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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.

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

Potential Dermatologic Manifestations

  • Butterfly rash on cheeks and bridge of nose
  • Scaly, disk-shaped scarring rash (DLE)
  • 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 septum
  • Atrophy (including striae or stretch marks)
  • Impaired wound healing
  • Easy bruising
  • Petechiae
  • Increased body hair (hirsutism)
  • Steroid-induced ecchymosis
  • Ulcers or gangrene on fingers or toes
  • Alopecia

Potential Problems

  1. Pain
  2. Alteration in joint function

Nursing Interventions

Objective: Minimize Pain from Joint and Muscle Complications

  1. Assess and document joint complaints and appearance. Changes may be transient.
  2. Assess patient's self-management techniques for controlling pain.
  3. Teach patient to apply heat or cold as appropriate.
  4. Instruct patient in use of prescription and nonprescription pain medications.
  5. If ordered by physician, teach patient to apply splints or braces.

Objective: Maintain Joint Function and Increase Muscle Strength

  1. Suggest warm showers or baths to lessen stiffness and pain.
  2. 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.
  3. Teach patient that an inflamed joint should not bear weight and suggest that patient avoid strenuous activity.
  4. If needed, assist patient to obtain crutches, a walker, or a cane.
  5. 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.
  6. Consider referring patient to an occupational therapist.

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