• Autoimmune disease that affects several body systems
• Characterized by unpredictable exacerbations and remissions
• Possible genetic link, but not totally proven
• For sure affects the connective tissue of affected person
• Hormone levels affect exacerbations

Discoid Lupus

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• Round, scaly, coinlike rashes
• Appears similar to ringworm

Subacute Lupus

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• Usually occurs on sun-exposed regions
• More exacerbations occur in the spring and summer due to increase in sunlight

Drug-Induced Lupus

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• Caused by long-term use of certain drugs
• Dilantin, hydralazine

Neonatal Lupus

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• Passed from a mother to her fetus
• Higher chance of exacerbation with higher estrogen levels in the mother

• Early: similar symptoms to RA, joint issues due to connective tissue disorder, achy pain, facial hair loss, joint inflammation
• Late: lupus nephritis, autoimmune, systemic, fever, weight loss, malaise, "butterfly rash" (across cheeks and nose), photosensitivity

• Lupus nephritis: monitor BUN and creatinine consistently, no cure, leads to renal failure
• Anemia, leukopenia, thrombocytopenia
• Cardiac and respiratory involvement in severe death, most causes of death
• High infection risk
• Pregnancy: increased exacerbations due to hormones
• Neurological symptoms: usually occur within one year of diagnosis, personality changes, mood swings, memory issues

• Labs: ANA increase (antinuclear antibody, check first), anti-Smith antibody (specific to lupus), CBC (anemia, kidney function, ESR, BUN, creatinine)
• Kidney biopsy: controversial due to compromised immune system of lupus patients, unnecessary unless we are unsure of the extent of kidney damage

• Short term: reduce inflammation (first), control symptoms, prevent complications, steroid use, treat arthritic pain
• Long term: focus on self-image issues

• Anything that will decrease inflammation; NSAIDS or steroids, both increase risk for infection, usually used to wean into other medications
• Anti-malarials: improve muscle and joint pain, plaquenil, high risk of retinopathy
• Immunosuppressants: methotrexate, benlysta
• IVIC, biologics
• Anticoagulants

• Assess signs and symptoms: monitor/trend vitals, monitor for complications, similar to a chemo patient

Education: stay out of sun, steer clear of exacerbating factors, pregnancy risks, adequate sleep