What is systemic lupus erythematosus?
Systemic lupus erythematosus commonly known as lupus can be defined as an autoimmune disease, distinguished by severe and chronic inflammation of body tissues and organs that has a severe impact on an individual overall well-being.
The immune system is a system of multiplex elements and proportions that serves as a defense complex within the body to combat infectious organisms and microbes by producing antibodies. Autoimmune disorders are characterized when immune system forms attacks the body’s own tissues and organs. Patients presenting with systemic lupus erythematosus form autoantibodies, which are abnormal antibodies that target organs and tissues within their own body. The normal immune system complex and regulatory defense mechanisms malfunctions and contributes to the formation and progression of systemic lupus erythematosus. B cells become over-active as a result of excess T helper cells, suppression of abnormal B cells, immune tolerance decrease and a rise in antigenic load. Pathogenic autoantibodies are produced as a result, and the disease is ultimately triggered my external environmental elements.
Risk factors of systemic lupus erythematosus
Age-prevalence of lupus among age groups ranges from of 15 to 45 years old. People usually experience symptoms at an early stage, thus most often diagnoses made at a relatively young age, that are more susceptible to disease.
Family history- there is a strong genetics factor between first degree and second degree relatives that increases the likely hood systemic erythematosus.
Sex and hormones-despite the fact that most pregnant women diagnosed with systemic lupus erythematosus carry and deliver their babies safely, are still considered to be at high risk. In addition women usually experience more severe symptoms of systemic lupus erythematosus before the onset of their menstrual cycles. It has thus lead to the belief of health practitioners that the hormone estrogen plays a significant in the development of systemic lupus erythematosus.
Environmental-scientists believe that external factors such ultraviolet light ant viruses stimulate the immune system in people with lupus.
Signs ; symptoms(S;S)
The signs and symptoms that most people often experience and present with varies, characteristically they can be moderate or acute, short-term or long-term and may develop instantaneously or progress slowly.
Common S;S of lupus include
Joint pain(ATHRITIS), stiffness and swelling
Loss of appetite
facial rash(butter-fly shaped
loss of hair on scalp
photosensitive skin lesions(worsens in sunlight)
Raynaud’s phenomenon(poor blood circulation to toes and fingers)
Dry scratchy eyes
Migraines and short-term memory loss
Loss of breath
There are many other signs and symptoms that people present with but not as common as the above mentioned S&S.
FIGURE 2- signs and symptoms https://ghr.nlm.nih.gov/art/large/signs-and-symptoms-of-systemic-lupus-erythematosus.jpegEpidemiology
Between the years 2000 and 2006, a reviewed Medicaid claim discovered there were over 42 200 patients diagnosed with systemic lupus erythematosus, aged from 15 to 45. According to various researchers and studies, there is a drastic rise in the prevalence of lupus worldwide. There is a higher prevalence in women than male and the ratio currently stands at 4:3, however there is a predicted increase change of statistics to 16:6.https://www.sciencedirect.com/science/article/pii/S1521694202902597 date accessed 6/14/2018 time 11:34
Racial based diagnostic studies of lupus in the US claims that 40% of the population with documented lupus is black, 38% white, 15% Hispanic, 5% Asian, and 2% Native American.https://www.webmd.com/lupus/news/20150115/lupus-death-rates-vary-by-race-ethnicity-study-finds date accessed 6/14/2018 time 11:55
Impact of systemic lupus erythematosus on the foot and lower limbs
Systemic Lupus erythematosus already identified as an autoimmune disease that severely impacts the lifestyle of people, with its many associated manifestations of disorders. What troubles people the most is the impact systemic lupus erythematosus has on the feet and the lower limbs.
Lupus patients are usually subjected to foot and ankle edema which is a form of inflammation of the joints in the foot and ankle regions, as a result of the abnormal functioning of the kidneys which is a more severe and less common sign of lupus. The swelling causes the patient extreme pain, discomfort and a lack of mobility in the foot especially on wait bearing. The foot and ankle edema in a lupus foot is problematic when it comes to footwear; shoes are too small and tight as the feet are swollen.
Patients also develop various other common foot deformities such as; hallux valgus (bunion), nail disorders (such as hammer toes, onycholysis, splinter hemorrhages), hyperkeratosis (corns and callus), Achilles tendonitis.https://www.mass4d.com/blogs/clinicians-blog/how-systemic-lupus-erythematosus-affects-the-feet date accessed 6/16/2018 time 08:53
Figure 3- foot and ankle edema figure 4- splinter haemorrhage of toes
Raynaudes phenomenon of the toes commonly occurs as part of associated signs and symptoms of systemic lupus erythematosus which comprises an inviduals vascular system, as they are more vulnerable to cold weather conditions resulting in vessel vasospasm, can also be triggered by emotional stress. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4689071/ date accessed 6/18/2018 time 10:38. Other vascular problems that can occur are vasculitis(changes to the walls of blood vessels as a result of inflammation of the blood vessels (https://www.mayoclinic.org/diseases-conditions/vasculitis/symptoms-causes/syc-20363435)date accessed 6/18/2018 time 10:06 and atherosclerosis(deposition of lipids and fibrous causing subsequent narrowing of small and medium sized arteries) S.NUTLI. the blockages in blood circulation responsible for carrying oxygen to the foot and lower limbs can all lead up to more severe complications such as painful leg ischaemia, gangrene and possible amputation of the foot or lower limb depending on progression. https://www.mass4d.com/blogs/clinicians-blog/how-systemic-lupus-erythematosus-affects-the-feet date accessed 6/16/2018 time 10:36
Figure 5-Ranaudes phenomenon Figure 6-gangrene
https://www.medscape.com/viewarticle/719231_6 https://medtube.net/diabetology/medical- pictures/11017-dry-gangrene-left-lower-limb-in-diabetic-patient
Rheumatoid arthritis (RA) a characteristic autoimmune disorder associated with systemic lupus erythematosus, causing degeneration of bones, joints and tissue in the foot and lower limb. RA IS A severely painful and problematic condition, people with RA have difficulty walking due to the deformation of bone structures and joints, they are also subjected extreme pain upon wait bearing activities. Like foot and ankle edema, RA is usually accompanied by various other foot deformities such as; corns and callus, nail problems and ulcers. sntuli
Figure 7- https://www.healthline.com/health/rheumatoid-arthritis-pictures
Patients develop ulcers which are particularly challenging to treat as the wound healing process is reduced due to the autoimmune nature of lupus.
Diagnoses of systemic lupus erythematosusSystemic lupus erythematosus has been described by many healthcare practitioners as a disease that is almost undetectable because of its complexity, with various accompanying signs and symptoms, along with manifestations of other problematic disorders. The diagnosis of lupus is based on careful patient history taking, observations and investigation of present signs and symptoms and performing various clinical tests. The American College of Rheumatology has created a guide that is followed by many healthcare specialists in diagnosing systemic lupus erythematosus;
Mouth ulcers ( persistent for more than 1 month)
Rashes ( presence malar rash/butterfly rash on the face or discoid rash/raised round oval patches )
Arthritis ( swollen and discomforting joint pain persistent for a couple of weeks)
Kidney dysfunction( drainage of blood and proteins into urine)
Inflammation of organ tissues (pericarditis of the heart and pleuritis of the kidneys)
Neurological dysfunction ( stroke, epilepsy, seizures)
Atypical blood pressure test results (low white blood cell concentration, presence of antinuclear antibodies-/autoantibodies, mutated antibodies present such as anti-double stranded DNA or anti- phospholipids.
https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Lupus date accessed 6/18/2018 time 12:05
The treatment plan for systemic lupus erythematosus is broad due to its multifactorial nature of associated manifestations of various other disorders and complications. The choice of treatment is determined by the by disease manifestations and by its acuteness. Long term treatment options include hyrodroxychloroquine for all lupus patients as well as rheumatoid arthritis patients. Non-steroidal anti-inflammatory drugs (NSAIDS) or mild immunosuppressive drugs are used for underlying and more general disorders that are considered low risk manifestations such as musculoskeletal, cutaneous or inflammations. A short term course of corticosteroids are also prescribed by health professionals. Patients with more chronic manifestations such as nervous system dysfunction and kidney failure are put on a long term dose of corticosteroids and more high-potent immunosuppressive medication.
Treatment plan of lupus patients also includes management of symptoms to reduce some pain and discomfort experienced by the patient. Common foot deformities are taking care of by a podiatrist, as well prescription and manufacturing of orthotics or insoles patients suffering from structural foot problems especially on weight-bearing. Patient education is an important aspect of vascular problems and on other disorders to improve the wellbeing of patients. https://emedicine.medscape.com/article/332244-treatment date accessed 6/19/2018 time 10:04