knott 2012). Again these medications will reduce the pateints ability to fight harmful infections and can cause many another(prenominal) side effects. Immunosuppresent medications used include azathioprine, mycophenolate mofetil and cyclophosphamide (BNF 2014).The final medication to be discussed is called Rituximab. Rituximab was or iginally created to treat blood cancer however an off-label use for this medication is to treat autoimmune diseases. The way Rituximab works is by destroying the B-Cells(The B-Cells which cause the release of antibodies resulting in the symptoms). As with all the other medications there could be side effects the most common being dizziness and vomiting. Rituximab can only be administered intravenoulsy so will normally require hospital entre for the patient to receive it .(Knott 2012)Other interventions include an advice session from the doctor regarding the patients lifestyle and diet may be of vital importance this may help the patient and minimise lifestyle related stress (GinzlerTayar 2012) . The patient may be suggested to work with a support group or even receive counselor as the condition can cause severe and life limiting symptoms while in relapse. Most patients with systemic lupus erythematosus are also advised to avoid the sun as it can aggravate and skin symptoms(Knott 2 012).ConclusionSystemic Lupus Erythematosus is a very complex disease and can present itself in many different ways depending on the patient and the part of the body affected. In the pre-hospital environment it is very important to get a detailed history in order to identify whether they have been diagnosed with this disease. Clinicians must record systemic lupus ertythematosus can limit a patients quality off life while they are having a relapse so it is important to assess each patients individual symptoms and if necessary administer pain relief and position them so they are comfortable. It is also important for ambulance clinicians to be mindful of the patients joints when using moving and handling techniques as this could obviously cause the patient discomfort or even pain due to the condition.ReferencesArthritus Research UK. (2014). Systemic Lupus Erythematosus. Available http//www.arthritisresearchuk.org/arthritis-information/drugs/hydroxychloroquine/what-it-is.aspx. Last ac cessed 20/03/2014.Blank M, Shoenfeld Y, Perl A. 2009. Cross-talk of the environment with the host genome and the immune system through endogenous retroviruses in systemic lupus erythematosus. Lupus. Nov18 (13)1136-43Giannouli, S (2006) Annals of rheumatic disease, Anaemia in systemic lupus erythematosus from pathophysiology to clinical diagnosis. 65(2) p144-148Ginzler E, Tayar J. 2012. Systemic lupus erythematosus (lupus). Updated January 2012. Available at http//www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/lupus.pdfsearch=sle. Accessed on February 21, 2014 at 2130Hemminki K, Li X, Sundquist J, Sundquist K (February 2009). Familial associations of rheumatoid arthritis with autoimmune diseases and related conditions. Arthritis Rheumatology. 60 (3) 6618Knott, L. (2012). Systemic Lupus Erythematosus. Available http//www.patient.co.uk/health/systemic-lupus-erythematosus. Last accessed 20/03/2014.Somers E, Thomas L, Smeeth L .2007. Incidence of systemic lupus e rythematosus in the fall in Kingdom, Arthritus Rheum 1557(4) p612 p618.