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Lupus Erythematosus - DEFINITION AND DESCRIPTON
Lupus means “wolf.”
Erythematosus means “redness.”
In 1851, doctors coined this name for
the disease because they thought the
facial rash that frequently accompanies
lupus looked like the bite of a wolf.
There are four categories of lupus:
systemic lupus erythematosus,
cutaneous lupus, drug-induced systemic
lupus erythematosus, and neonatal
lupus (see “Pregnancy” in Chapter
Four). Lupus: A Patient Care Guide for
Nurses and Other Health Professionals
is concerned primarily with systemic
lupus erythematosus.
Systemic lupus erythematosus (SLE,
or lupus) is a chronic, inflammatory,
multisystem disorder of the immune
system. In SLE, the body develops
antibodies that react against the
person’s own normal tissue. These
antibodies are markers for SLE, and are
one indicator of many immune system
abnormalities that lead to clinical
manifestations.
The course is unpredictable and
individualized; no two patients are alike.
Lupus is not contagious, infectious,
or malignant. It usually develops in
young women of childbearing years, but
many men and children also develop
lupus.
SLE also appears in the firstdegree
relatives of people with lupus
more often than it does in the general
population, which indicates a hereditary
component. However, most cases of SLE
occur sporadically, indicating that both
genetic and environmental factors play a
role in the development of the disease.
Lupus varies greatly in severity,
from mild cases requiring minimal
intervention to those in which significant
and potentially fatal damage occurs to
vital organs such as the lungs, heart,
kidneys, and brain. For some patients,
the disease can be characterized by
“flares” of activity interspersed with
periods of improvement or remission.
A flare, or exacerbation, is increased
activity of the disease process with an
increase in physical manifestations
and/or abnormal laboratory test values.
Periods of improvement may last weeks,
months, or even years. Other patients
have continuous, or chronic, activity.
Although remissions are unusual,
some patients never develop severe
manifestations, and the outlook is
improving for patients who do develop
them.
Cutaneous lupus, which affects
primarily the skin, is common among
patients with lupus erythematosus.
The most prevalent and severe form
of cutaneous lupus is called chronic
cutaneous lupus.
It is commonly
known as discoid lupus, but it has
other forms as well (see “Dermatologic
Manifestations” in Chapter 4).
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Drugs Implicated as Activators of Drug-Induced Lupus
Drugs with proven association
Drugs with possible association
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Drug-induced lupus erythematosus
develops after the use of certain drugs
or biologics and has symptoms similar
to those of SLE.
The characteristics of
this syndrome are pleuropericardial
inflammation, pleuritic chest pain,
pericarditis, fever, rash, and arthritis.
Serologic changes can occur.
The
clinical and serologic signs usually
subside gradually after the offending
drug is discontinued. A wide variety
of drugs is implicated in this form of
lupus (see box, above).
More recently,
the newer TNF (tumor necrosis factor)
inhibitors used to treat rheumatoid
arthritis, Crohn’s disease, and ankylosing
spondylitis have been associated with
the development of lupus symptoms.
As with lupus triggered by other drugs,
the symptoms resolve when the agent is
stopped.
Source: National Institutes of Health, U.S.Dept of Health and Human Services
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