T7: SLE and Myofascial Pain Syndrome and Fibromyalgia Flashcards
Systemic Lupus Erythematosus
chronic autoimmune inflammatory disease of collagen in skin, joints, and internal organs
SLE affects
skin, joints, serous membranes (pleura, pericardium), renal system, hematologic system, neurologic system
SLE clinical manifestations: dermatologic
-Vascular skin lesions (Most commonly in sun-exposed areas)
-Butterfly rash
-Discoid lesions (round-coin shaped lesions)
-Subacute cutaneous lupus
-Oral/nasopharyngeal ulcers
-Alopecia
SLE clinical manifestations: musculoskeletal
-Polyarthralgia with morning stiffness
-Arthritis
-Swan neck fingers
-Ulnar deviation
-Subluxation with hyperlaxity of joints
-Increased risk of bone loss and fracture
SLE clinical manifestations: cardiopulmonary
-Tachypnea
-Cough
-Pleurisy
-Dysrhythmias (Fibrosis of SA and AV nodes)
-Pericarditis
-Antiphospholipid syndrome-hypercoaguability (MI, stroke, gangrenous lesions due to emboli)
SLE clinical manifestations: renal
-Mild proteinuria to rapidly progressive glomerulonephritis
-Scarring, permanent damage can lead to end-stage renal disease-leading cause of death
treatments for SLE
-Corticosteroids-prednisone, methylprednisolone
-cytotoxic agents-Cytoxan
-immunosuppressive agents-Imuran, cyclosporine, CellCept
immunosuppressive drug fro SLE
methotrexate
SLE clinical manifestations: nervous system
-Generalized/focal seizures
-Peripheral neuropathy
-Cognitive dysfunction (Disordered thinking, Disorientation, Memory deficits)
SLE clinical manifestations: hematomogic
-Formation of antibodies against blood cells
-Anemia
-Leukopenia
-Thrombocytopenia
-Coagulation disorder
SLE clinical manifestations: infection
-Increased susceptibility to infections
-Defects in ability to phagocytize invading bacteria
-Deficiency production of antibodies
-Immunosuppressive effect of many antiinflammatory drugs
-Infection is a major cause of death
diagnostics for SLE
really hard to diagnose
-Anti-nucleic antibody (ANA)
-ANA is present in 97% of persons with the disease
-Anti-DNA 50%
-Anti-Sm(Smith) 30-40%
-ESR, CRP (only used for monitoring not diagnosis)
care for SLE
*managing the disease while preventing complications of treatments.
drug therapy for SLE
-NSAIDs (Mild arthralgia or arthritis)
-Antimalarial drugs
-Steroid-sparing drugs
-Corticosteroids (Severe cutaneous SLE)
-Immunosuppressive drugs (Methotrexate, azathioprine, cyclophosphamide)
in SLE observe for
-Fever pattern
-Joint inflammation
-Limitation of motion
-Location and degree of discomfort
-Fatigue
SLE Psychosocial Issues
-Supportive therapies to help patient cope with the disease
-Inform patient and caregiver that SLE has good prognosis for most people
-Stress importance of planning recreational and occupational activities
-Assist patient in developing goals
Lupus and pregnancy
-Infertility can result (Renal involvement, High-dose corticosteroids, Immunosuppressive drugs)
-Women with serious SLE should be counseled AGAINST pregnancy
health promotion of SLE
-Prevention of SLE is not currently possible
-Education of health professionals and the community to create a clear understanding of the disease and need for early diagnosis and treatment
ambulatory care of SLE
-Emphasize importance of patient involvement for successful home management
-Help patient understand that strong adherence to treatment is no guarantee against flares
-Reduce exposure to precipitating factors
precipitating factors that decrease activity in SLE
*fatigue, sun exposure, emotional stress, infection, drugs, and surgery.
Myofascial pain syndrome
*chronic form of muscle pain marked by musculoskeletal pain and tenderness, typically in the chest, neck, shoulders, hips, and lower back.
-can cause referred pain , HA, TMJ
trigger or tender points in myofascial pain syndrome are activated by
-Activated by pressure
-Worsens with activity or stress
patients with myofascial pain syndrome complain of
Deep, aching pain accompanied by burning, stinging, stiffness
treatment for myofascial pain syndrome
-Physical therapy
-“Spray and stretch” method
-Painful area is iced or sprayed with a coolant and then stretched
-Topical patches
-Trigger point injections
-Massage, acupuncture, biofeedback, ultrasound
Fibromyalgia
*chronic central pain syndrome marked by widespread, nonarticular musculoskeletal pain and fatigue with multiple tender points.
People with fibromyalgia may also experience
-Nonrestorative sleep
-Morning stiffness
-Irritable bowel syndrome
-Anxiety
Fibromyalgia is a disorder involving…
abnormal central processing of nociceptive pain input.
clinical manifestations of fibromyalgia
-Widespread burning pain
-Worsens and improves throughout day
-Trouble determining if pain is in muscles, joints, or soft tissues
-Head or facial pain
-Can accompany TMJ dysfunction
-Difficulty concentrating/memory lapses
-Migraine headaches
Tender Points in Fibromyalgia
*Physical examination typically reveals point tenderness at 11 or more of 18 identified sites.
allodynia
Pain due to a stimulus that does not normally provoke pain
complications of fibromyalgia
-Depression and anxiety
-Stiffness
-Nonrefreshing sleep
-Fatigue
-Paresthesia
-Restless legs syndrome
-Irritable bowel syndrome
-Difficulty swallowing
-↑ Frequency of urination and urinary urgency
-For women, difficult menstruation
diagnostic studies of fibromyalgia
-Low ANA titer, but not diagnostic
Fibromyalgia if two criteria are met:
-Pain is experienced in 11 of 18 tender points on palpation
-History of widespread pain is noted for at least 3 months
drug therapy for fibromyalgia (for chronic wide spread pain)
-Pregabalin (Lyrica) gabapentin (Neurontin)
-Duloxetine (Cymbalta)
-Milnacipin (Savella)
other medications for fibromyalgia
-Low-dose tricyclic antidepressants (TCAs), SSRIs, or benzodiazepines
-Muscle relaxants
-Nonopioid analgesics
-Zolpidem (Ambien)
interprofessional care for fibromyalgia
-Symptomatic treatment
-Requires high level of patient motivation
-Patient teaching to be an active part in therapeutic regimen
-Rest
nursing management of fibromyalgia
-Supportive care
-Massage combined with ultrasound
-Application of alternating heat and cold packs
-PT (gentle stretching)
-Yoga/Tai Chi
-Low impact aerobic exercise
-Limit intake of sugar, caffeine, alcohol (May be muscle irritants)
-Vitamin and mineral supplements
-Biofeedback, imagery, meditation, cognitive behavioral therapy
