Case Study 76 Systemic Lupus Erythematosus

Case Study 76 Systemic Lupus Erythematosus solved 1. What is the relevance of this information to her disease? Her age currently is 47, she had been diagnosed 18 years ago with SLE. This would put her at 19 years of age at diagnosis which is typical falling in between 15-45 years. Females are at a greater risk for SLE, 85%-90% of SLE patients are women. The occasional Naproxen and antacid use are normal. Naproxen can be used and effective for minor joint pain. Joint pain is a common manifestation of SLE. 2. What is the significance of the patient’s family history? The family history of rheumatoid arthritis, pernicious anemia, and graves disease is relevant because each of these are autoimmune diseases. Autoimmune diseases are found to run in families and have a genetic component that increases risks to develop these diseases. 3. Is this patient underweight, overweight, obese, or is this patient’s weight considered healthy and normal? The patient is currently underweight at 102lbs with a BMI of 17. A BMI of less than 18.5 is considered underweight. This is a change since her last exam 1 year prior where her weight was 125lbs with a normal BMI of 20.8. Decreased appetite and weight loss are clinical manifestations of SLE. 4. Explain the pathophysiology that underlies hair loss in this patient and the relevance of the abnormal ESR. The helper T cells or suppressor T cell function causes B lymphocytes to create antibodies against its own tissues. These autoantibodies bind with antigens creating immune complexes. Inflammation occurs when the immune complexes are trapped in body tissues, triggering the inflammation process the body uses to try to remove the immune complexes. Inflammation causes damage to the follicular openings in the scalp causing hair loss. There are many different types of hair loss in SLE, some are reversible, but others are permanent. Her ESR level of 25mm/hr was elevated out of the normal range of 0-20mm/hr for women under the age of 50. This does not diagnose SLE, but it does tell that there is an inflammation reaction going on. 5. What might have caused the lack of energy in this patient, and what type of tests might be ordered to support this conclusion? Fatigue in SLE may be caused by multiple factors including depression, anemia, pericarditis, decreased physical activity, infection, and fever. Tests that are done to help narrow down a SLE diagnosis related to fatigue would be CBC to asses for anemia, ESR for inflammation, WBC assess for infections, and interview related to activity, pain, and mood. 6. Why is Prednisone effective in relieving vasculitis? Prednisone reduces inflammation and the normal immune response in the body. This would relieve the signs and symptoms caused by vasculitis. 7. What can be said about the patient’s Hct, RBC count, WBC count, and Plt count? The Hct is 23% this is below the 37%-47% range, RBC is 3.5 million/mm3 this is slightly below the normal range of 3.61-5.11 million/mm3, the WBC and Plt counts were with in normal range. The destruction of cells such as WBC, RBC, and platelets is caused when the immune complexes form on their cell’s surfaces causing cell lysis. 8. What is most likely the cause of jaundice in this patient?