Systemic Lupus Erythematosus (SLE) Case Study Analysis Report

This report presents a case study of a 25-year-old woman diagnosed with Systemic Lupus Erythematosus (SLE). The report analyzes the patient's laboratory findings, including positive ANA, anti-dsDNA, anti-Sm tests, elevated CRP and ESR, and decreased C3 and C4 complement levels, and their significance in diagnosing SLE. It details the initial treatment with hydroxychloroquine and prednisone, and the subsequent intervention with methylprednisolone and plasmapheresis. The report explains the rationale behind these treatments and the potential side effects of each, such as nephrotoxicity associated with cyclosporine and the benefits and risks of plasmapheresis. The report also highlights the priority areas in the patient's care plan and the role of UAP in assisting with personal hygiene. The report references key medical research papers to support the analysis.

Running head: Systemic Lupus Erythmatosis (SLE)
Systemic Lupus Erythmatosis (SLE)
Name of the student
Name of the university
Author’s name

Systemic Lupus Erythmatosis (SLE)
1. Laboratory results of D.W indicated a positive antinuclear antibody (ANA) titer, positive
anti-dsDNA test, positive anti-Sm test, elevated C-reactive protein (CRP) and C and
decreased C3 and C4 serum complement. Upon conducting X-ray of her joint, she was
found to have a joint swelling, however, no joint erosion was whatsoever observed. She
was later diagnosed with systemic lupus erythematosus (SLE). SLE is an autoimmune
disease. In this disease, the body’s immune system attacks the healthy tissue mistakenly
that affect joints, skin, brain, kidney and other organs. When SLE is suspected ANA test
or anti-dsDNA test is recommended (Sandhu & Quan, 2017). ANA refers to a group of
antibiotics that are produced by the body’s immune system provided it is unable to
distinguish “self” and “nonself”. Thus, ANA test helps in detecting the autoantibodies in
the blood. Presence of ANA in the blood indicates the condition of SLE. Thus, the patient
D.W. was found to have positive ANA titer which indicates that she was suffering from
SLE. Anti-Sm tests are recommended since Anti-Sm antibodies are sometimes present in
SLE and a positive Anti-Sm test indicates that the person is suffering from SLE. Anti-C-
reactive protein (CRP) antibody is considered to be a potential biomarker for SLE and
patents suffering from SLE have a higher level of CRP (Castro & Gourley, 2010). The
patient, in the case study had an increased Anti-C-reactive protein (CRP) antibody which
indicates her medical condition. Other tests like erythrocyte sedimentation rate (ESR),
determines whether there is an inflammation in any part of the body which is a
characteristic symptom of SLE. C3 and C4 serum complement are measured to monitor
lupus because lupus autoantibodies give the same signal and also activates component
(Tešija Kuna et al., 2016).

Systemic Lupus Erythmatosis (SLE)
2. Anti-double-stranded DNA (dsDNA), in high titer, is closely specific to SLE. It is
typically related to a peripheral or homogeneous ANA pattern. The antibody is named for
its ability of binding to the normal DNA of the individuals. It is important to monitor
anti-dsDNA since complement levels vary with disease activity and a high titers indicate
active disease and low titers quiescent disease.
3. Some of the priority areas that will be addressed in D.W.’s care plan include intermittent
fatigue, unintentional weight loss, joint pain, fever and scaly rashes that indicated the
condition of SLE.
4. In the care of D.W., UAP can be delegated to assisting the patient with personal hygiene
measures.
5. In addition to the general complications associated with immunosuppression like
malignancy or an increased vulnerability to unscrupulous infections, individual
immunosuppressive agents have specific and potential side effects on human beings.
Nephrotoxicity is one of the major side effects associated with cyclosporine (CsA). A
number of attempts have been made in this area for minimizing the toxicity, including
drug blood levels monitoring, modification of the standard protocol, and co-administering
other agents. Other side effects associated with CsA include hepatotoxicity, hypertension,
tremor, hyperkalemia, hirsutism and overgrowth of gum. However, the initial side effects
include high fever with shaking chill, rigors, headache and hypotension. Thus, for
preventing them, an antihistamine, acetaminophen along with a steroid is administered
prior to injection.
6. Plasmapheresis is used to eradicate immune complexes circulating and pathogenic
antibiotics. It has been found that Plasmapheresis without concomitant

Systemic Lupus Erythmatosis (SLE)
immunosuppression induces a compensatory increase in the synthesis of auto antibiotics
and immune complexes. Patients suffering from SLE who have complement chances
indicating the presence of circulating immune complexes at a higher level may benefit
from Plasmapheresis (Puisset et al., 2013). However, patients having minor complement
changes and those who do not exhibit any detectable anti complementary activity are less
probable to get benefitted by plasmmapheresis. It is mainly beneficial for patients with
acute fulminating SLE provided that the disease in not responding to the steroids given,
rapidly or where cytotoxic drugs have either failed to show response or have shown
contradictions by the pancytopenia or neutropenia that makes the lupus complicated
often.
Plasmapheresis helps to relax a patient suffering from any auto immune disease, like the
patent in the case study (Gafoor et al., 2015). Following Plasmapheresis, the patient will
feel relieved in a few days. However, Plasmapheresis will only provide short term relief,
often the process needs to be repeated and the frequency as well as the outcomes
associated will be highly dependent on the severity of the patient’s condition.
Plasmapheresis also has various potential side effects. Some of the mild effects are
feeling cold, blurred vision, stomach cramps, dizziness and faintness. However, it can
also increase the risk of further complications like infection, allergic reaction and blood
clotting (Youngblood et al., 2013).

Systemic Lupus Erythmatosis (SLE)
References
Castro, C., & Gourley, M. (2010). Diagnostic testing and interpretation of tests for
autoimmunity. Journal of Allergy and Clinical Immunology, 125(2), S238-S247.
Gafoor, V. A., Jose, J., Saifudheen, K., & Musthafa, M. (2015). Plasmapheresis in neurological
disorders: Experience from a tertiary care hospital in South India. Annals of Indian
Academy of Neurology, 18(1), 15.
Puisset, F., White‐Koning, M., Kamar, N., Huart, A., Haberer, F., Blasco, H., ... & Chatelut, E.
(2013). Population pharmacokinetics of rituximab with or without plasmapheresis in
kidney patients with antibody‐mediated disease. British journal of clinical
pharmacology, 76(5), 734-740.
Sandhu, V., & Quan, M. (2017). SLE and serum complement: causative, concomitant or
coincidental?. The open rheumatology journal, 11, 113.
Tešija Kuna, A., Đerek, L., Kozmar, A., & Drvar, V. (2016). Current practice in laboratory
diagnostics of autoimmune diseases in Croatia. Survey of the Working group for
laboratory diagnostics of autoimmune diseases of the Croatian Society of Medical
Biochemistry and Laboratory Medicine. Biochemia medica: Biochemia medica, 26(3),
376-394.
Youngblood, S. C., Deng, Y., Chen, A., & Collard, C. D. (2013). Perioperative therapeutic
plasmapheresis. Anesthesiology: The Journal of the American Society of
Anesthesiologists, 118(3), 722-728.