Osteoarthritis: Etiology and Pathophysiology

Arthritis & Connective Tissue Diseases

• Chapter introduction covering arthritis and connective tissue diseases

Osteoarthritis (OA)

• OA is a slowly progressive, localized, noninflammatory disorder of the synovial joints, typically weight-bearing joints
• OA is more common in women
• Hand and knee OA are especially common after menopause
• Most adults begin to be affected by age 40
• Over 50% of people over 65 have X-ray evidence of OA in one or more joints

Risk Factors

• Increasing Age is a risk factor for OA
• Decreased estrogen at menopause is a risk factor for OA
• Obesity is a risk factor for OA
• ACL injury is a risk factor for OA
• Frequent kneeling and stooping are risk factors for OA
• Regular moderate exercise can decrease the risk of OA

Etiology and Pathophysiology of OA

• Destruction of articular cartilage causes narrowing of the joint space
• When cartilage is affected from OA it becomes softer and less elastic
• Damaged cartilage is less able to resist wear with heavy use
• Articular surfaces crack and wear down
• Spurs or osteophytes form
• Inflammation and thickening of the capsule and synovium cause early-stage pain and stiffness
• Central cartilage becomes thinner, while edges become thicker
• Osteophytes form, leading to uneven weight distribution
• Bones rub together, increasing pain in later stages

Joint Manifestations

• Joint pain that range from mild discomfort to significant disability
• Pain that worsens with joint use
• Rest relieves pain in early stages
• Pain occurs even at rest and causes trouble sleeping in later stages due to increased joint pain
• Pain may worsen with lower barometric pressure, such as during fall and spring season changes or before precipitation
• Pain can contribute to disability and loss of function
• Pain may be referred to the groin, buttock, or outside of the thigh or knee
• Sitting down and getting up from a chair may become difficult after periods of rest or unchanged position
• Early morning stiffness usually resolves within 30 minutes
• Overactivity leads to mild joint effusion and temporarily increases stiffness
• Crepitation, a grating sensation in the joints affected by OA
• OA affects joints asymmetrically
• Joints most affected by OA include hips, knees, metatarsophalangeal (MTP) joints, cervical vertebrae, and lumbar vertebrae
• Other specific joint involvement in OA:
• Heberden's nodes affect the distal interphalangeal (DIP) joints
• Bouchard's nodes affect the proximal interphalangeal (PIP) joints
• Heberden's and Bouchard's nodes may appear red, swollen, and tender
• Varus deformity, or bowleggedness, affects the medial knee
• Valgus deformity, or knock-knees, affects the lateral knee
• One leg may become shorter than the other at the hip
• Fatigue, fever, and organ involvement are not present in OA

Diagnostic Studies

• X-rays can confirm and stage OA
• Bone scans, CT scans, MRI, and X-rays can show early bone changes of OA
• Bone scans, CT scans, MRI, and X-rays are costly, and not used as much
• There are no specific lab tests or biomarkers; rheumatoid factor is negative
• Synovial fluid analysis can be performed
• There is no cure for treatment of OA
• Treatment goals involve managing pain and inflammation
• Treatment goals involve preventing disability along with maintaining and improving joint function
• Nondrug interventions are the basis for OA management
• Drug therapy supplements nondrug treatment

Rest and Joint Protection

• Balance rest and activity
• Rest during acute inflammation
• Functional positioning with splints or braces
• Avoid increasing stiffness by limiting immobility to less than 1 week
• Modify activities to decrease joint stress
• Avoid prolonged standing, kneeling, or squatting
• Use cane, walker, and crutches as needed

Heat and Cold Applications

• Heat helps reduce pain and stiffness, for no more than 20 minutes at a time
• Ice is typically used for inflammation or swelling, applied for 10-15 minutes at a time
• Use frozen vegetables, cold packs, or covered ice bags
• Hot packs, whirlpool baths, ultrasound, and paraffin wax baths can be used

Nutritional Therapy and Exercise

• Weight reduction is critical for overweight individuals
• Dietary changes are needed
• Exercise recommendations include aerobic exercise, range of motion exercises, muscle strengthening, and water therapy

Complementary and Alternative Therapies

• Acupuncture
• Massage
• Tai Chi
• Nutritional supplements
• Glucosamine and chondroitin are not recommended

Interprofessional Care: Drug Therapy

• Treatment is based on severity of patient's symptoms
• For mild to moderate joint pain medications include:
• Acetaminophen
• Topical agents like capsaicin cream
• Over-the-counter (OTC) creams containing camphor, eucalyptus oil, and menthol, such as BenGay or ArthriCare
• Topical salicylates, such as Aspercreme
• For moderate to severe joint pain, the following drug therapies may be used:
• NSAIDs: start with a low dose and increase if needed
  • Ibuprofen 200 mg up to 4 times per day
  • Misoprostol to decrease GI side effects
  • Arthrotec, a combination of misoprostol and diclofenac
  • Diclofenac gel, but avoid using both oral and topical NSAIDs
• COX-2 inhibitor celecoxib, or Celebrex
• Response to medications, cost, and the risk of NSAIDs vary
• Intraarticular corticosteroid injections may be used
• Four or more injections without relief suggests the need for additional intervention

Interprofessional Care: Surgical Therapy

• Arthroscopic surgery may be considered
• For patients with loss of function, unmanaged pain, and decreased independence
• Common for patients with knee OA
• May provide no additional benefit over physical therapy (PT) and medical treatment
• Hip and knee replacement can be done

Health Promotion

• Alter modifiable risk factors
• Avoid cigarette smoking
• Maintain good posture and body mechanics
• Seek help with tasks that may be injurious to joints
• Warm-up to prevent injury before exercise
• Make home and work modifications such as eliminating scatter rugs and using railings and night lights
• Wear well-fitting support shoes
• Avoid forceful repetitive motions
• Seek prompt treatment of traumatic joint injuries

Rheumatoid Arthritis (RA)

• RA is a chronic, systemic autoimmune disease with inflammation of connective tissue in diarthrodial (synovial) joints
• RA is characterized by periods of remission and exacerbation
• RA has extraarticular manifestations
• RA is a disabling form of arthritis that causes loss of independence and self-care
• RA affects all ethnic groups
• There is an increased incidence with age, with peaks between ages 30 and 50
• RA is three times as common in women as in men

Etiology and Pathophysiology of RA

• RA has an autoimmune etiology
• There is a combination of genetics and environmental triggers involved
• An antigen triggers the formation of abnormal immunoglobulin G or IgG
• Autoantibodies develop against the abnormal IgG
• Rheumatoid factor or RF combines with IgG
• RF combines with IgG to form immune complexes deposited on synovial membranes or cartilage in joints
• This leads to inflammation and cartilage damage

Manifestations

• RA can have a subtle onset
• The disease can cause fatigue, anorexia, and weight loss, generalized stiffness that becomes localized
• A history of precipitating stressful events may be reported
• Such events include infection, stress, exertion, childbirth, surgery, or emotional upset
• No direct correlation has been found in research

Joint Manifestations

• Specific joint involvement includes pain, stiffness, limited motion, and signs of inflammation
• Symptoms occur symmetrically
• RA often affects small joints, such as PIP, MCP, and MTP joints
• Larger joints and the cervical spine may be involved
• Joint stiffness occurs after periods of inactivity
• Morning stiffness lasts for 60 minutes or more
• MCP and PIP joints are typically swollen
• Fingers have a spindle shape
• Joints are tender, painful, and warm to the touch
• Pain increases with motion and the intensity varies and can cause the following deformities:
  • Ulnar drift
  • Swan neck
  • Boutonnière's deformity

Extraarticular Manifestations

• RA affects all body systems
• Rheumatoid nodules: firm, nontender masses on bony areas
• Cataracts and vision loss can occur
• Can cause Pleurisy, Pleural effusion, Pericarditis, Pericardial effusion, and cardiomypathy
• Sjögren's syndrome: dry, gritty eyes and photosensitivity
• Felty syndrome: enlarged spleen and low WBCs result in an increased risk of infection and lymphoma
• Flexion contractures occur
• Also causes self-care deficit

Diagnostic Studies

• History and Physical Exam (H&P)
• Diagnosis depends on specific criteria
• Joint involvement, serology, acute phase reactants, and duration of symptoms

Stages of Rheumatoid Arthritis

• Stage I: Synovitis and X-ray show soft tissue swelling, possible osteoporosis, no joint destruction
• Stage II: increased joint inflammation, gradual destruction in joint cartilage, and narrowing joint space from loss of cartilage
• Stage III: Formation of synovial pannus, extensive cartilage loss, erosion at joint margins, possible deformity
• Stage IV: Inflammatory process subsides, loss of joint function, formation of subcutaneous nodules

Lab tests

• CBC
• ESR: Indicates active inflammation
• CRP: Indicates active inflammation
• RF (positive in 80% of adults)
• Anti-CCP: antibody specific to RA
• ANA: autoimmune reaction

Other Diagnostic Studies

• Bone scans: early joint changes
• X-rays: progression
• Synovial fluid analysis: cloudy, straw-colored fluid with fibrin flecks and MMP-3

Drug Therapy

• Aggressive early treatment improves prognosis
• Drugs are the cornerstone of treatment
• Irreversible changes can occur in the first year
• Disease-modifying antirheumatic drugs (DMARDs) can be used
• They Slow disease progression and decrease the risk of joint deformity and erosion
• The drugs are chosen based on disease activity, functional level, and lifestyle considerations

Methotrexate

– Early treatment with lower toxicity

• Side effects (rare): bone marrow suppression and hepatotoxicity
• It is important to monitor CBC and CMP
• There are therapeutic effects in 4 -6 weeks; may be given alone or with BRMs
• Female patients must use contraception during and for 3 months after

Sulfasalazine

• Encouraging Drink fluids to prevent crystals
• May turn urine or skin orange-yellow in color
• Wear sunscreen

Hydroxychloroquine

• Requires Eye exam: baseline, then every 6-12 months
• Report decreased hearing or tinnitus to physician

Drug Therapy: Biologic Response Modifiers (BRMs)

• Also called biologics or immunotherapy
• Slows progression
• Used for Moderate-severe disease not responsive to DMARDs
• Used alone or in combo with DMARDs
• Tumor necrosis factor (TNF) inhibitors bind with TNF, inhibiting inflammation
• Etanercept (Enbrel): subcutaneous
• Infliximab (Remicade): IV infusion
• Adalimumab (Humira): subcutaneous
• TB test and chest x-ray are required before starting therapy
• Monitor for infection
• Avoid live vaccinations

Other Drug Therapy

• Corticosteroids
  • Intraarticular injections
  • Low-dose oral for limited time
  • Can cause complications such as: osteoporosis and avascular necrosis
• NSAIDs and salicylates can be used
  • Treat pain and inflammation
  • May take 2 -3 weeks for the full effect
  • Celecoxib is a COX-2 inhibitor
  • Non-aspirin NSAIDs increase the risk of blood clots, heart attack, and stroke

Health Promotion & Treatments

• Prevention may not be possible
• Early treatment helps to prevent further joint damage
• Community education programs help with recognition of Symptoms which promotes early diagnosis and treatment
• Nondrug therapy includes: balance of rest and activity
• Heat and cold application
• Relaxation techniques and joint protection
• Biofeedback - TENS and Hypnosis

Rest & Activity

• Alternate rest periods with activity
• Helps to relieve pain and fatigue
• Vary amount of rest
  • Avoid total bed rest
  • Recommend 8 -10 hours of sleep plus daytime rest
• Modify activities to avoid overexertion
• Use Firm mattress or bed board
• Encourage positions of extension
• Avoid flexion positions
  • No pillows under knees
  • Small, flat pillow under head and shoulders

Joint Protection

• Energy conservation
• Work simplification techniques
• Pacing and organizing
• Use of carts
• Joint protective devices
• Delegation
• Assistive devices

Cold and Heat Therapy and Exercise

• Cold is Especially beneficial during periods of disease activity
• Moist heat can be used such as Heating pads, moist hot packs, paraffin baths, warm baths, or showers
• Be alert for burn potential
• Individualized exercise plan to improve flexibility, strength, and endurance
• Patients need both recreational and therapeutic exercise
  • Avoid overly aggressive exercise
  • Gentle ROM exercises done daily to keep joints functional
  • Aquatic exercises in warm water
  • Limit to 1-2 reps during acute inflammation

Psychologic Support

• Patient challenges include: Limited function and fatigue
  • Loss of self-esteem and Altered body image
  • Fear of disability or deformity
  • Use of Unproven or even dangerous remedies
  • Need to Recognize fears and concerns
  • Self-help groups are helpful for some patients
  • Need Strategies to decrease depression

Gout

• Gout is characterized by hyperuricemia and deposition of uric acid crystals in one or more joints
• Sodium urate crystals may be in articular, periarticular, and subcutaneous tissues
• Gout is characterized by painful flares for days to weeks, then long asymptomatic periods

Incidence

• Incidence in US is greater than 8 million
• Blacks have a higher incidence than whites
• Gout is 3 times more common in men than in women
• Women rarely have gout before menopause
• Uric acid is the end-product of purine metabolism and is excreted by kidneys
• Gout occurs if kidneys can't excrete enough or if too much is being made
• Gout is caused by interaction of factors like:
• Metabolic syndrome, increased intake of high purine foods, prolonged fasting, and alcohol
• Two processes must occur for gout (not everyone with high uric acid levels have gout): Crystallization → Inflammation & tissue damage

Clinical Manifestations

• Affects One or more joints, usually less than 4
• Most common in the great toe
• Wrists, knees, ankles, midfoot, and olecranon bursae can also be affected
• Affected joints may be Dusky or cyanotic
• Sensitive to light touch & very tender
• Triggers of Systemic infection, trauma, surgery, or alcohol
• Symptom onset at night
• Sudden swelling and severe pain are present, coupled with a Low-grade fever
  • Duration is 2 to 10 days with or without treatment

Chronic Gout Manifestations

• Multiple joint involvement
• Tophi are visible deposits of crystals in subcut tissues, synovial membranes, tendons, and soft tissues; occur years after the onset of other symptoms
• Severity of gout is variable
  • It may involve infrequent, mild attacks or multiple severe episodes (up to 12 per year) with slow, progressive disability
  • High serum uric acid causes an increase in episodes and tophi
• Chronic inflammation leads to joint deformity, cartilage destruction, and OA
• Large crystal deposits may pierce skin, draining sinuses and causing infection

Complications

• Excessive uric acid excretion leads to kidney or urinary tract stones
• Pyelonephritis contributes to kidney disease

Gout Diagnosis

Serum uric acid levels > 6 mg/dL

• Analysis of a 24-hour urine sample for uric acid
• Synovial fluid aspiration can reveal uric acid crystal formation
• Assessment of Clinical symptoms

Goals of Treating Gout

• End acute attack
• Control hyperuricemia and gout with patient education and adherence

Drug Therapy

- Oral colchicine: anti-inflammatory
- Provides Pain relief in 12 hours & helps aid in diagnosis
- NSAIDs: analgesia
- Corticosteroids: oral or intraarticular
- ACTH

Gout drug therapies

• Prevention includes Xanthine oxidase inhibitor, which decreases uric acid production like allopurinol or Probenecid
• Probenecid increases urinary excretion of uric acid & avoid aspirin
• May cause renal impairment and take w food. Recommend 2L of water daily
• Alternates consist of Pegloticase that metabolizes uric acid to a harmless chemical
• Losartan is used in older adults w gout and HTN

Gout Treatments

• Monitor serum uric acid regularly
• Patient should adhere to Dietary restrictions
• Limit alcohol and food high in high purine
• Red meats as well as adequate urine volume
• Organ meats should be limited
• Shellfish and Fructose-containing drinks should be limited
• Patients should maintain Weight reduction
• Good to implement Supportive care of inflamed joint;
• Assess motion limitations and pain

Spondyloarthropathies

• This is a Group of multisystem inflammatory disorders that affect the spine, peripheral joints, and periarticular structures around the joints . Are Negative for Rheumatoid Factors
• Includes Genetic and Environmental Factors
• Key Symptoms entail Lower Back and Hip Pain brought on by periods of inactivity Includes:
• Ankylosing Spondylitis
• Psoriatic Arthritis
• Reactive Arthritis

Ankylosing Spondylitis (AS)

• Chronic inflammatory disease that primarily affects axial skeleton
  • Sacroiliac joints, intervertebral disc spaces, and costovertebral articulations
• Has a Genetic role (HLA-B27 present in 90%)
• Manifestations lead to Inflammation of joints and adjacent tissues as well as
  • Granulation tissue and fibrous scarring form = joint fusion

Ankylosing Spondylitis (AS) Diagnosis and Complications

• Diagnosis can be done by MRI or a HLA-B27 antigen
• Results in Postural abnormalities such as:
  • Deformities can cause disability
• Impaired spinal ROM and fusion coupled with vision problems cause concerns about safe ambulation
• Can cause Risk for aortic insufficiency, pulmonary fibrosis, and Cauda equina syndrome can occur

Ankylosing Spondylitis (AS) Management and patient care

• Decrease Pain and Inflammation & Maintain maximal skeletal mobility
• Recommend: Heat; hydrotherapy
• Recommend NSAIDs and salicylates or BRM and anti-TNF
• EXERCISE PLAN that entails stretching, gentle movements.
• Surgical intervention may entail Spinal osteotomy or total joint replacement

Patient Education for Ankylosing Spondylitis (AS)

• Disease and Principles of Therapy Provide Physical Therapy/Home Therapy involving:
• Exercise/posture
• ROM and gentle movements
• Use of heat, and drug therapy
• ROM and gentle movements
• Avoid excessive/long workouts or prolonged walks/standing/sitting
• Avoid heavy lifting (spinal flexion)
• Discourage Smoking Cessation
• Provide Vaccines to counteract infection
• Should Maintain Proper Posture and Positioning and maintain
  • Firm Mattress

Psoriatic Arthritis (PsA)

• Involves autoimmune disease that causes skin inflammation and scaly patches with peripheral joints
• Effects the hands and feet
• Can lead to joint stiffness, swelling, pain with Symmetric and Asymmetrical presentation -Environmental, Immune, and Genetic Link (HLA-B27)
• Forms include: - Ends of finger and toes with Arthritic mutilans(severe) - The spine and neck

Diagnostic criteria and Treatments

• X-ray reveals Cartilage loss similar to RA Elevated ESR and serum Uric Acid -Treatment involves:
  • Splinting, Joint ptotection and therapy.
  • NSAIDs, DMARDs, BRMs

Goal and management planning

Teach patients : - the act of Splinting and Joint protection

• provide physical exercises
• instruct use of NSAIDs, DMARDs, BRMs
• and the need for Vaccines as well as being on the lookout for S/s of Infections on immunosuppressants

Reactive Arthritis aka Reiter's Syndrome

• With its most evident symptom being Arthritis is the last symptom to appear in this disorder
• Can be brought on from a bacterial infections in the digestive tract, urinary tract, or genitals - Such bacteria involved may entails Chlamydia, Salmonella, Shigella, Campylobacter
• Leading to Joint pain and inflammation --Symptoms in the eyes, skin, and urinary tract.

Reactive Arthritis manifestation

• Urethritis develops 1 to 2 weeks after sexual contact or GI infection - Followed by low-grade fever, conjunctivitis, and arthritis over next several weeks
• Women also exhibit cervicitis
• Arthritis appears last and may be: - Asymmetric; involves toes and large joints of lower extremities; low back pain as well as Skin and mucous membrane lesions

Treatments (symptom based)

• Use of Doxycycline for patient AND sexual partners
• Recommend Ophthalmic corticosteroids to treat uveitis
• NSAIDs and DMARDs (if becomes chronic) for joint symptoms

Scleroderma: Connective tissue disorder

• Defined by fibrotic and degenerative processes
• Includes inflammatory changes in the skin, blood vessels, synovium, skeletal muscle, and internal organs
• in layman terms :
• a chronic autoimmune disease which causes hardening and thickening of the skin and other connective tissues

Localized scleroderma manifestation and types

• mainly affects the skin More common in children Skin changes appear limited Prognosis better for limited disease

Systemic manifestation and types

• Systemic manifestation is found in Adults
• Changes progress rapidly and effects organs

Scleroderma statistics

• More commonly found in blacks, Native Americans, which effects Japanese descent
• Onset between is found between 20-50 years of age Affects about 300,000 people in the US
• More common in women and is Rare condition, 250 out of every million people in US

Scleroderma: Pathophysiology

• Develops from immunologic and vascular abnormalities
• Risk Factors: environmental or occupation exposure to coal, plastics, silica dust
• Collagen causes tissue fibrosis and blood vessel occlusion
• Function Disruption of lungs, kidneys, heart, Gl tract
• Early Vascular problems involving the small arteries and arterioles Range from benign with limited skin disease to diffuse that rapidly progresses

Clinical Manifestations of Scleroderma

• Diffuse Scleroderma Widespread thickening of the skin that effects Especially hands, arms, thighs, chest, abdomen, face and Damage to blood vessels, heart and lungs, joints and muscles, esophagus, intestines
• Limited Scleroderma does not effect these parts:
• Affects face, fingers, hands, lower arms and legs - and causes CREST syndrome - Calcinosis
• Raynaud's phenomenon
• Esophageal dysfunction
• Sclerodactyly
• Telangiectasia

the CREST pattern in Clinical Scleroderma

• C -- Calcinosis- Calcium deposits in the skin.
• R --Raynaud's phenomenon - spasms of blood vessels in response to cold or stress.
• E --Esophageal dysfunction - acid reflux and decrease in motility of esophagus.
• S --Sclerodactyly - thickening and tightening of the skin on the fingers and hands.
• T --Telangiectasias - dilation of capillaries causing red marks on surface of the skin.

Scleroderma Joint and Skin Changes

• Symmetric, painless swelling or thickening of the fingers and hands may progress to diffuse
  • Scleroderma of the trunk may be limited, doesn't extend above elbow or knee and involve face

Scleroderma - Limited VS Diffused symptoms

• Diffused Causes a Loss of elasticity of skin in which shiny skin causes expressionless face
• Has limited movement in temporomandibular joint and effects Fingers (sclerodactyly)

Scleroderma: Organ Involvement

• Systemic diseases:Sjögren's syndrome, dry eyes and mouth, Esophageal can cause weight loss and constipation
• Malignant causes death if untreated : RENAL DISEASE

Scleroderma: Testing and Diagnosis

• No lab testing can determine this
• Begin dx by ruling out other differential diagnoses.
• Look forOrgan involvement as well as how the disease is showing itself.

SLE (SYSTEMIC LUPUS ERYTHEMATOSUS) general facts

• It is Multisystem inflammatory autoimmune disease
• The Complex multifactorial disorder includes Genetic, Hormonal, Environmental, Immunologic
• Specifically Affects Skin, Joints, Serous membranes (Pleura & Pericardium), Renal system, and the Hematologic and Neurologic system

Systemic Lupus Erythematosus and women

• Its course is Unpredictable as it
• There periods of remission and exacerbation
• Effects the US population being 1.5 million w the disease and it is
• Common in blacks, Asian Americans, Hispanics, and Native Americans than in Whites patients that are
• 90% are women ages 15 to 45 years

SLE (SYSTEMIC LUPUS ERYTHEMATOSUS) Etiology

• The Etiology of : (SLE) is Causes: Unknown cause; type III hypersensitivity response
• Probable causes:
• The 1st is Genetic influence: where high prevalence among family members and where -Hormone factors and pregnancy are involved.

SLE (SYSTEMIC LUPUS ERYTHEMATOSUS) pathophysiology

• Drugs may be involved such as procainamide, hydralazine, quinidine
• Specifically Autoantibodies made against: DNA, erythrocytes, coagulation proteins, lymphocytes, and platelets And the Circulating immune complexes deposited in basement capillary membranes of: effects kidneys, heart, skin, brain, and joints .

Symptoms and Complications for SLE (SYSTEMIC LUPUS ERYTHEMATOSUS)

The Severity of (SLE) is extremely variable between patients and:

• ranges from mild to rapidly progressive disease affecting many body systems and
• Most commonly affects skin, muscles, lining of lungs, heart, nervous tissue, and kidneys with;

General Symptoms

• the General symptoms are fever, weight loss, joint pain, and excessive fatigue precede worsening disease activity

Neurologic and Hemolytic

• Neurologic-effects stroke and brain functions
• Hematologic-Anemia effects +General for renal abdominal and cardiac and pulm.

Clinical Manifestations and Complications vascular

-Includes the vascular system as it presents lesions Most commonly in sun-exposed areas there is a prominent skin: Butterfly rash (Malar rash) that occurs with 55%-85% of cases Dry patchy Alopecia may also be noted

Polymyalgia Arthiritis Increase RISK OF BONE loss

Clinical Manifestations and Complications

• Cardiac- and Pleurisy occur often Dysrhythmia and Tachycardia (HR)
• Anti-phospholipid syndrome can lead to a stroke

SLE SYSTEM problems

• renal- protein and kidney troubles
• Neveous- seizures
• heme- blood disorders

SLE problems explained

• Renal problems are: increased amounts of Protenuria as it effects the kidney and causes kidney problems and
• Nervous- can cause Generalized and/or focal seizures Hematologic issues are that it is a blood disease due to Antibody attacks to normal cells

Clinical Manifestations and Complications

• Infection
• Risk for contracting Pneumonia and the inability for body 2 eliminate bacteria along side a suppressant for multi inflammatory drugs. . and
• Pt has No live vaccines or with cytotoxin

SLE Diagnostic facts

• dx by using symptoms -blood and antibodies need more study

diagnostic test for (SLE)

• There is No one specific tests to SLE: you you must get diagnosed is symptomology
• To do an thorough analysis you check : H&P and you need the: Patient history
• Check 4 Antibodies. As it has the most Specific of what this effects : *ANA (Antinuclear Antibody) are specific to 97% of ppl and
• Anti-DNA
• Anti Sm (Anti-Smith)

In SLE patient work up do these test

• do the CBC and check -serum complement
• Urinalysis-and X-rats and ECG

treatment for (SLE)

Treatment- 1st- manage. activity and balance by giving treatment

• AgeRace

• Gender-

• and Socio eco

• early dx,and-

• Effective treatment.

• -the #1 goal is the meds-

(SLE): Drug - Therapy)

• NSAIDS works as an anti inflammatory and lessions the pains

Drug therapy- Antimalarials-hydroxychloroquine--- Corticosteroids IMMUNOSUPPRESSANTS

Nursing SLE

• Educate how to treat and understand diagnosis .

  Teach Patient to understand

  Explain therapy administration and to take it .

• Therapeutic

• PREGNANT*. .

• Monitor renal cardiovascular

• monitor pregnancy issues

• Therapeutic abortion is 1 step

Implementation nursing SLE

-Understand and support with

Supportive therapy is important -Educate patient

• Understand and support the disease
• Assit patient in developing goals
• understand the issues or problems