1. Rheumatoid Arthritis and Systemic Lupus Erythematosus

2. RA - Predisposing Factors GenderInfection GeneticHormonal RA

3. SLE - Predisposing Factors GenderRaceGenetic Toxins UV light SLE

4. Pathophysiology - RA Antigenic Stimulus (virus?) IGg formed Rheumatoid Factor (RF) Autoantibody IGg + RF = Immune Complexes Deposited in joints, vessels and pleura

5. RA - Pathophysiology Microvascular injury = synovial inflammation Pannus formation = invades joint and bone Fibrous tissue replaces pannus= deformity and dysfunction Calcification + ankylosis = immobility

6. SLE - Pathophysiology

7. Antigen - Antibody Complex Complement Activation Immune Complex Buildup = Lupus Vasculitis Ischemia

8. SLE - Pathophysiology ISCHEMIA Thickened lining Fibrinoid degeneration Thrombus

9. Complications of RA

10. -Cysts

11. Complications of RA -Cysts -Infection

12. Complications of RA -Cysts -Infection -Osteoporosis

13. Complications of RA -Cysts -Infection -Osteoporosis -Amyloidosis

14. Complications of RA -Cysts -Infection -Osteoporosis -Amyloidosis -Spinal Cord Compression

15. Complications of SLE

16. Clinical Manifestations of RA and SLE

17. Diagnostic Tests

18. Diagnostic Tests - RA -ESR - Elevated in 85% - Used to monitor response to TX -RF - Greater than 1:160 in 80% -WBC - Greater than 30,000 in synovial fluid

19. Diagnostic Tests - RA -Synovial Fluid - Increased volume and turbidity - Decreased viscosity -X-ray - Early - Bone Demineralization - Soft tissue swelling - Late - Narrowed joint space - Erosion - Deformity

20. Diagnostic Tests - SLE -ESR - Increased -Gamma Globulin - Increased -Hct -WBC -Platelets Decreased

21. Diagnostic Tests - SLE -EKG -X-ray - Pericarditis - Pleural effusion

22. Diagnostic Tests - SLE -Antinuclear Antibody (ANA) - Present in 99% of cases - Not specific for SLE -RPR - False positives -UA - Cellular casts - Proteinuria

23. Diet Therapy RA and SLE Depression Steroids H20 Retention

25. Lifestyle Interventions - RA PAIN !!!!! - Thermal Treatment - Heat up to 20 minutes - Cold up to 15 minutes - Decrease stress to joints (modify tasks) - Pain meds before activities

26. Lifestyle Interventions - RA MOBILITY - ROM - in water and out - Moist heat - Rest joints - splints and modify tasks - More strenuous activities later

27. Lifestyle Interventions - RA INCREASE ENERGY - Schedule and space activities - Rest periods - Regular exercise to tolerance - Energy conservation - Joint protective devices

28. Lifestyle Interventions - RA SELF-CARE DEFICIT - Assistive devices - Sequence activities

29. Lifestyle Interventions - SLE EFFICIENT ENERGY EXPENDITURE - Spacing - Scheduling - Sequencing

30. Lifestyle Interventions - SLE SKIN INTEGRITY - Mild soap and water - Avoid sun - Only Rx. skin lotions

31. Lifestyle Interventions - SLE INCREASE ACTIVITY - Pacing - Relaxation techniques - Pain management - Recreational activities

32. Lifestyle Interventions - SLE ADEQUATE NUTRITION - Manage depression - Food preferences - Small frequent meals - Monitor lab values