NR 503 Week 6 Assignment: Epidemiological Analysis: Chronic Health Problem (Lupus Disease).
Systemic Lupus Erythematosus
NR 503: Week
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Sometimes just looking at a patient, the provider has a difficult time knowing what is wrong with the patient. In this paper we are going to discuss the disease known as systemic lupus erythematosus, or SLE. This disease is one that attacks its patients’ body and is not always easily diagnosed. The patient is often more fatigued, running fevers and has a rash appear that they are unfamiliar with. This disease will be discussed at length and will look at the incidence, prevalence and statistics as well as the signs, symptoms and other background information about the disease.
Background
Systemic lupus erythematosus, also known as SLE or lupus is a chronic autoimmune disease that can damage any part of a person’s body such as skin, joints, and organs (Lupus Foundation of America, 2014). A person with Lupus has symptoms of severe arthritis with pain and swelling in the joints and are often placed on steroids and immune system suppressants such as methotrexate are often used as part of the treatment. This is because the immune system of a patient with lupus is overactive. Lupus is a chronic disease and has no cure, but the symptoms can be managed with medical treatment. Patients can also use antimalarial drugs to help prevent the disease from having flare-ups. Lupus causes a patient to be more sensitive to sunlight or UV rays and can cause their disease to flare-up. It is important that they get plenty of rest, exercise regularly, limit alcohol use and eat a healthy diet, as these will help improve their immune system function. A person living with lupus must learn self-management skills and learn how to manage their disease so that they are not feeling sick all the time. Each person with SLE will have different treatments depending on their system involvement and symptoms. The prevalence of SLE in the United States have ranged from 1.8 to 23.2 cases per 100,000 per year (Ferucci, 2014). Studies have shown that the disease is highest in Afro-Americans then Asians and followed by Caucasians. This disease seems to affect more women that are at their child-bearing age. The table below shows some of the prevalence of SLE by age, sex and region. There was no data found for the state of Illinois.
Table 1.
Prevalence of SLE according to the primary definition, categorized by sex and region
Unadjusted Age-adjusted
Rate Rate
95% confidence 95% confidence
Denominator # of cases Interval Interval
Female 116,551 251 215
(190-244) 271
(238-307)
Male 95,365 34 36
(26-50) 54
(36-77)
Regional
Alaska 117,964 130 110
(93-131) 149
(124-177)
Phoenix 70,311 125 178
(149-212) 248
(204-297)
Oklahoma 23,641 30 127
(89-179) 138
(96-191)
United States 1.4 million 63,052 194 n/a
Note: Reprinted from Data for Prevalence of SLE according to the primary definition, categorized by sex and region, by Ferucci, E. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617772/ Sept. 2014.
Current surveillance methods
The centers for disease control and prevention funded studies in California by using data obtained from hospitals, laboratories, rheumatologists, nephrologists, commercial laboratories and a state hospital discharge database. They looked at medical records to determine the patients that met at least four out of eleven of the American College of Rheumatology classification criteria of SLE (Dall’Era, M, 2017). They did this to determine the prevalence and incidence of the disease in Hispanics and Asians. Case control studies and cohort studies are done to help show the factors that are related to developing SLE. This way once the physician determines the patient’s risk factors, they can start preventative treatment to try and control the risk of getting SLE. However, SLE tends to show up in patients that have a lower risk than those with a higher risk. People should avoid smoking as this is a risk that can be avoided that can lead to SLE, cancer and cardiovascular diseases.
Descriptive epidemiological analysis
The prevalence of SLE in the United States is approximately 20 cases in 150 per 100,000 people. Since we are more able to detect this illness now, the incidence has tripled within the last 40 years. There seems to be a correlation between geographical location and race as well as the frequency and severity of the disease when looking at prevalence. For some reason, this disease appears more in urban areas than rural areas. Within the United States this disease is presented highest in Asians, African Americans, African Caribbean’s and Hispanics when compared to Caucasians. The disease has also been found in the European countries to be more prevalent in Asian and Africans, but SLE is not found much in Africa. It has been found that those that are not Caucasian tend to be more ill and have a higher risk of early mortality with SLE. If patients contract the disease as a child, they also have a more severe disease with higher damage and higher mortality rates. It has been found that race, age and gender play a large role in mortality rates and the effects the disease has on the patient.
Screening and diagnosis
The diagnosis of SLE requires the patient to have four or more of the eleven criteria, which include: malar rash, discoid rash, photosensitivity, oral ulcer, arthritis, serositis, renal disorder, persistent proteinuria neurologic disorder, hematologic disorder, immunologic disorder and positive antinuclear antibody test result or ANA (Washio, 2018). The four that most patients present with are the positive ANA, arthritis, hepatologic disorder and immunology disorder. Lupus can be difficult to diagnose and requires time to diagnose. Physicians must perform a history and physical examination including all major systems at each clinic visit. They must look at the disease activity at every visit (Fernando, 2016). It can also be difficult to tell if the inflammation is current from the patients’ symptoms or if it is damage that could show permanent changes, and there are some tools they can use to determine these changes. There are many scales to use, however they have not been validated and are not recommended to use in the diagnosis of SLE. There is the health assessment questionnaire that is widely used in rheumatoid arthritis and it has been validated in patients with SLE who have arthritis (Fernando, 2016). The only problem with this questionnaire is that it only focuses on the joint pain and arthritis and SLE has many different symptoms. There is a short form-36 that is preferred to be used in clinical practice for the diagnosis of SLE and it has been validated. It has been shown that the ANA test is one of the most sensitive diagnostic tests available for SLE. 98% of patients with SLE will have a positive ANA test, confirming the diagnosis.
Plan of Action
Working as a nurse practitioner I will want to care for my patients with Lupus by helping to reduce their inflammation, regain mobility, decrease their pain and their frequency of increased disease symptoms. At each and every visit we would assess and monitor any rashes on the skin, mucous membranes for any oral lesions or ulcers, assess and manage the patients pain, explain to patients the importance of deep breathing exercises to prevent lung diseases, encourage the patient to do activity as tolerated with rest breaks as they probably get very fatigued with any activity, monitor labs, order any needed medications such as steroids and immunosuppressants and review healthy nutrition with them to help promote healing and prevent more inflammation. In my community, I would first identify the people that are at increased risk of developing lupus and try to do some preventative interventions. We need to develop and put into action strategies to help improve the communication with those patients in the community and the physicians in the community. Often patients are scared to go to the physician’s office. We need to obtain large population samples in our area that includes health records and geographical data so that we can try and identify any new risk factors and health disparities that may be playing a part in patients with SLE. Our community could bring patients in to be researchers to evaluate data through social media and questionnaires to help find some patient-centered approaches to evaluate autoimmune disease research. Lupus affects a patient’s life at times by causing them severe joint pain, fatigue and depression. Depression often sets in as a patient cannot function in their life the way they want to. They often have stress because they are too tired and hurt too bad to work and often cannot hold a job due to their disease. They are at increased risk of strokes, headaches, vision problems, seizures and can have trouble expressing their thoughts at times which also makes it difficult for them to hold a job (Ferucci, 2014). One research study that was reviewed showed that patients with SLE that did twelve weeks of aerobic exercise supervised by a health professional, led to reduced fatigue and increased vitality for those patients (Wu, 2017). This would be a good intervention to push for with patients and educate them on. Patients need to also be educated on smoking. Smoking increases the risk of cardiovascular disease in patients with SLE and affects the heart and blood vessels (Lupus Foundation of America, 2014). Education in the community regarding SLE and the signs and symptoms to be aware of as well as what to do to be diagnosed and management of the disease would be a large intervention. The prevalence of the disease would be assessed over several years to see if the interventions were effective and to determine what else could be done further in getting the awareness of this disease out into the community. Patients need to become more aware of their symptoms and be able to feel comfortable in coming to their providers for diagnosis and treatment.
Conclusion
SLE is a chronic, autoimmune disease that is not curable. Patients can control their symptoms with medical management, exercise, rest and good nutritional habits. Management of this disease also varies from patient to patient depending on their severity of symptoms and how they manifest. This disease is often difficult to diagnose because it can mimic many similar diseases and it does take time to diagnose by monitoring a patient’s symptoms over time. They must look at clinical findings and monitor over time as well as laboratory testing. The prevalence of the disease has increased over the last many years but could also be related to their being more information out about the disease and better diagnosis of the disease. The need to stress the importance of taking medications and keeping appointments must be stressed to patients that have SLE. This disease has no specific cause but can be related to genetic, ethnic or environmental factors. There are also many risk factors that could cause SLE such as low birthweight, childhood exposure to agricultural pesticides, cigarette smoking, estrogen use and exposure to ultraviolet light. SLE has had elevated mortality rates over the last few decades, but those rates have decreased. Life expectancy varies depending on the involvement of major organs. With the improvement in treatment and advances in medical care patients are living longer with SLE. The earlier they are diagnosed the better and therefore healthcare workers need to get out in our communities and really stress the signs and symptoms of the disease and make it better known. SLE can be a more manageable disease if we detect it early and can educate the patient on management of the disease early on.
References:
Dal’Era, M, et al. (2017). The incidence and prevalence of systemic lupus erythematosus in San Francisco county, California: The California lupus surveillance project. Arthritis Rheumatoid. 69(10): 1996-2005. doi: 10.1002/art.40191
Fernando, M (2016). How to monitor SLE in routine clinical practice. Journal of Rheumatology. 6(30). 445-468.
Ferucci, E. (2014). Prevalence and incidence of systemic lupus erythematosus in a population-based registry of American Indian and Alaska native people. Arthritis Rheumatoid. 66(9): 2494-2502. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617772/
Lupus Foundation of America (2014). Retrieved on August 16, 2019 from:
https://www.lupus.org/resources/what-is-lupus
Washio, M. (2018). Epidemiology of systemic lupus erythematosus. AJN. 7(30). 231-238.
Wu, M, (2017). The effectiveness of exercise in adults with systemic lupus erythematosus. Worldviews Evid Based Nursing. 14(4): 306-315. doi: 10.1111/wvn.12221. [Show Less]