Care of the Lupus Patient
Musculoskeletal Manifestations continued...
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.
Morning stiffness and aching
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
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
Increased body hair
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