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Immune System Disorder- Systemic Lupus Erythematosus (SLE)

Immune System Disorder- Systemic Lupus Erythematosus (SLE)

The Pathophysiology of Systemic Lupus Erythematosus (SLE)

Systemic lupus erythematosus (SLE) is a chronic and complex systemic autoimmune disorder with multiorgan involvement (Lever et al., 2020). Notably, lupus attacks the epithelial tissues on various parts of the body, such as the lungs, kidneys, and skin. The basic pathological characteristics of SLE include systemic, chronic inflammation of the various body parts leading to organ damage and failure and vassal abnormalities, majorly occlusive vasculopathy, and immune complexes (IC) deposition. SLE has a high variability across individuals and course of development due to genetic, gender, age, hormonal, exposure, and lifestyle differences (Lever et al., 2020). The innate immune system is largely involved in the pathophysiology of SLE.

The innate immune response is involved in systemic lupus erythematosus. This is because the innate immune response mechanisms are essential to the development of the body’s adaptative immune mechanisms during an SLE attack. The patient’s body loses its tolerance to itself as auto-responsive T and B cells are activated. Dendritic cells (DCs) are presumed to be responsible for the activation of these autoreactive T and B cells, as the DCs are critical in the development of adaptive immune mechanisms by activating the T and B cells. The activation of the autoreactive T and B cells leads to increased production and release of pathogenic autoantibodies. These antibodies attack self-proteins majorly in the cell nucleus, causing cell inflammation, tissue injury, and subsequent organ damage and failure. People with SLE tend to have various types of auto-antibodies in their bloodstream. The auto-antibody attacks on the self-protein are the main factor for the development of SLE.

Treatment for Systemic Lupus Erythematosus

The use of antimalarials, glucocorticoids (GC), and immunosuppressants (IS) has proved to be beneficial to patients as treatments for patients with SLE (Lever et al., 2020). However, the treatment for SLE should be individualized, taking into account the variability of the disease across different patients and how it influences SLE pathophysiology, the organs involved, the manifested symptoms, and the level of tissue injury incurred. According to the European Alliance of Associations for Rheumatology (EULAR) guidelines on the treatment of SLE, the focus of the treatment plan should be on remission, achieving a low auto-antibody activity, and preventing flares (Fanouriakis et al., 2019).

Hydroxychloroquine is recommended as the first-line treatment for SLE. Hydroxychloroquine can achieve substantial therapeutic outcomes in all patients with lupus; therefore, it can be used to address the disorder variability challenge in the management of lupus. The hydroxychloroquine dosage recommended should not exceed 5 mg/kg of the patient’s real body weight (Fanouriakis et al., 2019). Other medications and types of treatment, such as glucocorticoids, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and biologics, can be titrated for chronic maintenance in case of severe organ involvement. The recommended glucocorticoid dosage, majorly prednisone for chronic maintenance, should be maintained below 7.5 mg/day if needed but should be withdrawn based on symptoms (Fanouriakis et al., 2019). Other immunomodulators such as methotrexate, mycophenolate, and azathioprine can be initiated based on the need to replace glucocorticoids.

Interview Summary

The patient is a 32-year-old African-American woman diagnosed with systemic lupus erythematosus three years ago. She feels that she has had the disorder for approximately five years before she got diagnosed. The patient noted that she had related symptoms two years before her confirmatory diagnosis and had suffered for a while. In addition, the patient feels that being diagnosed with SLE has hurt her life at work and home. She feels that she is no longer the same. Due to the effects on her body organs, especially the skin mostly on her face, she has developed self-esteem issues, and she feels that she needs to remain indoors. She noted that she feels like she is a prisoner of medication as she needs to use medications to control the flares. She tries a lot to avoid her past life. The doctors told her that most of her lifestyle behaviors could act as triggers.

Although she can do most of her daily activities independently, she sometimes suffers from joint stiffness, pain, and fatigue and may experience episodes of confusion that make it difficult to carry out her daily activities independently. The patient notes that she usually uses hydroxychloroquine from time to time. However, sometimes she gets too fatigued and feels the pain is too much and may end up using prednisone as an alternative. She notes that either medication gives her various side effects. For instance, using hydroxychloroquine has, in some instances, given her some swelling on her face, lips, and hands, and she also noted that she had hive-like swelling around her feet and vagina. However, she experiences the most swelling on her feet and body when she uses prednisone continuously. She also noted that prednisone increased her blood pressure and gave her some prediabetic symptoms and mood swings. However, the patient notes she has not used any alternative therapies for the disorder. Nonetheless, she is open to trying any other alternatives as long as they help her manage and cure the condition.

References

Fanouriakis, A., Kostopoulou, M., Alunno, A., Aringer, M., Bajema, I., Boletis, J. N., Cervera, R., Doria, A., Gordon, C., Govoni, M., Houssiau, F., Jayne, D., Kouloumas, M., Kuhn, A., Larsen, J. L., Lerstrøm, K., Moroni, G., Mosca, M., Schneider, M., … Boumpas, D. T. (2019). 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Annals of the Rheumatic Diseases, 78(6), 736–745. https://doi.org/10.1136/ANNRHEUMDIS-2019-215089

Lever, E., Alves, M. R., & Isenberg, D. A. (2020). Towards Precision Medicine in Systemic Lupus Erythematosus. Pharmacogenomics and Personalized Medicine, 13, 39. https://doi.org/10.2147/PGPM.S205079

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Question 


Identify a person you know who has an immune disorder or cancer. Review the content in your text for potential types of disorders. Interview the affected person and write a 3-5 page paper.

Immune System Disorder- Systemic Lupus Erythematosus (SLE)

Immune System Disorder- Systemic Lupus Erythematosus (SLE)

Identify your findings, including Identifying the pathophysiology of the immune system disorder, discussing the treatment for the immune system disorder, and summarizing the findings of the Interview. Use at least one scholarly source to support your findings or Identify therapies that may be new or different from what the affected person may be using.

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