Diagnosing and Treating Lupus: A Case Study

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Hey everyone, welcome back to the podcast. I’m Eva Aguilar, and today we’re diving into a lupus case study—specifically systemic lupus erythematosus, or SLE for short. Our case is about Maria Lopez, she’s 28, and honestly, her journey’s pretty classic but also a little tricky, so let’s break it down.

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So, Maria shows up with this combo of fatigue—like, not the “oh, I partied too hard last night” fatigue, but the kind that doesn’t go away even with rest—plus joint pain, mostly in her hands and knees. There’s that morning stiffness, joint swelling, photosensitivity, and then, of course, the facial rash. The butterfly or malar rash over her cheeks and nose, classic lupus right? I think most of us would spot that, but there’s so much overlap with other autoimmune things, it’s easy to second-guess at first.

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Now, for labs—her ANA is positive, ESR is up, and she’s got low complement levels. These are really the bread and butter for confirming the diagnosis, especially when you put them together with those SLICC and ACR criteria. I always kind of get them scrambled in my head, but you really want at least one clinical and one immunologic criteria—Maria definitely checks those boxes. Actually, she ticks a lot: malar rash, arthritis, photosensitivity, positive ANA, low complement, and she even has some mild anemia.

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You know, something I’ve seen in practice is that SLE can start off kinda subtle. I remember one woman who came in for months with just unexplained fatigue and achy joints, and, you know, you could chalk it up to stress, being overworked, fibromyalgia—even depression, sometimes. But for her, it was those little oddities—like her rash flared up after a family picnic, joint swelling that came and went, and hair thinning in the shower. Classic, but so easy to brush off, especially in young women. So, it’s a reminder to look at the whole picture and not just single symptoms. It’s not always obvious when it’s lupus and not something else like rheumatoid arthritis or even viral infections. But, yeah—put it all together, trust your gut, and use those labs to back you up.

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Once the diagnosis is in, you’ve gotta set up a treatment plan that actually helps the patient live their life, right? So let’s talk meds. Maria got started on hydroxychloroquine, which, honestly, is usually a mainstay for SLE—the anti-malarial thing always throws people at first but, yeah, it helps a ton with joint and skin issues. One thing nurses always have to keep an eye on: retinal toxicity. I can’t tell you how many times patients just sort of shrug off the whole “get a baseline and yearly eye exam” advice. But it’s crucial, because damage can be sneaky and permanent.

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Then she’s on prednisone for flares, which is great for knocking down inflammation but, oof, the side effects, right? I mean, you’re always watching blood sugar, bone loss, mood issues—the works. So for Maria, we made sure to schedule a bone density scan and talk to her about watching for weight gain and mood swings. NSAIDs are in the mix for pain and stiffness—those need careful monitoring for GI upset and renal function, which gets overlooked sometimes, especially in younger, “otherwise healthy” patients like Maria.

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Oh, and with immunosuppressants—methotrexate or azathioprine, they’re more for folks with organ involvement or if steroids and hydroxychloroquine aren’t enough. At this point, Maria doesn’t need them, but it’s on our radar for the future if things escalate. But because she’s on steroids, we also got her started on vitamin D and calcium—trying to ward off osteoporosis before it even starts.

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Quick example—when Maria first started hydroxychloroquine, there was some confusion with scheduling her ophthalmology referral. She thought, “I’m young, my eyes are fine, I don’t need to rush.” But nurses, you’re in the best spot to reinforce how serious retinal exams are, especially for long-term users. We sat down and went over what to watch for, like changes in vision, and, honestly, a little repetition helped her get on board. The pitfalls are usually they miss that first eye appointment, or nobody tells them about it in the first place, which is... yeah, super fixable with just good communication.

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Now, moving into nursing interventions—there’s a whole mix of preventative and supportive care needed here. First, infection monitoring is massive, especially if someone’s on immunosuppressants or steroids. I’m always checking for even little signs, like a slight cough or a skin break, and I’ll admit, sometimes I feel like a broken record but it’s so important to remind them: report fevers, new rashes, chest pain, you name it.

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Skin protection can almost feel like another full-time job for SLE patients. Teaching about using SPF 30 or above, wearing wide-brimmed hats, protective clothes, and just avoiding the midday sun when possible—those specifics really stick. And then there’s energy conservation, which is just pacing activities and listening to their own limits. Marie had to learn it’s okay not to push through bad days—it was hard at first, but she got the hang of planning errands or visits on days she felt best.

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Education wise, it’s about reinforcing how important it is to stick with their meds, even when they feel “fine”—because flares can sneak up outta nowhere. Also, avoiding contact with sick people, staying on top of vaccinations, following the anti-inflammatory diet—it all adds up. Nutrition can help with energy levels and even reduce inflammation; I usually suggest seeing a dietitian, especially early on.

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You know, I remember supporting a pretty young woman, probably around Maria’s age, who was just diagnosed and totally overwhelmed. We built her discharge plan together—setting up a symptom diary, making those follow-up appointments, referrals to a rheumatologist, derm, a dietitian, and even a support group. She was nervous at first, but just having that plan in her hands and someone to check in with gave her a sense of control back. Patient education isn’t just about facts—it’s about empowering patients to handle the ups and downs. That’s the heart of it, and it truly shapes their outcome over the long run.