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Care of the Lupus Patient

Dermatologic Manifestations continued...

Skin alterations in the lupus patient, particularly those of DLE, can be disfiguring. As a result, patients may experience fear of rejection by others, negative feelings about their body, and depression. Changes in lifestyle and social involvement may occur.

Potential Problems

  1. Alteration in skin integrity
  2. Alopecia
  3. Discomfort (pain, itching)

  4. Alteration in body image
  5. Depression

Nursing Interventions

Objective: Minimize Appearance of Lesions

  1. Document appearance and duration of lesions and rashes.
  2. Teach patient to minimize direct exposure to UV rays from sun and from fluorescent and halogen light bulbs. (Glass does not provide complete protection from UV rays.)
  3. Instruct patient to use a sunscreen with an SPF of 15 or greater and wear protective clothing. Patients who are allergic to PABA will need to find a PABA-free sunscreen.
  4. Provide information on hypoallergenic concealing makeup.
  5. Instruct patient to avoid topical applications, such as hair dyes and skin creams, and the use of certain drugs that may make her or him more sensitive to the sun.

Objective: Alleviate Discomfort

  1. For patients with mouth lesions, suggest a soft-food diet, lip balms, and warm saline rinses.
  2. Instruct patient to take medications that may help to alleviate discomfort and itching as ordered. (The doctor may give the patient intralesional steroid injections.)
  3. Suggest self-help measures for patients with Raynaud's phenomenon, including: keep warm, particularly in cold weather; use chemical warmers, gloves, socks, hats; avoid air conditioning; use insulated drinking glasses for cold drinks; wear gloves when handling frozen or refrigerated foods; quit smoking; control stress; and exercise as tolerated.

Objective: Help Patients to Cope with Potential Psychological Manifestations

See the nursing interventions dealing with psychological issues under manifestions in this article.

Musculoskeletal Manifestations


Arthralgia or arthritis is experienced by 95% of SLE patients at some time during the course of the disease. Articular pain is the initial symptom in about one-half of patients eventually diagnosed with SLE. Morning stiffness and joint and muscle aching can also occur. Joint pain may be migratory; it is typically symmetric but is asymmetric in many patients. Joints may become warm and swollen. X rays of the joints usually do not show erosion or destruction of bone.

Unlike rheumatoid arthritis, the arthritis of SLE tends to be transitory. Proliferation of the synovium is more limited, and joint destruction is rare. The joints most commonly involved are those of the fingers, wrists, and knees; less commonly involved are the elbows, ankles, and shoulders.

Several joint complications may occur in SLE patients, including Jaccoud's arthropathy and osteonecrosis. Subcutaneous nodules, especially in the small joints of the hands, are seen in about 5% of patients. Tendinitis, tendon rupture, and carpal tunnel syndrome are seen occasionally.

Potential Musculoskeletal Manifestations

  • Morning stiffness and aching
  • Joint pain
  • Warm, swollen joints
  • Ulnar deviation of the fingers with swan neck deformities and subluxations
  • Generalized myalgia and muscle tenderness, especially in the upper arms and upper legs

WebMD Public Information from the U.S. National Institutes of Health

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