Care of the Lupus Patient
Musculoskeletal Manifestations continued...
- Butterfly rash on cheeks and bridge of
- Scaly, disk-shaped scarring rash
- Erythematous, slightly scaly papules
(subacute cutaneous LE)
- Psoriasiform or arcuate (curved) lesions
on the trunk of the body (subacute cutaneous LE)
- Itching and burning
- Ulcers in the mouth, vagina, or nasal
- Atrophy (including striae or stretch
- Impaired wound healing
- Easy bruising
- Increased body hair
- Steroid-induced ecchymosis
- Ulcers or gangrene on fingers or
Alteration in joint
Objective: Minimize Pain from Joint and
- Assess and document joint complaints and
appearance. Changes may be transient.
- Assess patient's self-management
techniques for controlling pain.
- Teach patient to apply heat or cold as
- Instruct patient in use of prescription
and nonprescription pain medications.
- If ordered by physician, teach patient to
apply splints or braces.
Objective: Maintain Joint Function and
Increase Muscle Strength
- Suggest warm showers or baths to lessen
stiffness and pain.
- If indicated, refer patients with acutely
inflamed joints to a physical therapist for passive range-of-motion (ROM)
exercises. The physical therapist may train a family member to assist the
patient with ROM exercises at home.
- Teach patient that an inflamed joint
should not bear weight and suggest that patient avoid strenuous
- If needed, assist patient to obtain
crutches, a walker, or a cane.
- Assist patient in developing a regular
exercise plan that can be carried out during periods of remission. This plan
should include exercises that promote muscle tone and fitness, minimize
fatigue, and increase well-being.
- Consider referring patient to an
Abnormal blood conditions are
common in patients with SLE. Problems include anemia, thrombocytopenia, and
other clotting disorders.
Anemia, which is common in SLE
patients, reflects insufficient bone marrow activity, shortened RBC life span,
or poor iron uptake. Aspirin, NSAIDs, and prednisone can cause stomach bleeding
and exacerbate the condition. There is no specific therapy for this type of
anemia. Immune-mediated anemia (or hemolytic anemia), which is due to
antibodies directed at RBCs, is treated with corticosteroids.
Thrombocytopenia may occur and
may respond to low-dose corticosteroids. Mild forms may not need to be treated,
but a severe form requires high-dose corticosteroid or cytotoxic drugs. The
major clinical features of APLs and APL syndrome are venous thrombosis,
arterial thrombosis, and thrombocytopenia with a history of positive
anticardiolipin antibody (ACL) tests.
Abnormal laboratory tests may
include a false-positive VDRL test for syphilis. Fluorescent treponemal
antibody absorption (FTA-ABS) and microhemagglutination-Treponema pallidum
(MHA-TP) tests, which are more specific tests for syphilis, are almost always
negative if the patient does not have syphilis. An elevated erythrocyte
sedimentation rate (ESR) is a common finding in active SLE, but it does not
always mirror disease activity.
- Inability to complete ADL because of
fatigue and weakness.
- Potential for hemorrhage
- Potential to develop venous or arterial
- Increased risk of infection