Systemic Lupus Erythematosus

Description: Systemic lupus erythematosus (SLE) is an autoimmune disorder where the immune
system attacks and destroys healthy body tissues. Ehrenstein and Isenberg state that the most
common symptoms of lupus include extreme fatigue, kidney problems, painful or swollen joints
and skin rashes). Symptoms the patient will experience are likely to vary and may be mild or
severe. These symptoms can come and go over time and new symptoms can continue to occur
for several years after the initial diagnosis. Along with these symptoms, SLE is accompanied
with depression, (Schattner, Shahar, Lerman, & Shakra, 2010). Some individuals may have
multiple organ systems involved, while others only have one system of the body involved, (as
cited in Ferenkeh-Koroma, 2012). Isenberg and Rahman explain that patients with SLE often
experience random flare-ups that can be activated from sunlight, stress and pregnancy, (as cited
in Ferenkeh-Koroma, 2012). Signs of a flare-up may include malaise, intense fatigue, increasing
alopecia, pyrexia, arthralgias, hematuria, dyspnea and unexplained skin rash. (Ferenkeh-Koroma,
2012).
Diagnostic Criteria: A person that has systemic lupus erythematosus will undergo multiple
blood test to determine hematological involvement, complement C3 and complement C4,
antinuclear antibody, anti-double stranded-deoxyribonucleic acid (DNA) and anti-Smith
antibodies. Anti-double stranded-DNA is a specific blood test; 40-70% of patients with lupus
have a positive anti-double stranded-DNA, compared to less than 0.5% of the healthy non-lupus
population (Rahman & Isenberg 2008).
Etiology and Prognosis: According to Ramos et al. the exact cause of Systemic Lupus
Erythematosus is unknown. The autoimmune disease usually has excessive B-cell activity and
abnormal T-cell function resulting in defects in programmed cell death, and atypical production
of regulatory proteins, (as cited in Robinson, Sheets Cook, & Currie, 2011). The outcome of SLE
depends on which organ systems are impaired. The skin and musculoskeletal systems have the
best outcomes, and central nervous system (CNS) and renal disease having the worst outcomes.
Males who are diagnosed with SLE tend to have more severe symptoms, and a higher 1-year
death rate than females. Five-year survival has increased from 40% in the 1950s to greater than
90% in the 21st century, (Robinson, Sheets Cook, & Currie, 2011).
Epidemiology: Johnson et al state that ELS affects approximately 40 out of every 100,000
northern Europeans, more than 200 out of every 100,000 black African and black Caribbean
people. Isenberg and Manzi claim that it also affects about 100 per 100,000 Asian people from
Bangladesh, India and Pakistan. ELS mostly affects women of child-bearing age (15-50 years). It
also affects woman about nine times as much a men (Pons-Estel et al 2010). In one study in
Birmingham, the prevalence of lupus in women aged 18-65 years was estimated at between 54
per 100,000 and 200 per 100,000 individuals (Ferenkeh-Koroma, 2012).
OT Treatment: Occupational therapy practitioners would not be able to do anything to help heal
the disease. However, a person affected with systemic lupus erythematosus would attend
occupational therapy to help suppress the symptoms that come with the disease. OT practitioners

would be able to teach the client energy conservation techniques like sitting on a shower chair
while taking a shower, dress while sitting in a chair, and use a cart to carry necessary items. Work
simplification techniques like taking breaks when beginning to feel tired, do tasks in order from
hardest to easiest, and plan tasks ahead. Both energy conservation and work simplification will
help reduce fatigue. For the swollen and painful joints, OTs can provide range of motion
exercises for larger joints, and for smaller joints, like wrist and finger joints, they can provide
splints and adaptive equipment for eating like built up utensils, writing like pencil grips, and
other ADL activities. People that have SLE and also have depression can go to group therapy and
one on one therapy to work on coping strategies. When they are at therapy, the OT can work with
the client on coping skills to help focus on what is going good in their life.

Works Cited
Ferenkeh-Koroma, A. (2012). Systemic lupus erythematosus: Nurse and patient education. Nursing
Standard, 26(39), 49-57.
Rahman, A., & Isenberg, D. A. (2008). Systemic lupus erythematosus. N Engl J Med, 358(9), 929939. doi:10.1056/NEJMra071297
Robinson, M., Sheets Cook, S., & Currie, L. M. (2011). Systemic lupus erythematosus: A genetic
review for advanced practice nurses. Journal Of The American Academy Of Nurse
Practitioners, 23(12), 629-637. doi:10.1111/j.1745-7599.2011.00675.x
Schattner, E., Shahar, G., Lerman, S., & Shakra, M. A. (2010). Depression in systemic lupus
erythematosus: The key role of illness intrusiveness and concealment of symptoms.
Psychiatry, 73(4), 329-40. doi:http://dx.doi.org/10.1521/psyc.2010.73.4.329