Lupus Flashcards
What is the most common autoimmune disease?
Rheumatoid arthritis
What is the second most common autoimmune disease?
Systemic Lupus Erythematosus
What areas of the body are affected by Lupus?
- multiple organ systems
- primarily skin, joints, kidneys
Lupus is more prevalent in females from ____ descent groups
African
What sex is Lupus more common in?
F>M (9:1)
What age group is primarily affected by Lupus?
onset from late teens to 40 yrs
(peak = 20-40yrs)
Lupus is often over-diagnosed as what other condition?
fibromyelgia
What is the etiology of Lupus?
probably genetic (doesn’t have to be)
What factors may trigger Lupus?
- medications
- pain killers & antibiotics
- exposure to UV light
What are the general clinical manifestations of Lupus?
- gradual onset
- fever & malaise
- anorexia & weight loss
- alopecia (spotty hair loss)
- pain & swelling like RA
- acute necrotizing vasculitis
What are the effects of Lupus on joints?
- polyarthralgia (“everything hurts”)
- often self-limiting
- non-erosive synovitis/tenosynovitis
- deformity (tendon rupture) without arthropathy (non-erosive)
- ^instability eventually results in arthritis
Lupus is characterized as a ____-____ disease
collagen-vascular
What is acute necrotizing vasculitis?
- deposition of immune complexes & fibrinoid materials in small aa and arterioles
- thickening & narrowing of small BVs
How does acute necrotizing vasculitis affect organs?
organ fibrosis
acute vasculitis of serosal membranes may lead to ____
ulceration
What are the effects of Lupus on the kidney?
Acute necrotizing vasculitis causes:
- glomerular damage
- renal failure
What is the term for the effect of Lupus on the skin?
Erythema
(caused by acute vasculitis)
What is erythema?
painful skin rash caused by acute necrotizing vasculitis
Where are the common locations of erythema seen in Lupus?
- bridge of nose & cheeks (butterfly/malar rash)
- neck
- elbows
- hands (palms)
The butterfly rash of systemic lupus erythematosus is also known as ____
malar rash
What sign may be seen in a patient with Lupus if there are small temperature changes in the environment?
Raynaud phenomenon
(acute necrotizing vasculitis causes hyperreactivity of BVs)
____ is one of the number one causes of death from Lupus
renal failure
When do the skin effects of Lupus occur in relation to other symptoms?
flare up at same time
What can worsen erythema in a patient with Lupus?
sunlight (UV exposure)
What are the radiographic characteristics of Lupus?
- BL symmetric jt involvement
- reversible subluxations in hands (deformity w/out arthropathy)
- swan neck, boutonniere, hitch-hiker deformities
- atlanto-axial instability
- soft tissue necrosis & calcifications
- osteonecrosis
What radiographic characteristics of Lupus are caused by vasculitis?
- soft tissue necrosis & calcifications
- osteonecrosis
What deformities may be caused by Lupus?
(reversible subluxations)
- swan neck
- boutonniere
- hitch-hiker thumb
- ulnar drift
What is the radiographic latency period of Lupus?
2-5 years (late stage, would already have Dx)
What imaging test is required before any treatment to the neck in a patient with any autoimmune condition?
cervical radiographs with flexion/extension
What joints are primarily affected by Lupus?
- hands
- wrists
- knees
- shoulders
How does soft tissue calcification in Lupus appear radiographically?
diffuse (tiny white dots everywhere)
What does radiographic soft tissue calcification in Lupus represent?
areas of necrosis
What are the 3 radiographic findings for osteonecrosis in order of occurrence?
- sclerosis
- flattening
- fragmentation
In a patient with a diagnosis of Lupus, what areas would you be concerned about avascular necrosis?
areas of poor blood supply
(hips, ankles, shoulders, knees)
How would a patient who is unaware that they have Lupus (no diagnosis) present?
complains of bone pain (not jt pain), unable to recreate pain with ortho
What are the relevant lab findings for Lupus?
- ^ESR/CRP
- anemia of chronic dz
- RF neg.
- Anti-double-stranded DNA (dsDNA)
- Anti-nuclear antibodies (ANA) pos. in 95% (not specific)
- ^creatinine in urine (reduced renal function)
Patients with late stage Lupus will have (localized/systemic) avascular necrosis
systemic
(multiple sites of involvement)
What does bone marrow fibrosis caused by Lupus result in?
anemia of chronic dz
What are the possible treatments for Lupus?
(refer to rheumatology)
- corticosteroids (acute) or other drug therapy (DMARDs)
- anti-inflam. diet
- education
- soft tissue work
- low impact activity
- do not adjust unstable jts
