Systemic Lupus & Sclerosis Flashcards
Is systemic lupus erythematosus (SLE) inflammatory?
Yes
What are the three most common autoimmune diseases?
- Rheumatoid arthritis
- Systemic lupus erythematosus
- Systemic sclerosis
Which systems/anatomical structures are affected by lupus?
Multisystem autoimmune disease primarily affecting skin, joints, and kidneys
Which sex is more predominantly affected by lupus?
Of which ethnicity?
Females (9:1)
African descent groups
What is the age of onset for lupus?
Late teens to 40 years of age
Lupus is often mis-/over-diagnosed as ___
fibromyalgia
What is the suspected etiology of lupus?
- 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
What are the general symptoms of lupus?
Gradual onset of:
- Fever
- Malaise
- Anorexia
- Weight loss
- Alopecia (spotty)
- Pain and swelling (like rheumatoid arthritis)
Lupus often presents as a self-limiting form of ___
rheumatic disorder
What are some physical effects of lupus on joint structure?
- Non-erosive synovitis (and tenosynovitis)
- Spontaneous tendon rupture
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?
Lupus
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?
Lupus
A patient with lupus presents with a spontaneous tendon rupture.
What are the consequences of this injury?
- Deformity without arthropathy
- Attacks collagen, non-erosive
- Eventual arthritis as instability increases
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?
Acute necrotizing vasculitis
lupus
How might necrotizing vasculitis affect the kidneys?
Leads to fibrosis of kidneys (glomerular damage) and eventually renal failure
lupus
Acute vasculitis of serosal membranes may lead to ___
ulceration
What are some of lupus’ effects on the skin?
- 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)
Is lupus joint involvement bilateral or unilateral?
Bilateral and symmetrical
Which joints are primarily affected by lupus?
- Hands
- Wrists
- Knees
- Shoulders
(usually distal)
What are some deformities that may present with lupus?
- Swan neck
- Boutonniere
- Hitch-hiker thumb
Are hand deformities from lupus reversible?
Subluxations are reversible (deformity without arthropathy)
What is an example of a reversible subluxation in hands besides bony deformities?
Non-erosive synovitis
Lupus can cause ___ instability in the spine
atlanto-axial
In the case of lupus, what are some conditions resulting from vasculitis?
- Soft tissue necrosis and calcifications
- Osteonecrosis
What x-rays are needed before treating a lupus patient?
What are some restrictions on adjusting this patient?
Need cervical flexion extension x-rays before treating
No manipulation of upper cervical spine
lupus
How does Boutonniere deformity appear radiographically?
Proximal interphalangeal joint is flexed while distal interphalangeal joint is extended
lupus
How does swan neck deformity appear radiographically?
Proximal interphalangeal joint is extended while distal interphalangeal joint is flexed
How does soft tissue calcification appear in lupus?
What do these areas represent?
Appear diffuse
Represent areas of necrosis
Patients with a diagnosis of lupus have more pain in areas of ___ blood supply
less
Patients unaware that they have lupus have what sort of complaint?
How do they recreate the pain?
Report bone pain, not joint pain
Cannot recreate the pain
Lupus involves vascular weakening
What are three results of this that can occur at the hip joint?
- Sclerosis
- Flattening
- Fragmentation
What are the ESR and CRP levels in someone with systemic lupus erythematosus?
Both elevated
Why do those with chronic lupus experience anemia?
Bone marrow fibrosis
Are those with lupus positive or negative for RF factor?
Negative
Which noninflammatory musculoskeletal condition involves anti-double-stranded DNA and anti-nuclear antibodies (ANA) while RF negative?
Systemic lupus erythematosus
ANA is positive in 95% of those with lupus
Is this specific to lupus?
Not specific, positive in several autoimmune conditions
Lupus can decrease renal function
What may be found upon urinalysis of someone with lupus?
Elevated creatinine
What are some treatments for lupus?
- 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
Systemic sclerosis is a collagen vascular disorder, similar to ___
lupus
Systemic sclerosis involves excess deposition of ___ causing ___
A major component of this is ___
deposition of collagen causing organ fibrosis
major component is vasculitis
What is the age of onset for systemic sclerosis?
Which sex is primarily affected by systemic sclerosis?
Onset 40-50-years-old
Primarily females
Systemic sclerosis has ___ involvement 80% of the time
GI
What are some ways the GI system is involved in systemic sclerosis?
- Xerostomia (desert mouth)
- Loss of peristalsis (difficulty swallowing)
- Severe reflux (GERD, Barret esophagus, esophageal carcinoma)
What is one of the most common causes of death from lupus?
Renal failure
What is the most common cause of death from systemic sclerosis?
Lung disease (COPD, emphysema)
Which systems are most commonly affected by systemic sclerosis fibrosis?
Pulmonary, renal, and cardiac fibrosis
How does systemic sclerosis affect the kidneys and in turn, the cardiovascular system?
Renal insufficiency and malignant hypertension
What are some musculoskeletal symptoms associated with systemic sclerosis?
- Swelling
- Arthralgia
- Synovitis
- Loss of active range of motion
- Deformity
affects many joints
Systemic sclerosis is overdiagnosed as ___
fibromyalgia
Systemic sclerosis involves increasing ___ activity
fibroblastic
How might vasculitis due to systemic sclerosis appear?
Raynaud phenomenon in finger and toe tips, ears, and nose
Systemic sclerosis involves a combination of fibroblastic and vascular changes.
What are some of these combined changes?
- 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)
What are the ESR and CRP levels in a patient with systemic sclerosis?
Both elevated
When will systemic sclerosis lead to anemia?
Once chronic
Is systemic sclerosis RF positive or negative?
Negative
Systemic sclerosis patients are ANA postive 90% of the time
Is ANA specific for systemic sclerosis?
No
Systemic sclerosis decreases renal function
What may be found in a urinalysis of a patient with systemic sclerosis?
Elevated creatinine (and liver enzymes)
Is systemic sclerosis inflammatory?
Yes
