Joint disorder

Question 1

A 35-year-old woman presents to your office with a six-month history of arthralgia, fatigue, and a facial rash. She is concerned that she may have systemic lupus erythematosus (SLE). You share her concern.

List three other symptoms associated with SLE.

Answer 1

Weight loss
Fever without focal infection
Myalgias
Malar rash
Photosensitivity
Pleuritic chest pain
Raynaud's phenomenon
Mouth sores 

Ref: CFPC Self Learning Module Vol 32.2 (April 2017)

Question 2

A 35-year-old woman presents to your office with a six-month history of arthralgia, fatigue, and a facial rash. She is concerned that she may have systemic lupus erythematosus (SLE). You share her concern.

List three initial lab tests you should perform.

Answer 2

Antinuclear antibody (ANA)
Complete blood count (CBC)
Erythrocyte sedimentation rate (ESR)
C-reactive protein
Urinalysis
Direct Coombs test
Comprehensive metabolic panel

Question 3

A 35-year-old woman presents to your office with a six-month history of arthralgia, fatigue, and a facial rash. She is concerned that she may have systemic lupus erythematosus (SLE). You share her concern.

The American College of Rheumatology has 11 diagnostic criteria for SLE. List four.

Answer 3

Pleuritis or Pericarditis 
Hemolytic anemia or Leukopenia or Thrombocytopenia 
Positive antinuclear antibodies 
Elevated anti-dsDNA, Elevated anti-Smith antibody, or Elevated antiphospholipid antibody 
Discoid rash 
Photosensitivity 
Oral or nasal ulcers 
Non-erosive arthritis 
Seizure or Psychosis 
Proteinuria 
Malar rash 

If a patient meets at least four criteria, lupus can be diagnosed with 95% specificity and 85% sensitivity.

Question 4

A 35-year-old woman presents to your office with a six-month history of arthralgia, fatigue, and a facial rash. She is concerned that she may have systemic lupus erythematosus (SLE). You share her concern.

Your patient asks if it is safe for her to take hormonal contraceptives if she has SLE. What do you advise her?

Answer 4

Patients with SLE may use hormonal contraceptives, unless there is a specific contraindication such as antiphospholipid syndrome.

Question 5

A 35-year-old woman presents to your office with a six-month history of arthralgia, fatigue, and a facial rash. She is concerned that she may have systemic lupus erythematosus (SLE). You share her concern.

Management of SLE depends on the manifestations in each patient. If this patient met the diagnostic criteria for SLE, what initial treatment might you offer for her arthritis?

Answer 5

Antimalarials (e.g. hydroxychloroquine)

Low-dose glucocorticoids