18: ARTHRITIS AND COMMON TISSUE DISEASES
LUPUS ERYTHEMATOSUS (DLE/SLE)
>>> PATHO
• Lupus is probably caused by a complex combo of genetic and environmental factors
• 2 main classifications:
o Discoid lupus erythematosus (DLE) – effects only the skin
o Systemic lupus erythematosus (SLE) – more common
• Systemic lupus erythematosus (SLE):
o Chronic, progressive, inflammatory connective tissue disorder that can
cause major body organs/systems to fail
o Spontaneous remissions and exacerbations
o Onset may be acute or insidious (slow)
o Potentially fatal, but most live many years
o Autoimmune process – invades organs or deprives them of blood and oxygen
o Immune complexes invade organs directly or cause vasculitis (vessel
inflammation), which deprives the organs of arterial blood and
oxygen.
o Autoimmune complexes tend to be attracted to glomeruli of the kidneys
o Often some degree of kidney involvement (lupus nephritis) – this is the
leading cause of death from this disease
o Onset at 20-40 years old
>>> ASSESSMENT
>> PHYSICAL ASSESSMENT
• When in remission pt. may
appear fully healthy
• When disease flares up, pt. may
need to be admitted to the
hospital
1
,• MT skin condition daily and at
every home visit
2
,CHART 18-11 KEY FEATURES – SLE AND SSc
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) SYSTEMIC SCLEROSIS (SSc)
SKIN Inflamed, red rash on face Inflamed
(“butterfly rash”) Fibrotic
Sclerotic
- can appear on other sun-
Edematous
exposed areas
- disappears when in remission
Discoid lesions
- worsen when exposed to sunlight
or UV light
- do not disappear, but fade in
remission
RENAL Nephritis Kidney failure
CARIAC Pericarditis (chest pain, SOB, fever) Myocardial fibrosis
Raynaud’s phenomenon (decreased Raynaud’s phenomenon
blood flow to fingers) Deep vein thrombosis
PULMONARY Pleural effusions (accumulation of fluid Interstitial fibrosis
around the lungs) Pulmonary HTN
Pneumonia
NEURO CNS lupus Not common
GI Abd. pain Esophagitis
Ulcers
GERD
MUSCLE Joint inflammation (polyarthritis) Arthralgia
Myositis Myositis
OTHER Fever (indicates exacerbation) Fever
Fatigue Fatigue
3
, Anorexia Anorexia
Weight loss Vasculitis
Generalized weakness
Vasculitis
Osteonecrosis (bone necrosis from lack
of oxygen)
- most common in the hip
>> PSYCHOSOCIAL ASSESSMENT
4
LUPUS ERYTHEMATOSUS (DLE/SLE)
>>> PATHO
• Lupus is probably caused by a complex combo of genetic and environmental factors
• 2 main classifications:
o Discoid lupus erythematosus (DLE) – effects only the skin
o Systemic lupus erythematosus (SLE) – more common
• Systemic lupus erythematosus (SLE):
o Chronic, progressive, inflammatory connective tissue disorder that can
cause major body organs/systems to fail
o Spontaneous remissions and exacerbations
o Onset may be acute or insidious (slow)
o Potentially fatal, but most live many years
o Autoimmune process – invades organs or deprives them of blood and oxygen
o Immune complexes invade organs directly or cause vasculitis (vessel
inflammation), which deprives the organs of arterial blood and
oxygen.
o Autoimmune complexes tend to be attracted to glomeruli of the kidneys
o Often some degree of kidney involvement (lupus nephritis) – this is the
leading cause of death from this disease
o Onset at 20-40 years old
>>> ASSESSMENT
>> PHYSICAL ASSESSMENT
• When in remission pt. may
appear fully healthy
• When disease flares up, pt. may
need to be admitted to the
hospital
1
,• MT skin condition daily and at
every home visit
2
,CHART 18-11 KEY FEATURES – SLE AND SSc
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) SYSTEMIC SCLEROSIS (SSc)
SKIN Inflamed, red rash on face Inflamed
(“butterfly rash”) Fibrotic
Sclerotic
- can appear on other sun-
Edematous
exposed areas
- disappears when in remission
Discoid lesions
- worsen when exposed to sunlight
or UV light
- do not disappear, but fade in
remission
RENAL Nephritis Kidney failure
CARIAC Pericarditis (chest pain, SOB, fever) Myocardial fibrosis
Raynaud’s phenomenon (decreased Raynaud’s phenomenon
blood flow to fingers) Deep vein thrombosis
PULMONARY Pleural effusions (accumulation of fluid Interstitial fibrosis
around the lungs) Pulmonary HTN
Pneumonia
NEURO CNS lupus Not common
GI Abd. pain Esophagitis
Ulcers
GERD
MUSCLE Joint inflammation (polyarthritis) Arthralgia
Myositis Myositis
OTHER Fever (indicates exacerbation) Fever
Fatigue Fatigue
3
, Anorexia Anorexia
Weight loss Vasculitis
Generalized weakness
Vasculitis
Osteonecrosis (bone necrosis from lack
of oxygen)
- most common in the hip
>> PSYCHOSOCIAL ASSESSMENT
4
