Rheumatoid Arthritis and Systemic Lupus Erythematosus.

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Presentation transcript:

Rheumatoid Arthritis and Systemic Lupus Erythematosus

RA - Predisposing Factors GenderInfection GeneticHormonal RA

SLE - Predisposing Factors GenderRaceGenetic Toxins UV light SLE

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

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

SLE - Pathophysiology

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

SLE - Pathophysiology ISCHEMIA Thickened lining Fibrinoid degeneration Thrombus

Complications of RA

-Cysts

Complications of RA -Cysts -Infection

Complications of RA -Cysts -Infection -Osteoporosis

Complications of RA -Cysts -Infection -Osteoporosis -Amyloidosis

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

Complications of SLE

Clinical Manifestations of RA and SLE

Diagnostic Tests

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

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

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

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

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

Diet Therapy RA and SLE Depression Steroids H20 Retention

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

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

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

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

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

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

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

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

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