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DISCUSSION POST # 1 Reply to Ella and Tiffany

LUPUS

Lupus can be difficult to diagnose because it has many symptoms that come and go and can mimic symptoms of other disorders or diseases. When speaking to your doctor about your symptoms, be sure to include symptoms that may no longer be present. Your doctor may need to rule out other causes before diagnosing lupus. At this time, no single test diagnoses lupus. Doctors can diagnose the condition by:

· Asking about your medical history and symptoms, and, if necessary, reading your previous medical records.

· Asking if anyone in your family has lupus or other autoimmune diseases.

· Performing a complete physical exam.

· Taking samples of blood for laboratory tests, such as:

· Antinuclear antibodies (ANA), a sensitive test for lupus. Almost all people with lupus with have a positive ANA. However, having a positive ANA does not mean you have lupus since totally healthy people can have a positive ANA.

· Antiphospholipid antibodies, anti-smith, and anti-double-strand DNA antibodies, which doctors order when you have a positive ANA and can help determine if you have lupus.

· Complete blood counts, to check for low platelet counts, low red blood cell counts, and low white blood cell levels, which can happen if you have lupus.

· Metabolic panel to look for changes in kidney function.

· Taking urine samples to check for abnormal levels of protein in the urine.

· Performing a biopsy of the skin or kidney (when labs indicate there may be a problem with the kidney) by taking a small sample of tissue to examine under a microscope.

· Treatment

· Most people will see a rheumatologist for their lupus treatment. A rheumatologist is a doctor who specializes in rheumatic diseases, such as arthritis and other inflammatory or autoimmune issues. Clinical immunologists, doctors who specialize in immune system disorders, may also treat people with lupus. Other health care providers may provide treatment, including:

· Primary care providers, such as a family physician or internal medicine specialist.

· Mental health professionals, who provide counseling and treat mental health disorders such as depression and anxiety.

· Nephrologists, who treat kidney disease.

· Cardiologists, who specialize in treating diseases of the heart and blood vessels.

· Hematologists, who specialize in blood disorders.

· Endocrinologists, who treat problems related to the glands and hormones.

· Dermatologists, who specialize in conditions of the skin, hair, and nails.

· Pulmonologists, who treat lung problems.

· Neurologists, who treat disorders and diseases of the spine, brain, and nerves.

· Steroids   (corticosteroids, including prednisone): Steroid creams can be directly applied to rashes. The use of creams is usually safe and effective, especially for mild rashes. The use of steroid creams or pills in low doses can be effective for mild or moderate features of lupus. Steroids can also be used in higher doses when internal organs are threatened. Unfortunately, high doses are also most likely to produce side effects.

· Hydroxychloroquine (Plaquenil®) : This medication is commonly used to help manage mild lupus-related problems, such as skin and joint disease. It’s also used to treat fatigue and mouth sores.

· Azathioprine   (Imuran®): A medication originally used to prevent rejection of transplanted organs, this is commonly used to treat the more serious features of lupus.

· Methotrexate (Rheumatrex®):  This medication is another chemotherapy drug that’s used to suppress the immune system. Its use is becoming increasingly popular for skin disease, arthritis and other non-life threatening forms of disease that have not responded to medications such as hydroxychloroquine or low doses of prednisone.

· Cyclophosphamide (Cytoxan®) and mycophenolate mofetil (CellCept®):  These medications are chemotherapy drugs that have very powerful effects on reducing the activity of the immune system. They are used to treat more severe forms of lupus, especially lupus that affects the kidneys.

· Belimumab (Benlysta®):  This medication is a  monoclonal antibody  that reduces the activity of white blood cells (lymphocytes) that make autoantibodies. Autoantibodies are important as they cause tissue damage. Belimumab is used to treat lupus that does not involve the kidneys and has not responded to other types of treatments.

· Rituximab (Rituxan®) : This medication is also a monoclonal antibody that reduces the activity of white blood cells (lymphocytes) that make autoantibodies. It’s sometimes used to treat lupus that has not responded to other types of treatments.

Complications

Renal: Lupus Nephritis:

· Lupus nephritis is a type of kidney disorder that results from systemic lupus erythematosus (SLE) which is an autoimmune disease. In lupus nephritis, the immune system attacks the kidneys, causing inflammation and damage to the kidney tissue.

· LN is significantly associated with an increase in the morbidity and mortality of patients. The involvement of the kidney during the course of the disease affects between 30% and 60% of adult SLE patients. Approximately 10–20% of these patients will progress to end-stage renal disease within 5 years after diagnosis, while 40% of them with LN will develop chronic kidney disease (Morell et al., 2021).

Cardiovascular:

· Atherosclerosis

· Myocarditis

· Pericarditis

· Thrombosis

· Pulmonary hypertension

· The prognosis in systemic lupus erythematosus (SLE) has improved due to better treatment and care, but cardiovascular disease (CVD) still remains an important clinical problem, since the risk of CVD in SLE is much higher than among controls (Frostegård, 2022).

Neurological

· Patients with Lupus often experience neurological issues, which can be mild to severe, based on the amount of nerve damage for example: 

· Cognitive dysfunction :  People with Lupus may experience "brain fog" which can cause problems with memory, attention, and processing speed.

Pulmonary

· Pulmonary involvement is prevalent and seen in 50 to 70% of SLE patients and may even be the presenting feature in 4 to 5% of patients (Hannah & D'Cruz, 2019).

· Some of the common pulmonary complications in lupus include:

· Pulmonary embolism-blood clots, which can travel to the lungs and cause pulmonary embolism. This can result in chest pain, shortness of breath, and even sudden death.

· Pleuritis-Inflammation of the lining of the lungs  can cause chest pain and shortness of breath.

· Infections

Living with LUPUS:

· Learn to recognize the warning signs of a flare so that you and your doctor might reduce or prevent them. Warning signs include:

· Increased tiredness.

· Joint swelling.

· Pain.

· Rash.

· Fever.

· Abdominal pain.

· Headache.

· Eat a healthy well-balanced diet rich in fruits, vegetables, and whole grains.

· Exercise to help keep your body strong; however, talk to your doctor before starting an exercise program.

· If you smoke, quit. This will help lower your risk for heart disease that can be a complication of lupus.

· Protect yourself from the sun – sometimes, exposure to the sun can cause a flare. Wear protective clothing, such as a hat or long-sleeved shirts, and use sunscreen any time you go outside.

· Reach out to online and community support groups.

· Keep the lines of communication open. Talk to your family and friends about your lupus to help them understand the disease.

· Take a break from focusing on the disease, and spend some time doing activities you enjoy.

· Lower your stress – try meditating, reading, or deep breathing. Remember, stress can trigger a flare.

· Make changes if you need to in your work environment so you can try to continue to work, such as:

· Creating a flexible schedule – for example, work from home or start the workday later.

· Working part time.

· Adjusting your work area so that you are more comfortable.

· Most people with mild disease or who are in remission can usually participate in the same life activities they did before they were diagnosed.  

DISCUSSION POST #2 Reply to Ashlesha and Regine

Anemia

· Anemia is a deficiency of Red blood cells. RBC delivers oxygen from the lungs to the tissues and carbon dioxide from the tissues to the lungs with the support of hemoglobin-iron-rich protein. (Joseph M, 2021)

· Blood loss, increased destruction of RBCs (hemolysis), or decreased RBC production impairs the body’s ability for gas exchange (Joseph M, 2021).

Risk factors

· Poor diet, intestinal disorders, chronic disease, infections, women with menstruations or pregnancy, and getting older age lead to Anemia. (Joseph M, 2021)

· Chronic diseases like Rheumatoid arthritis, autoimmune disease, kidney disease, cancer, liver disease, thyroid disease, and inflammatory bowel disease also cause anemia. (Joseph M, 2021)

· Family history, Alcoholism.

Pathophysiology of anemia

· Reduce the RBCs, Hb, or Hct level due to blood loss, hemolysis, and decreased production of RBCs.

· Reduce oxygen-carrying capacity

· Tissue hypoxia. Shock, hypotension, or coronary and pulmonary insufficiency and effects on organ functions.

· Signs and symptoms of Anemia

Diagnosis of anemia:

· RBC 

· MCV = Mean corpuscular volume

· If > 100: Macrocytic anemia

· If 80 – 100: Normocytic anemia

· If <80: Microcytic anemia 

· RDW = Red blood cell distribution width 

· (Standard deviation of red cell volume / mean cell volume) x 100

· Normal value is 11-15%

Treatment

· Iron supplementation is given to treat iron deficiency anemia. 

· Include more iron-rich foods in your diet. Iron from meat is best absorbed by the body.

· Avoiding items like coffee, tea, egg whites, milk, fiber, and soy protein will help your body absorb iron.

· Women should undergo screenings during pregnancy, and kids should undergo screenings at age one. If the patient is not responding to therapy, further testing may be administered after giving the patient supplemental iron initially.

Health Promotion:

· Once the underlying cause has been addressed, oral iron therapy can be started to top off iron reserves.

· Patients who are unable to tolerate or absorb oral preparations may benefit from parenteral therapy.

Prognosis:

· The prognosis depends on the severity of the disease, underlying cause, and rapidity. Sickle cell, thalassemia, and aplastic anemia have a poor prognosis. (Danphy et al., 2023)

· The hemolytic-uremic syndrome has significant morbidity and mortality if untreated. As many as 40% of those affected die, and as many as 80% develop renal insufficiency. (Danphy et al., 2023)