SYSTEMIC LUPUS ERYTHEMATOSUS
Journal Article
Title: Seasonal Variation in the Activity of Systemic Lupus Erythematosus
Citation: J. Rheumatol (2012). Seasonal Variation in the Activity of Systemic Lupus Erythematosus. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3597113/. [Accesssed 2 February 2014}
Summary: The objective of the article was to find a correlation between seasonal change and clinical/systemic onsets of Systemic Lupus Erythematosus symptoms (photosensitive rash, arthritis/joint activity, renal activity, CNS). Included in the Cohort study were 2102 patients with SLE, of whom 92.3% were women. A total of 1183 were white, 780 African American, and 65 were Asian. All patients with SLE were members of the Hopkins Lupus Cohort from 1986-2010. Each patient was seen quarterly or more frequently if medically indicated. Viral and bacterial infections were registered at each visit.
Results: There were significant seasonal variations in photosensitive rash (butterfly-shape), which was more frequent in the Spring and Summer months, whereas, arthritis and joint pain had increased activity in May through October. Differences in CNS were not found, however, the highest amount of activity was in August, September, October, and November compared to the rest of the year. And last, renal activity showed evidence to decrease activity from June through October. These changes likely reflect environmental factors that influence disease activity, including UV light and infections. Also, there was no strong evidence that seasonality activity of disease differed between whites and African Americans. The exception to this was photosensitive rash, which exhibited increased activity in whites but not for African Americans as we are fair skinned.
In completing the article, it confirmed the importance of empathy needed to truly understand what patients may be feeling at home or in a dental setting. For those patients living with disease, I'm certain one time or another they've experienced changes in psychological, social, and emotional states (depression and lack of self-esteem). My role as a hygienist, is to consider these factors and make the appointments as comfortable as possible. Raising awareness in how to treat oral side effects is extremely important if patients aren't informed of the possible ulcerations, xerostomia, and dysgeusia (abnormal taste) caused by many of the medications taken by those with SLE. The alterations observed may lead to nutritional deficiencies, long term dental problems, even worse, dental neglect.
Personal Reflection: I was not only intreged to learn more about SLE once my father was diagnosed, but through research on more the two handful of times, there has been mention of the presents of a rash across the cheeks and nose in the general shape of a butterfly. The rash alone isn't enough to diagnose, but roughly 30% of lupus patients typically express this common characteristic. Exposure to the sun (even artificial) can worsen the symptoms. When scheduling appointments, with the patients best interest at heart, early morning or evenings are best to reduce the risk of sun exposure. Thorough understanding of the disease will allow me to provide patients with beneficial information for their overall health. Also, learning to better manage a patient with SLE will assist me in treatment as well as develop the compassion to understand what they may be feeling during their dental appointment.
Journal Article
Title: Seasonal Variation in the Activity of Systemic Lupus Erythematosus
Citation: J. Rheumatol (2012). Seasonal Variation in the Activity of Systemic Lupus Erythematosus. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3597113/. [Accesssed 2 February 2014}
Summary: The objective of the article was to find a correlation between seasonal change and clinical/systemic onsets of Systemic Lupus Erythematosus symptoms (photosensitive rash, arthritis/joint activity, renal activity, CNS). Included in the Cohort study were 2102 patients with SLE, of whom 92.3% were women. A total of 1183 were white, 780 African American, and 65 were Asian. All patients with SLE were members of the Hopkins Lupus Cohort from 1986-2010. Each patient was seen quarterly or more frequently if medically indicated. Viral and bacterial infections were registered at each visit.
Results: There were significant seasonal variations in photosensitive rash (butterfly-shape), which was more frequent in the Spring and Summer months, whereas, arthritis and joint pain had increased activity in May through October. Differences in CNS were not found, however, the highest amount of activity was in August, September, October, and November compared to the rest of the year. And last, renal activity showed evidence to decrease activity from June through October. These changes likely reflect environmental factors that influence disease activity, including UV light and infections. Also, there was no strong evidence that seasonality activity of disease differed between whites and African Americans. The exception to this was photosensitive rash, which exhibited increased activity in whites but not for African Americans as we are fair skinned.
In completing the article, it confirmed the importance of empathy needed to truly understand what patients may be feeling at home or in a dental setting. For those patients living with disease, I'm certain one time or another they've experienced changes in psychological, social, and emotional states (depression and lack of self-esteem). My role as a hygienist, is to consider these factors and make the appointments as comfortable as possible. Raising awareness in how to treat oral side effects is extremely important if patients aren't informed of the possible ulcerations, xerostomia, and dysgeusia (abnormal taste) caused by many of the medications taken by those with SLE. The alterations observed may lead to nutritional deficiencies, long term dental problems, even worse, dental neglect.
Personal Reflection: I was not only intreged to learn more about SLE once my father was diagnosed, but through research on more the two handful of times, there has been mention of the presents of a rash across the cheeks and nose in the general shape of a butterfly. The rash alone isn't enough to diagnose, but roughly 30% of lupus patients typically express this common characteristic. Exposure to the sun (even artificial) can worsen the symptoms. When scheduling appointments, with the patients best interest at heart, early morning or evenings are best to reduce the risk of sun exposure. Thorough understanding of the disease will allow me to provide patients with beneficial information for their overall health. Also, learning to better manage a patient with SLE will assist me in treatment as well as develop the compassion to understand what they may be feeling during their dental appointment.
![Picture](/uploads/2/5/6/8/25686586/7424685.jpg)
Additional Information:
One of the S.L.E. Lupus Foundation’s most important goals is to help people with lupus understand that they are not alone with their disease. The Foundation is a valuable resource for general lupus information and referrals, and offers a variety of counseling services free of charge. For more information: http://www.lupusny.org/programs/support-groups [Accessed 10 February 2014]
Burning mouth syndrome is an idiopathic pain disorder that appears to be quite common amongst those taking medicaitons for SLE. The journal article is a great resource for those who experience the side effects: http://www.cda.org/SearchResults.aspx?sb-search=The+burning+mouth&sb-inst=0_dnn_avtSearch&sb-logid=272040-0v2motbb639oe62d[Accessed 10 February 2014]
After reviewing my journal article on seasonal variations of disease activity amongst those who have symptoms of the "butterfly" rash, I thought it would be helpful to include a slideshow of the many symptoms one may experience with lupus. http://www.WebMD.com/lupus/ss/slideshow-lupus-overview [Accessed 12 February 2014]
One of the S.L.E. Lupus Foundation’s most important goals is to help people with lupus understand that they are not alone with their disease. The Foundation is a valuable resource for general lupus information and referrals, and offers a variety of counseling services free of charge. For more information: http://www.lupusny.org/programs/support-groups [Accessed 10 February 2014]
Burning mouth syndrome is an idiopathic pain disorder that appears to be quite common amongst those taking medicaitons for SLE. The journal article is a great resource for those who experience the side effects: http://www.cda.org/SearchResults.aspx?sb-search=The+burning+mouth&sb-inst=0_dnn_avtSearch&sb-logid=272040-0v2motbb639oe62d[Accessed 10 February 2014]
After reviewing my journal article on seasonal variations of disease activity amongst those who have symptoms of the "butterfly" rash, I thought it would be helpful to include a slideshow of the many symptoms one may experience with lupus. http://www.WebMD.com/lupus/ss/slideshow-lupus-overview [Accessed 12 February 2014]
![Picture](/uploads/2/5/6/8/25686586/2919024.jpg)
Images from:
Molly's Fund (2013). Image. Lupus Signs and Symptoms. Retrieved from http://www.mollysfund.org/2013/01/lupus-symptoms-and-signs/ [Accessed 28 January 2014]
National Institute of Arthritis and Muskulotskeltal and Skin Diseases (2012). Image. Do I have Lupus? Retrieved from http://www.kobobooks.com/ebook/Lupus-Do-I-Have-Lupus/book-Ek_aqoOHik63jzX5MuIUmA/page1.html [Accessed 28 January 2014]
Lupus CIDPUSA Foundation (2013). Image. Lupus. Retrieved from http://www.cidpusa.org/SLE.html [Accessed 28 January 2014]
Molly's Fund (2013). Image. Lupus Signs and Symptoms. Retrieved from http://www.mollysfund.org/2013/01/lupus-symptoms-and-signs/ [Accessed 28 January 2014]
National Institute of Arthritis and Muskulotskeltal and Skin Diseases (2012). Image. Do I have Lupus? Retrieved from http://www.kobobooks.com/ebook/Lupus-Do-I-Have-Lupus/book-Ek_aqoOHik63jzX5MuIUmA/page1.html [Accessed 28 January 2014]
Lupus CIDPUSA Foundation (2013). Image. Lupus. Retrieved from http://www.cidpusa.org/SLE.html [Accessed 28 January 2014]
Work Cited:
Darby, M. L., & Walsh, M. M. (2010). Dental hygiene theory and practice (3rd Edition). Individuals with special needs: Lupus Erythematosus (pg.929-930). St. Louis, MI: Linda Duncan. [Accessed 31 January 2014]
Little, J. W., Falace, D. A., Miller, C. S., & Rhodua, N. L. (2008). Dental Management of the medically compromised patient (7th edition). Rheumatologic and connective tissue disorders:(SLE) (pg. 329-332). St. Louise, MI: Linda Duncan [Accessed 31 January 2014] .
Lupus Foundation of America. (2014). Lupus. Retrieved from: http://www.lupus.org/action/put-onpurple. [Accessed 2 February 2014]
Womens Health.gov. (2014). Could I have lupus? Retrieved from: http://www.womenshealth.gov/about-us/government-in-action/couldihavelupus.html [Accessed 4 February 2014]
Darby, M. L., & Walsh, M. M. (2010). Dental hygiene theory and practice (3rd Edition). Individuals with special needs: Lupus Erythematosus (pg.929-930). St. Louis, MI: Linda Duncan. [Accessed 31 January 2014]
Little, J. W., Falace, D. A., Miller, C. S., & Rhodua, N. L. (2008). Dental Management of the medically compromised patient (7th edition). Rheumatologic and connective tissue disorders:(SLE) (pg. 329-332). St. Louise, MI: Linda Duncan [Accessed 31 January 2014] .
Lupus Foundation of America. (2014). Lupus. Retrieved from: http://www.lupus.org/action/put-onpurple. [Accessed 2 February 2014]
Womens Health.gov. (2014). Could I have lupus? Retrieved from: http://www.womenshealth.gov/about-us/government-in-action/couldihavelupus.html [Accessed 4 February 2014]