Systemic Lupus Erythematosus (SLE) – Kate Felmark

One of the first things I learned about Systemic Lupus Erythematosus (SLE) based on Professor Lupus: Roses Experience With SLE is that historically, it is harder to diagnose skin conditions on black people because a majority of research for skin conditions has been completed on white people. The typical red butterfly-looking rash on people’s faces with SLE may appear purple in color and scaley on black skin. Some of the risk factors Rose has is being black, in her reproductive years, and the fact that she is in the second trimester of pregnancy. 

There are many different factors that predispose people to SLE with genetics and environmental factors being the two most common. Different environmental factors include UV light, viral infection, estrogen, or smoking. Typically with SLE people will have rashes to their skin exposed to sun such as the face and body, ulcers in their mouth or nose, and hair loss. More significant symptoms include arthritis, declining kidney function, seizures, and generalized fatigue. 

Diagnosis of SLE is completed with blood work that shows a positive with antinuclear antibodies (ANA). Other blood disorders that coincide with SLE are hemolytic anemia, leukopenia, lymphocytes, or thrombocytopenia. People do not need to have flare-ups to be diagnosed with SLE, oftentimes people will have ANA in their blood before becoming symptomatic. Due to the length of time between people becoming symptomatic and seeking medical attention, it can take years for people to receive a SLE diagnosis. Other diagnostics include: double-stranded DNA. 

Cellular damage and cell death occur with SLE due to DNA mutation from elevated levels of ANA. It is assumed that due to genetic predisposition, macrophages fail to recognize the mutated DNA, causing more antibodies than antigens. These antibody-antigen complexes get deposited throughout the body, specifically in the capillaries of the kidneys, joints, skin, and heart causing damage to the blood vessels. This is known as a hypersensitivity three reaction. In SLE, the body uses antigen-presenting cells (APCs) to present self antigens which causes an immune attack on itself. The body also makes more B cells, which make auto-antibodies and attack its body tissues. These are some of the reasons that cause SLE to be an autoimmune disease

There is no cure for SLE, but treatment is based on flare-ups and remission periods. Due to Rose being pregnant, not only is she at risk for flare-ups, especially in the second trimester and postpartum, but her baby also faces many risks with the potential of developing SLE if she has the genetic factors and environmental factors. Medications that can be taken to treat SLE symptoms include NSAIDS, ASA, naproxen, corticosteroids, and antimalarial drugs for periods of remission. A special diet, avoiding UV lights, and physical activity can increase energy and minimize disease flare-ups. There is also current research being completed on Naive B cells with a new type of chemotherapy that can help move patients into remission!

During my efforts to comprehend the interconnections of SLE and Rose, there were a few small noticeable gaps in content that I believe would have been beneficial in enhancing my learning. I would have appreciated a more in-depth and all-at-once explanation of a type three hypersensitivity reaction. Although they did discuss the important components of what a hypersensitivity type 3 reaction is, I would have enjoyed it if there had been a pause in their explanation of Rose’s case and then a breakdown of  what a hypersensitivity 3 reaction is. This would have allowed me to understand what and why Rose was experiencing the symptoms she had. 

Another small gap that I believe would have been beneficial for me was more information of the genetic testing. They spoke about how genetics plays a factors and people can be genetically predisposed, but I feel like this is something I would have liked more information about. I would have liked a bit more information about how genetic testing is done and if there is just one type or are there multiple different genetic tests. I know they spoke about the ANA testing but I would have liked some more information on what the test entails. But on a positive note it helped make me self-aware to my own lack of knowledge about genetic testing and autoimmune disorders in general.

The main teaching and learning strategy that the SLE group used that supported my learning was their use of storytelling. The story of Rose’s case was very relatable because she had many similar symptoms and risk factors that one of my family members who was diagnosed with SLE had. I was able to easily follow along the story of Rose and her different symptoms that led to her accessing healthcare. Also, as students, we are often running in a state of high-stress especially around exam times, which clearly is one of the factors that led to an exacerbation of her symptoms. In reality I am sure many of us have noticed even without an autoimmune disorder we are often getting sick and more fatigued because of this constant stress. They were able to differentiate the difference between expected symptoms and what Rose was experiencing due to her not having the typical red butterfly rash. They did a great job at explaining how skin conditions differ on different races and how it is due to a lack of research which was great for me to make some connections I wouldn’t have initially made without them pointing that out. Typically most research is done on white men especially which is something healthcare workers really need to improve on to ensure we are providing the best care and have the most knowledge. 

The one change I would recommend to improve the content of their video would be pictures or a small video clip to help visualise the SLE symptoms. This is mainly because I am a visual learner, but also taking into account that their video was on a disease such as SLE that often presents as a skin condition. The key takeaway I had from the beginning of the video was when they explained most research on skin conditions is completed on white people. They then went on to describe how SLE is harder to diagnose on black skin and that there was a lack of research on any other races other than Caucasians. They did a great job at describing what the typical SLE rash would look like on white skin and black skin, but a picture or quick video would have helped me consolidate that information. After listening to their video I decided to do some research of my own not only out of curiosity but for my learning. I also think that if they had videos or pictures embedded within their podcast it would have better shown what the antigen-antibody complexes are, and how they look when they get stuck in the blood vessels would have been a fun approach to showing how SLE becomes systemic and why it is an autoimmune disease.

One example of how I will integrate the information I learned from the SLE content in my future practice is by being more aware of the different ways disease can present themselves in different races. Rather than expecting diseases or symptoms of disease to be presented in the way we are traditionally taught or expected, I will be more open to thinking outside the box. This will help promote me to take more thorough assessments and look deeper into my findings. I will collaborate with my co-workers in times when I am unsure and be accepting of others’ thoughts and opinions even if they do not fit the status quo. 

When working with patients who suffer from SLE I will remember that it can be a very scary diagnosis because it is often unpredictable. They go through periods of flare-ups and remission for unknown amounts of time and that is often difficult to manage especially depending on the severity of their symptoms. Hopefully as I work with more SLE patients I will better understand the ups and downs of SLE and be able to better support them holistically. I can use my knowledge of the different interprofessional team members and will be able to connect them with the appropriate support if they are open and willing. It may be beneficial for me to help explain to whoever their support system (ie.. friends, and family) what to expect with SLE so they can better assist and support their loved ones. This may help minimise and prevent future flare-ups and allow the patient to stay out of acute care and be managed in their home environment for longer.   

Lastly, I will be able to explain the different types and options for medication management used for patients with SLE. Oftentimes this can be foreign and scary to people who previously haven’t had to use medications. By helping the person better understand why medications are used and what they will help with will help empower and promote autonomy which is vital in chronic incurable diseases.