MS and Autoimmune1.pdf

Musculoskeletal and Autoimmune Evaluation Health Assessment MS Diseases/Disorders Two key components Deformities Chronic inflammation Chronic inflammation can lead to vasculitis and multiorgan dysfunction CV, pulmonary, renal, hepatic, integumentary, GI, central nervous, peripheral nervous Rheumatoi...

Musculoskeletal and Autoimmune Evaluation Health Assessment MS Diseases/Disorders Two key components Deformities Chronic inflammation Chronic inflammation can lead to vasculitis and multiorgan dysfunction CV, pulmonary, renal, hepatic, integumentary, GI, central nervous, peripheral nervous Rheumatoid Arthritis Chronic inflammation – joints and multiorgan involvement Women double men in number Distal joints more than proximal TMJ and cricoarytnoid cartlidge involvement Limited mouth opening Hoarseness Limited rang of motion Atlantoaxial subluxation can occur in up to 46% of patients Airway and RA Can result in atlantoaxial instability and cervical myelopathy Anterior atlas-dens interval (AADI) >9mm Posterior interval males Fever, chronic fatigue, migratory arthritis impacting small joins of hands and feet Dermatologic manifestations Alopecia, photosensitivity, ”butterfly rash” across cheeks Vasospastic component SLE Interstitial lung disease, pleural effusions, infections, and pulmonary hypertension is common Pulmonary hypertension Results from chronic pulmonary emboli and vasculopathy Premature CAD, pericarditis, myocarditis, and cardiomyopathy HTN is difficult to control Lupus nephritis is end-stage disease Anemia and leukopenia SLE Exam focuses on evaluation of all major organ systems Cough, dyspnea, atypical chest pain, orthopnea require further workup Despite long PTT, high risk of thromboembolic events Neuro exam including central and peripheral neuropathy/deficits EKG, Lytes, CBC, and PTT is indicated Frequently have antiphospolipid antibodies resulting in the frequent thromboembolic events Systemic Sclerosis Scleroderma is the other term Autoimmune disease causing excessive fibrous tissue deposits Skin thickening Raynaud syndrome Three classes Localized (just skin) Limited (skin of face and UE, GI involvement) Diffuse (generalized skin, multiple end-organs) Heart failure (R>L), Coronary A fibrosis, pericarditis Systemic Sclerosis Pulmonary hypertension (from interstitial lung disease) is leading cause of death Presence of pulmonary hypertension is an ominous sign and increases perioperative risk Careful pulmonary and cardiac history Airway involvement due to fibrosis Systemic Sclerosis Raynaud Syndrome Exaggerated vascular response to cold/stress Associated connective tissue diseases 95% of patient with systemic sclerosis 30% of patients with Sjogren disease/SLE Cutaneous vasospasm Raynaud itself is not an anesthetic issue, comorbid diseases are a concern Very different from peripheral vascular disease Ehler’s-Danlos Syndrome Disorder of collagen synthesis Joint hypermobility Type IV disease more serious because of vascular fragility Type VI have muscle weakness, scoliosis, osteopenia Can involve heart valves Focuis on positioning issues Marfan Syndrome Tall, long digits, scoliosis, valvular heart disease AI Aortic dissection MVP MR These patients all need a complete and thorough cardiac evaluation