Systemic Lupus Erythematosus Case Study: Difference between revisions
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*Relatively rare disease which occurs in 15-124/100,000 of the population worldwide.<ref name="3">Lazaro D. Elderly-onset systemic lupus erythematosus: prevalence, clinical course and treatment. Drugs &amp;amp;amp; Aging [serial online]. 2007;24(9):701-715. Available from: MEDLINE, Ipswich, MA. Accessed March 21, 2015.</ref> | *Relatively rare disease which occurs in 15-124/100,000 of the population worldwide.<ref name="3">Lazaro D. Elderly-onset systemic lupus erythematosus: prevalence, clinical course and treatment. Drugs &amp;amp;amp;amp; Aging [serial online]. 2007;24(9):701-715. Available from: MEDLINE, Ipswich, MA. Accessed March 21, 2015.</ref> | ||
*Most common in persons between the ages of 15-40 years.<ref name="2" /> | *Most common in persons between the ages of 15-40 years.<ref name="2" /> | ||
*Rarely occurs in the elderly population. <ref name="2" /> | *Rarely occurs in the elderly population. <ref name="2" /> | ||
*Women are affected 10-15x more often than men. <ref name="2" /> | *Women are affected 10-15x more often than men. <ref name="2" /> | ||
*About 6-19% of lupus patients, the diagnosis was made after the fifth and sixth decades of the patients life.<ref name="3" /> | *About 6-19% of lupus patients, the diagnosis was made after the fifth and sixth decades of the patients life.<ref name="3" /> | ||
*During the disease course, discoid rash lesion | *During the disease course, discoid rash lesion is significantly more common in men compared to females.<ref name="4">Faezi S, Hosseini Almodarresi M, Davatchi F, et al. Clinical and immunological pattern of systemic lupus erythematosus in men in a cohort of 2355 patients. International Journal Of Rheumatic Diseases [serial online]. May 2014;17(4):394-399. Available from: MEDLINE, Ipswich, MA.</ref> | ||
*The disease is 2-4x more frequent and severe in among nonwhite populations around the world and tends to be more severe in men, pediatric, and late-onset lupus.<ref name="5">Pons-Estel G, Alarcón G, Scofield L, Reinlib L, Cooper G. Understanding the epidemiology and progression of systemic lupus erythematosus. Seminars In Arthritis And Rheumatism [serial online]. February 2010;39(4):257-268. Available from: MEDLINE, Ipswich, MA.</ref> | *The disease is 2-4x more frequent and severe in among nonwhite populations around the world and tends to be more severe in men, pediatric, and late-onset lupus.<ref name="5">Pons-Estel G, Alarcón G, Scofield L, Reinlib L, Cooper G. Understanding the epidemiology and progression of systemic lupus erythematosus. Seminars In Arthritis And Rheumatism [serial online]. February 2010;39(4):257-268. Available from: MEDLINE, Ipswich, MA.</ref> | ||
*More prevalent in first-generation family history more often when compared to the general population.<ref name="1" /> | *More prevalent in first-generation family history more often when compared to the general population.<ref name="1" /> | ||
Revision as of 04:00, 29 March 2015
Author/s[edit | edit source]
Sara Gress, Kelly Mudlo, Micheal Rangel, and Shelby Wagoner from the Bellarmine University Physical Therapy Program's Pathophysiology of Complex Patient Problems Project.
Definition/Description[edit | edit source]
Lupus erythematosus, sometimes referred to as lupus, is a chronic inflammatory autoimmune disorder that appears in several forms; discoid lupus erythematosus (DLE), which affects only the skin, and systemic lupus erythematosus (SLE), which can affect any organ or system of the body. Other forms include drug-induced lupus, antiphospholipid antibody syndrome, and late-stage lupus.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Systemic lupus erythematosus belongs to the family of autoimmune rheumatic disorders that can be characterized by injury to skin, joints, kidneys, heart and blood-forming organs, nervous system, and mucous membranes. Discoid lupus is a limited-form of the disease confined to the skin presenting as coin-shaped lesions, which are raised and scaly. Discoid lupus rarely develops into systemic lupus. Systemic lupus is usually more severe than discoid lupus and can affect almost any organ or system of the body. For some people, only the skin and joints will be involved. In others, the joints, lungs, kidneys, blood, or other organs or tissues may be affected.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Background/Prevalence[edit | edit source]
The exact cause of SLE is unknown, although it appears to result from an immunoregulatory disturbance brought about by combination of genetic, hormonal, chemical, and environment factors. Some of the enviormental factors that may trigger the disease are infections (e.g., Epstein-Barr virus), antibiotics, and other medications, exposure to ultraviolet light, extreme physical and emotional stress, including pregnancy. Although there is a known genetic predisposition, no known gene is associated with SLE.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
- Relatively rare disease which occurs in 15-124/100,000 of the population worldwide.Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title - Most common in persons between the ages of 15-40 years.Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title - Rarely occurs in the elderly population. Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title - Women are affected 10-15x more often than men. Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title - About 6-19% of lupus patients, the diagnosis was made after the fifth and sixth decades of the patients life.Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title - During the disease course, discoid rash lesion is significantly more common in men compared to females.Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title - The disease is 2-4x more frequent and severe in among nonwhite populations around the world and tends to be more severe in men, pediatric, and late-onset lupus.Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title - More prevalent in first-generation family history more often when compared to the general population.Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title
Patient Characteristics[edit | edit source]
Patient demographics
- Patient is a 46 year old caucasian female who works full time as a secretary. She presented to the hospital with a six-month history of generalized weakness and significant weight loss of 40 lbs.
Current diagnosis
- Systemic Lupus Erythematosus, acute inflammatory arthritis of elbows and knees.
Co-morbidities
- Hypertension: unmanaged by medications due to financial constraints
- Obesity: BMI 28
Previous care or treatment
- This patient has been treated for past episodes of leukopenia on more than two occasions.
Examination[edit | edit source]
Subjective:
- Patient presented to the hospital with a six-month history of generalized weakness and significant weight loss of 40 lbs over the past 4 months. Over the past two weeks, she has been having progressing symptoms of worsening dyspnea. She has been unable to do yard work due to her fatigue and pain in her elbows and knees. She has had to take leave from work for several weeks due to her inability to type and sit for long periods of time.Cite error: Invalid
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Patient History and Systems Review:
- Patient has no history of smoking, drug, or alcohol use. She has had a history of leukopenia on several occasions, but this episode of symptoms seems to be the most exaggerated. She has not hospitalized for any other relevant conditions. Her goals are to return to work and to be able to perform household duties with less pain and fatigue.
Self Report Outcome Measure:
- Systemic Lupus Activity Measure-Revised (SLAM-R): 20/81
Physical Performance Measures:
- 5 sit to stands in 30 seconds
Objective :
- Blood pressure: 102/66 mm/Hg
- Heart Rate: 88 bpm
- Temperature: Normal
- Respiratory Rate: 24 breaths/min
- Oxygen saturation: 92%
- Lab results revealed anemia, leukopenia, elevated blood urea nitrogen, and elevated creatinine. Urinalysis showed trace proteinuria.
- Serological work-up: high anti-nuclear antibody, anti-double stranded DNA antibody, and anti-Smith antibody titers
Physical Examination
- Integumentary observation: Patient presented with mucosal pallor, showed no signs of cyanosis, digital clubbing, pitting edema, skin rash, or joint deformities.
- Palpation/percussion: Examination and palpation of patient’s distended abdomen was non-tender to palpation. Palpation of lymph nodes revealed rubbery axillary and inguinal lymphadenopathy.
- Respiratory system: Decreased breath sounds and dullness to percussion were noted on the left base.
- Cardiovascular and Neurological: Unremarkable
- ROM: Painful ROM in bilateral elbows and knees. All other joints WNL
- MMT: Generalized weakness
Clinical Impression[edit | edit source]
Summarization of Examination Findings[edit | edit source]
Working Diagnosis and Targeted Interventions
Intervention[edit | edit source]
- Phases of Interventions (e.g. protective phase, mobility phase, etc.)
- Dosage and Parameters
- Rationale for Progression
- Co-interventions if applicable (e.g. injection therapy, medications)
Outcomes[edit | edit source]
Findings Over time
Discussion[edit | edit source]
Summary Statement which should include related findings in the literature, potential impact on clinical practices
Related Pages[edit | edit source]
add links to related pages here
References[edit | edit source]
