Pathway Interventions and Systemic Lupus Erythematosus: The Case of Mary Anne

Systemic lupus erythematosus (SLE) is a complex and typically chronic illness, producing a wide variety of symptoms and an unpredictable course. SLE is an autoimmune condition, commonly affecting the skin, joints, kidneys, brain, and other organs. This article describes the application of a multilevel integrative care plan, following the pathways model, to assist a patient with SLE in managing and moderating symptoms and improving quality of life. The patient, Mary Anne, was a 33-year-old female nurse with a 14-year history of SLE. Her initial response to lupus was biomedical, with a passive reliance on a wide range of medications and an increasingly inactive, sedentary lifestyle. Along with lupus she developed obesity, hypertension, migraine, sleep disturbance, depression, and anxiety. Her rheumatologist referred her for behavioral health interventions to help her to learn nonpharmacologic forms of pain management and motivate her for illness self-management for her various chronic conditions. The interventions were organized into the three levels of the pathways model and included Level 1, movement, sleep hygiene, and mindful eating; Level 2, aquatherapy, an illness self-management support group, and a mindfulness class; and Level 3, heart rate variability (HRV) biofeedback, self-hypnosis training with healing imagery, a nutrition consultation, and a sleep medicine clinic. This patient mastered excellent skills with self-hypnosis, paced breathing, and HRV biofeedback. She sustained increased physical activity and a modified diet. At the 3-year point, she reported less frequent pain and joint swelling, less nausea and sick feeling, moderate improvement in sleep, and less frequent and less severe Lupus flares.