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Systemic Lupus Erythematosus

Patient History

Mrs. Evan has been married for six years and has one 5-year-old son. She attended two years of college and works full time as an accounting assistant for a large manufacturing firm. She has been active in her community and church. She also volunteers with her son's daycare and participates in his swimming and sporting activities.

Mrs. Evan is of African American/American Indian descent. Her parents are alive and in good health. Her mother has type 2 diabetes mellitus that is controlled with lifestyle changes and oral medications. Her father has hypertension that is controlled by lifestyle changes (dietary changes, exercise, and weight loss) and medication. Both sets of grandparents have died from a motor vehicle accident, or from complications from diabetes mellitus or heart disease.

Mrs. Evan reports having the "normal" childhood illnesses of chickenpox and mumps. She denies any complications or prolonged illnesses or injuries. She denies any known family history of lupus, rheumatoid arthritis or other rheumatic conditions.

She reports that her current level of fatigue is challenging to her as she was always active and energetic prior to her miscarriage. She describes needing to rest after her morning routine of showering, dressing and fixing breakfast. She reports that she is only able to complete one or two other tasks such as vacuuming, laundry or dusting before she needs to rest again.

Mrs. Evan describes her sleeping pattern as follows: difficulty falling asleep, waking after 2 to 3 hours followed by difficulty returning to sleep for 1 or more hours after waking, then feeling like her sleep was not restful when she gets out of bed in the morning. She notes that her lack of sleep interferes with her memory and coping abilities. She states, "I always prided myself on remembering names, dates, and appointments. Now, if I don't write it down immediately, I forget it. I also find myself irritated at little things that normally would not bother me."

Mrs. Evan describes pain, swelling and stiffness in her joints as progressing over the past 3 months. She first noted stiffness in her fingers in the morning and after activity such as typing on the computer. About 2 months ago she noticed swelling in her fingers and wrists. Initially she thought this was due to her pregnancy and the hot July weather. In the past 2 to 3 weeks she has noticed swelling in her knee along with difficulty rising from a seated position. She describes the pain as intermittent, most notable in the morning and after activity involving her hands and knees. Her pain is relieved by rest and by Tylenol or ibuprofen.

Mrs. Evan explains that her appetite remained decreased after her morning sickness subsided 2½ months ago. She denies any type of rash after sun exposure, but reports that her arms and tops of her feet itch after she is in the sun without sunscreen.