Madison Fuglseth

Adult Diagnosis Part I

Lupus
Lupus also known as systemic lupus erythematosus (SLE) is a chronic and incurable
autoimmune disease in which the body attacks its own tissues causing internal
inflammation. The bodys immune system is made up of three lines of defense. The
first line of defense is the bodys skin, mucous membranes, hairs and cilia, gastric
juice, vaginal secretions, urine, tears, sweat, saliva, and cerumen also known as ear
wax. The second line of defense the body has is white blood cells (WBC). This line of
defense is the most commonly line affected by lupus. White blood cells are in
charge of destroying and fighting off foreign invaders. Foreign invaders are viruses
like colds and bacteria that can enter the body through breaks in the bodies 1 st line
of defense.. (Human Biological Science Unit 3B, n.d)
When a person is diagnosed with Lupus, their own body makes antibodies that their
body mistakes for foreign invaders. This causes the body to attack and destruct its
own cells. Because blood cells are located in blood vessels, a Lupus flare up causes
the blood vessels to become inflamed and leak fluid. When the body mistakes its
own self for a foreign invader, white blood cells begin to fight everything including
the persons own DNA. When the bodys antibodies connect to DNA, it creates an
Immune Complex. This can lead to inflammation called Lupus Nephritis. (Lupus
Medical Media, 2013)
Symptoms that people who have Lupus might see are a butterfly rash on the face,
small sores inside the mouth or nose, possible arthritis due inflammation in joints
caused by the antibodies, blue or white fingers when cold, pain during deep
breathing due to inflammation of the lungs, extreme fatigue, headaches, fever,
anemia, swelling, muscle pain and weakness, and hair loss. People can be put on
medication to help with the symptoms of Lupus, however, there is no cure for Lupus
so flare ups even on medication are possible. One thing that causes flare ups is over
exposure to sun. Medications that people typically see in the treatment of Lupus are
non-steroidal anti-inflammatory drugs (NSAIDS) such as anti-inflammatory drugs,
anti-malarial, and non-steroidal drugs. People also can be put on Immune
suppressing drugs such as corticosteroids. (Lupus Medical Media, 2013) Because the
symptoms of Lupus are so similar to those of other diseases, it can be very hard to
diagnosis. It can take approximately up to 6 years for a person to be diagnosed with
Lupus. (Lupus Foundation of America, 2016)
Lupus affects 90 % more women than it does men and typically develops between
the age of 15 and 44. According to Lupus Foundation of America, it is estimated
that approximately 1.5 million people in America suffer from Lupus and
approximately 5 million people worldwide suffer from Lupus. Lupus comes in many
forms but the most common is Systematic Lupus which is accountable for about
70% of all cases. 20% of people that develop lupus have a family member who has
lupus or carries the same possibility of developing lupus and approximately 5% of
children that are born to people that have lupus will develop the disease. As far are
the prevalence of Lupus in other ethnicities, women of color such as African

Americans, Natives, Hispanics, etc. are more likely than white females to get Lupus.
For the most part, people who have Lupus can lead a normal life. Death due to
Lupus is more likely caused by other health complications that are connected to the
symptoms of Lupus such as respiratory and heart issues. (Lupus Foundation of
America, 2016)
Current Occupational Therapy treatment for Lupus consists of range of motion
exercises, strengthening, and endurance exercises. This specific treatment plan is
important for numerous reasons. Because of the inflammation that Lupus causes as
well as the potential muscle weakness and fatigue, people are at risk of joint
stiffness because of lack of motion in joints. Strengthening exercises target
symptoms such as fatigue, muscle weakness, and weak bones that can be a side
effects of all the medications that are taken. Strengthening the muscles can help
with the strength and stabilization of the joint making peoples gait pattern smooth
and easy which will help decrease fatigue symptoms. Because of side effects of the
medication and the amount of fatigue that people feel, people that suffer from
Lupus have a tendency to gain weight. It is important to work on endurance training
and a diet program to reduce the amount of stress put on the inflamed joints due to
heavy weight. By using these three exercise programs, occupational therapy
professionals are able to target all areas that are needed to complete ADLs and
IADLs that are hindered by fatigue or muscle weakness. (Nowak, 2012)
Due to weight gain from fatigue and medications, it is important to educate the
patient on proper exercises to do at home when they are away from therapy.
However, losing weight and keeping it off when fatigue is an issue and when on
steroidal medications is no easy task, it can take a toll on the patients mental state
of well-being. Dieting is a lifestyle change that can lead to social isolation and
mental illness due to depression and anxiety. Having exercise as one of the main
sources of treatment is crucial in treating not only obesity in patients with lupus but
also in elongating the life of a patient with lupus. Typically, people with lupus can
live normal term life expectancies, however, lupus increases the risk of
cardiovascular deficits. According to (Eriksson et al., 2012) patients with systemic
lupus erythematosus have a shorter life expectancy than the general population
and premature cardiovascular disease. (p. 290) Studies have shown that
approximately 23% of the lupus population have been shown to hold an inactive
status. This means that whether its due to symptoms or personal choice, patients
with lupus have chosen to not take proper steps to maintain their current level of
ability that they held prior to onset of symptoms. Occupational Therapy can
advocate for the importance of preforming exercise therapy to improve and/or
maintain their functional ability so they can complete ADLs and IADLs. (Jose, 2015)
A study done on 272 patients with systematic lupus was administered to determine
the level of physical activity in patients with lupus and the effects of physical
activity on patients with lupus. According to the study, patients with lupus showed a
lower ability in the areas of walking, jogging, and running. Patients even reported I
cannot walk without help or handicap aids. (p.293) Participants also reported the
need for many rest breaks during gait. Participants stated the factors causing poor
gait were as follows: poor fitness, pain, and fatigue. Occupational Therapy has the

skills and knowledge to work on pain management and endurance training. This will
allow patients to increase not only their gait pattern but their overall physical
endurance ability that is necessary to complete things such as independently
bathing, cooking, cleaning, working, and overall maintaining a meaningful and
purposeful life. (Eriksson et al., 2012)
According to Poole, Atanasoff, Pelsor,Wilmer, Sibbitt, (2005), an Assessment of
Motor and Process Skills was given to women with Systematic Lupus Erythematosus
to test the performance of a person in the areas of motor skills including postural
control, mobility, coordination, and strength as well as process skills. Results from
the assessment showed that because of the scores on the assessment, people with
lupus showed difficulty with complex tasks. Assessments also showed that people
with lupus showed a lack in skill performance which is considered a potential safety
risk. Throughout the assessments, an important factor to look at was the fact that
the people with lupus stated minimal difficulty with daily tasks including all ADLs
and only half of the questions pertained to IADL performance. It is clear from the
results of this assessment that there is in fact a deficit in the functional performance
of tasks performed by people with lupus. Since the patients with lupus didnt feel
that their ADLs were hindered, the role of Occupational Therapy would be to
educate. OT can educate the patients on not only what ADLs are but they can also
educate on adaptive equipment that can enhance performance and compensatory
techniques people with lupus can use to complete ADLs successfully. It is an
important aspect of Occupational Therapy to focus on rehabilitating the functional
performance of people with lupus so they can live functional lives without difficulty.
Performing activities such as exercise is important in the rehabilitation of ADL and
IADL success. (Poole et al., 2005)

Citations

[Nucleus Medical Media]. (2013, July 24th). Lupus. Retrieved January 13, 2016, from
https://www.youtube.com/watch?v=WgfFcpAD9XQ
Eriksson, K., Svenungsson, E., Karreskog, H., Gunnarsson, I., Gustafsson, J., Mller,
S., & ... Bostrm, C.
(2012). Physical activity in patients with systemic lupus
erythematosus and matched controls. Scandinavian Journal Of Rheumatology,
41(4), 290-297. doi:10.3109/03009742.2011.624117
Human Biological Science Unit 3b. (n.d) The immune system-three lines of
defensce. Retrieved January
14, 2016, from
http://tle.westone.wa.gov.au/content/file/969144ed-0d3b-fa042e888b23de2a630c/1/human_bio_science_3b.zip/content/004_internal_defence/pag
e_05.
Jose, S. (2016).Lupus Foundation of America. Statistics on Lupus. Retrieved January
15, 2016, from
http://www.lupus.org/about/statistics-on-lupus
Nowak.B. (2012). Lupus Treatment/Rehabilitation. Retrieved January 14, 2016, from
http://www.slideshare.net/LupusNY/lupus-treatment-and-rehabilitation
Poole, J. L., Atanasoff, G., Pelsor, J. C., & Sibbitt Jr., W. L. (2006). Comparison of a
self-report and
performance-based test of disability in people with systemic
lupus erythematosus. Disability &
Rehabilitation, 28(10), 653-658.
doi:10.1080/09638280500264691
Renal Society of Australasia Journal. (2015). Lupus nephritis: a nursing perspective,
11(3), 125-130 6p.