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Musculoskeletal Physiopathology > Systemic Lupus & Sclerosis > Flashcards

Systemic Lupus & Sclerosis Flashcards

1
Q

Is systemic lupus erythematosus (SLE) inflammatory?

A

Yes

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2
Q

What are the three most common autoimmune diseases?

A
  1. Rheumatoid arthritis
  2. Systemic lupus erythematosus
  3. Systemic sclerosis
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3
Q

Which systems/anatomical structures are affected by lupus?

A

Multisystem autoimmune disease primarily affecting skin, joints, and kidneys

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4
Q

Which sex is more predominantly affected by lupus?
Of which ethnicity?

A

Females (9:1)
African descent groups

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5
Q

What is the age of onset for lupus?

A

Late teens to 40 years of age

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6
Q

Lupus is often mis-/over-diagnosed as ___

A

fibromyalgia

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7
Q

What is the suspected etiology of lupus?

A
  • Probably genetic component (but doesn’t have to be)
  • May be induced by some medications (such as pain killers and antibiotics)
  • May be triggered by exposure to UV light
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8
Q

What are the general symptoms of lupus?

A

Gradual onset of:

  • Fever
  • Malaise
  • Anorexia
  • Weight loss
  • Alopecia (spotty)
  • Pain and swelling (like rheumatoid arthritis)
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9
Q

Lupus often presents as a self-limiting form of ___

A

rheumatic disorder

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10
Q

What are some physical effects of lupus on joint structure?

A
  • Non-erosive synovitis (and tenosynovitis)
  • Spontaneous tendon rupture
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11
Q

A patient presents with pain and swelling, much like rheumatoid arthritis. They report that “everything hurts”. Upon examination, you find they have a fever and acute necrotizing vasculitis. With more questioning, the patient reports a painful butterfly rash that is accentuated by sunlight.
What is the likely diagnosis?

A

Lupus

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12
Q

A patient presents with spotty hair loss and is noticeably less heavy than you last saw them. They report joint pain and you find that multiple joints are swollen. They also mention that their hands get very white with any temperature drop. Furthermore, they sometimes find erythema on their neck, elbows, and hands.
What is the likely diagnosis?

A

Lupus

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13
Q

A patient with lupus presents with a spontaneous tendon rupture.
What are the consequences of this injury?

A
  • Deformity without arthropathy
  • Attacks collagen, non-erosive
  • Eventual arthritis as instability increases
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14
Q

Lupus has led to deposition of immune complexes and fibrinoid materials in small arteries and arterioles. This has thickened and narrowed small blood vessels.
What is the term for this?

A

Acute necrotizing vasculitis

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15
Q

lupus

How might necrotizing vasculitis affect the kidneys?

A

Leads to fibrosis of kidneys (glomerular damage) and eventually renal failure

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16
Q

lupus

Acute vasculitis of serosal membranes may lead to ___

A

ulceration

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17
Q

What are some of lupus’ effects on the skin?

A
  • Erythema that flares up with other symptoms
  • Painful butterfly rash over bridge of nose and cheeks
  • Sunlight accentuates lesions
  • May appear on neck, elbows, and hands (vasculitis will lead to necrosis)
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18
Q

Is lupus joint involvement bilateral or unilateral?

A

Bilateral and symmetrical

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19
Q

Which joints are primarily affected by lupus?

A
  • Hands
  • Wrists
  • Knees
  • Shoulders

(usually distal)

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20
Q

What are some deformities that may present with lupus?

A
  • Swan neck
  • Boutonniere
  • Hitch-hiker thumb
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21
Q

Are hand deformities from lupus reversible?

A

Subluxations are reversible (deformity without arthropathy)

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22
Q

What is an example of a reversible subluxation in hands besides bony deformities?

A

Non-erosive synovitis

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23
Q

Lupus can cause ___ instability in the spine

A

atlanto-axial

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24
Q

In the case of lupus, what are some conditions resulting from vasculitis?

A
  • Soft tissue necrosis and calcifications
  • Osteonecrosis
25
Q

What x-rays are needed before treating a lupus patient?
What are some restrictions on adjusting this patient?

A

Need cervical flexion extension x-rays before treating
No manipulation of upper cervical spine

26
Q

lupus

How does Boutonniere deformity appear radiographically?

A

Proximal interphalangeal joint is flexed while distal interphalangeal joint is extended

27
Q

lupus

How does swan neck deformity appear radiographically?

A

Proximal interphalangeal joint is extended while distal interphalangeal joint is flexed

28
Q

How does soft tissue calcification appear in lupus?
What do these areas represent?

A

Appear diffuse
Represent areas of necrosis

29
Q

Patients with a diagnosis of lupus have more pain in areas of ___ blood supply

A

less

30
Q

Patients unaware that they have lupus have what sort of complaint?
How do they recreate the pain?

A

Report bone pain, not joint pain
Cannot recreate the pain

31
Q

Lupus involves vascular weakening
What are three results of this that can occur at the hip joint?

A
  1. Sclerosis
  2. Flattening
  3. Fragmentation
32
Q

What are the ESR and CRP levels in someone with systemic lupus erythematosus?

A

Both elevated

33
Q

Why do those with chronic lupus experience anemia?

A

Bone marrow fibrosis

34
Q

Are those with lupus positive or negative for RF factor?

A

Negative

35
Q

Which noninflammatory musculoskeletal condition involves anti-double-stranded DNA and anti-nuclear antibodies (ANA) while RF negative?

A

Systemic lupus erythematosus

36
Q

ANA is positive in 95% of those with lupus
Is this specific to lupus?

A

Not specific, positive in several autoimmune conditions

37
Q

Lupus can decrease renal function
What may be found upon urinalysis of someone with lupus?

A

Elevated creatinine

38
Q

What are some treatments for lupus?

A
  • Corticosteroids (short-term) or other drug therapy
  • Education
  • Soft tissue work
  • Low impact activity
  • Treat like other inflammatory diseases
  • Do not adjust an unstable joint
39
Q

Systemic sclerosis is a collagen vascular disorder, similar to ___

A

lupus

40
Q

Systemic sclerosis involves excess deposition of ___ causing ___
A major component of this is ___

A

deposition of collagen causing organ fibrosis
major component is vasculitis

41
Q

What is the age of onset for systemic sclerosis?
Which sex is primarily affected by systemic sclerosis?

A

Onset 40-50-years-old
Primarily females

42
Q

Systemic sclerosis has ___ involvement 80% of the time

A

GI

43
Q

What are some ways the GI system is involved in systemic sclerosis?

A
  • Xerostomia (desert mouth)
  • Loss of peristalsis (difficulty swallowing)
  • Severe reflux (GERD, Barret esophagus, esophageal carcinoma)
44
Q

What is one of the most common causes of death from lupus?

A

Renal failure

45
Q

What is the most common cause of death from systemic sclerosis?

A

Lung disease (COPD, emphysema)

46
Q

Which systems are most commonly affected by systemic sclerosis fibrosis?

A

Pulmonary, renal, and cardiac fibrosis

47
Q

How does systemic sclerosis affect the kidneys and in turn, the cardiovascular system?

A

Renal insufficiency and malignant hypertension

48
Q

What are some musculoskeletal symptoms associated with systemic sclerosis?

A
  • Swelling
  • Arthralgia
  • Synovitis
  • Loss of active range of motion
  • Deformity

affects many joints

49
Q

Systemic sclerosis is overdiagnosed as ___

A

fibromyalgia

50
Q

Systemic sclerosis involves increasing ___ activity

A

fibroblastic

51
Q

How might vasculitis due to systemic sclerosis appear?

A

Raynaud phenomenon in finger and toe tips, ears, and nose

52
Q

Systemic sclerosis involves a combination of fibroblastic and vascular changes.
What are some of these combined changes?

A
  • Acro-osteolysis (finger/toe tips erode, cheekbones and chin erode)
  • Soft tissue calcifications (of necrosed areas and high contact areas)
  • Loss of facial expression (due to tight skin)
53
Q

What are the ESR and CRP levels in a patient with systemic sclerosis?

A

Both elevated

54
Q

When will systemic sclerosis lead to anemia?

A

Once chronic

55
Q

Is systemic sclerosis RF positive or negative?

A

Negative

56
Q

Systemic sclerosis patients are ANA postive 90% of the time
Is ANA specific for systemic sclerosis?

A

No

57
Q

Systemic sclerosis decreases renal function
What may be found in a urinalysis of a patient with systemic sclerosis?

A

Elevated creatinine (and liver enzymes)

58
Q

Is systemic sclerosis inflammatory?

A

Yes

Musculoskeletal Physiopathology (32 decks)

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