Systemic Lupus Erythematosus in

children

Objectives

• Student will be able to define Lupus

• Student will be able list at least 3 clinical manifestation of Lupus

• Student should be able to explain the diagnostic criteria for lupus

• Student should know the Nurse Practitioner role in care for a Lupus patient

What is Lupus

• It is a autoimmune disease (Sato et al., 2012).

• It affects multiple organs or systems in the body.

• Lupus is a chronic disease that has periods of remission and flare up (Hay, Levin, Deterding, Abzug, & Sondheimer, 2012).

• It also has signs and symptoms similar to other disease processes, which can cause a delay in diagnosis (Manson & Rahman, 2009).

Epidemiology

• The incidence of Lupus is 20 to 70 per 100,000 persons (Ferri, 2012).

• Systemic Lupus Erythematosus is common in girls between the ages of 9 and 15 years old (Sato et al., 2012).

• It is more common in African American than other ethnic group (Manson & Rahman, 2009)

Diagnosis

Four out of the eleven criteria must be present in order to diagnose Lupus.

1. Malar rash commonly called the butterfly rash present on the cheeks of patients (Ferri, 2012).

2. Discoid rash is an annular, scaly rash on the face, extremities, and scalp, which may lead to scaring (Manson & Rahman, 2009).

Diagnosis

3. Photosensitivity

4. Mucous membrane ulcers found on hard palate and nasal septum (Ferri, 2012).

5. Arthritis

6. Serositis includes pleuritis and pericarditis –complains of SOB and chest pain (Arnaud, Alexis, Boddaert, & Amoura, 2012)

Diagnosis

7. Renal Disorder- proteinuria greater than 0.5mg/dl (Manson & Rahman, 2009).

8.Neurological disorder such as seizure and psychosis

9. Hemolytic disorders, such as hemolytic anemia, leucopenia, and thrombocytopenia, (Manson & Rahman, 2009).

10. Positive ANA

11. Immunologic disorder –anti-DNA or anti-Sm or positive antiphospholipid antibodies (Concannon, Rudge, Yan, & Reed, 2013)

Lab

• CBC

• PT/PTT

• BMP

• ANA-Antinuclear antibodies

• dsDNA; anti-Smith antibodies

Treatment

• Lupus is treated based on the organ or system that is affected.

• Immunosuppressive drugs are used as steroid sparing drugs such as Methotrexate to decrease the severity of the disease (Bernknopf, Rowley, & Bailey, 2011).

• Nonsteroidal anti-inflammatory drugs –Joint pain

• Topical or intradermal cortcostroids – skin rashes

Treatment

• Renal- dialysis, Kidney transplant, Cyclophosphamide combined with corticosteroid (Daleboudt, Berger, Broadbent, & Kaptein, 2011).

• Rituximab and intravenous immunoglobin- sever leucopenia, autoimmune hemolytic anemia, and autoimmune thrombocytopenia (Bernknopf, Rowley, & Bailey, 2011).

• Neurological seizure and psychosis- anticonvulsants and antopsychotis

NP Role

• The NP role is to manage the care of lupus patient. Identify the problem through lab work and refer patients to appropriate specialist.

Refer to-rheumatologist, hematologist, nephrologist, cardiologist and dermatologist

• Nurse practitioners can manage care in patients with Lupus by educating patients about the disease process

Reference

Arnaud, L., Alexis, A., Boddaert, J., & Amoura, Z. (2012). Late-Onset Systemic Lupus Erythematosus Epidemiology, Diagnosis and Treatment. Journal of Advance medicine, 29(3), 181-189.

Bernknopf, A., Rowley, K., & Bailey, T. (2011). A review of systemic lupus erythematosus and current treatment option. Formulary Journal, 46.

Concannon, A., Rudge, S., Yan, J., & Reed, P. (2013). The incidence, diagnostic clinical manifestations and severity of juvenile systemic lupus erythematosus in New Zealand Maori and Pacific Island children: The Starship experience (2000_-2010). Lupus, 22(11), 1156-61.

ReferenceDaleboudt, G., Berger, S., Broadbent, E., & Kaptein, A.

(2011). Health-related quality of life in patients with systemic lupus erythematosus and proliferative lupus nephritis. Psychology, Health & Medicine, 16(4), 393-404.

Ferri, F. F. (2012). Ferri's clinical advisor 2013: 5 books in 1. St. Louis, Mo: Elsevier Mosby.

Hay, W., Levin, M., Deterding, R., Abzug, M., & Sondheimer, J. (2012). Current diagnosis and treatment (21st ed.). NY, New york: McGrae Hill.

Manson, J. J., & Rahman, A. (2009). Systemic lupus erythematosus. Orphanet Journal of Rare Disease, 1(6).

Reference

Sato, V., Marques, I., Goldenstein, P., Carmo, L., Jorge, L., Titan, S., Barros, R., & Woronik, V. (2012). Lupus nephritis is more severe in children and adolescents than in older adults. Lupus, 21.