- First to be affected

MUSCULO-SKELETAL SYSTEM - Butterfly rash (malar rash) – rash across the

- Machine of the body bridge of the nose

Purposes: 2. Mucus membrane

1. Movement - Stomatitis
2. Structural support
3. Protection to underlying organs 3. Lungs
- Pleuritis – restrict lung expansion
Bones: - SOB
1. Long bones - Chest pain
- Shape like rods
- Bones of upper & lower extremities except wrist 4. Heart
& ankles - Endocarditis
- SOB
2. Short bones - Chest pain
- Cube-shaped
- Bones of wrist & ankles, kneecap 5. Joints
- Polyarthritis
3. Flat bones
- Located where extensive protection is needed 6. Kidney
- Skull, ribs & sternum - Lupus nephritis = AGN
- Hematuria
4. Irregular - Edema
- Vertebrae - Proteinuria
- Jaw
7. Bone marrow
SYSTEMIC LUPUS ERYTHEMATOSUS - All blood cells are decreased
- Chronic, progressive, systemic inflammatory
disease 8. Brain
- Hallucinations
Cause: autoimmune - Seizures
- Genetic
- Environmental Diagnostics:
1. Antinuclear antibody
- Most sensitive
- Not specific

2. ↑ESR
- Systemic inflammation
- Not specific

3. LE Cells
- Neutrophils are phagocytized
- Not specific

4. Anti-smith antibody
Antinuclear antibody – targets cells with nucleus - Most specific
- Attacks RNA

5. Anti-DS DNA
- Attacks DNA
- Most specific

1. Skin Management:
1. Prevent exacerbation (acute signs & symptoms)
2. Decrease severity of illness
- DOC: corticosteroids (immunosuppressant)
- Plasmapheresis – removes auto-antibodies &
replace with saline & albumin
3. Avoid direct exposure to sunlight
- SPF 30
- Wide rim light
1. Two point gait
- Partial weight bearing on lower extremities
- Advance right crutch & left foot together then left
crutch & right foot together
2. Three point gait
- One leg suspended (affected)
- No weight bearing on affected leg
- Advance both crutches & affected leg together
followed by unaffected leg

4. Avoid pregnancy 3. Four point gait

- Weight bearing is allowed
Nursing management:
1. Based on organ involved 4. Swing to gait (↑muscle strength)
Lungs – administer O2 - Will land at the level of the crutches
Endocarditis – administer O2, monitor ECG
Polyarthritis – aspirin for joint pain 5. Swing through gait (↑muscle strength)
Kidney – monitor I & O - Will land pass the level of the crutches
Brain – reorient to reality, seizure precaution
6. Going up
Diet: - Good leg first
- ↑iron - Bad leg together with crutches
- ↑vitamins
- ↑protein (if no kidney involvement) 7. Going down
- Bad leg first together with crutches
ASSISTIVE DEVICES - Good leg
- To improve functioning & to promote
independence

Size
- 30˚ elbow flexion
- Handgrip at greater trochanter/top crease of wrist

Cane
- On the strong side
- Unilateral weakness
- Advance cane together with affected leg
- Position self at the weak side of patient
- Use gait belt

Walker
- Provides greater stability
- For people with significant balance issues
- Bilateral weakness
- Hands bear the weight

Crutches
- For temporary restriction on ambulation
- Palms bear the weight
- Space of 2-3 finger widths between axilla & crutch
rest pads to prevent damage of brachial
plexus/axillary nerve
- Tripod position – 6-10 inches (4in side, 2in front)

Types of gait ARTHRITIS

- Inflammation of joints - Genetic effect – purine metabolism

Alphabetically arranged: Purine rich food: (SAROB)

- Sardines
- Soy
- Anchovies
- Red meat
- Raisin
OSTEOARTHRITIS - Organ meat
- Chronic, non-systemic disorder of joints - Beans
- Degeneration of articular cartilage - Beer
- NO fever, anorexia, etc. because non-systemic
Systemic manifestations: fever, headache, anorexia
SIGNS AND SYMPTOMS
- Slow blood flow; distal
- Great toe and ankle
- Wrist and ears
- Tophi and inflammation (crystal)
- Systemic manifestation

MANAGEMENT
- Low purine diet or avoid purine rich food
- ALLOPURINOL
- Increase OFI
Signs & symptoms: - PROBENECID
1. Heberden’s nodes - Promotes uric acid excretion
- Distal interphalangeal joints - DOC FOR PAIN: COLCHICINE

2. Bouchard’s nodes RHEUMATOID ARTHRITIS

- Proximal interphalangeal joints - Chronic, progressive autoimmune inflammation of
joints
Joint stiffness - Genetic (dormant) + environmental (triggers) =
- On weight bearing ones (lumbar, hips, knees, modification of antigen / joint nucleus
wrist)
- Experienced during morning <1hr
- Due to inactivity
- Aggrevated by movement

Treatment
- Palliative treatment
- Acetaminophen (DOC)
- COX-2 inhibitors (if high risk for GI complication)

Surgical treatment
Signs & symptoms
- Osteotomy
- Fever, headache, anorexia & malaise
- Bilateral join affectation – head, shoulders,
elbows, knees & toes
- Morning stiffness (worsened by rest >1hr)
- Pain aggravated by movement, relieved by rest –
morning stiffness

Extra-articular
1. Liver - ↓iron stores = anemia
2. Felty’s syndrome
- Splenomegaly
- Anemia
GOUTY ARTHRITIS
- Neutropenia
- Thrombocytopenia
- Arthritis

Management
1. Pain
- Aspirin (no bleeding)

2. DOC: corticosteroids
- Immunosuppressant

3. DMARD’s
- Disease Modifying Anti-Rheumatic Drugs
- Inhibits T-cell action
- Immunosuppressant
- Methotrexate (chemo)
- Cyclosporine (chemo)
- Monoclonal antibody (-mab)

GENERAL MANAGEMENT
1. Priority: pain

2. Pain: rest & cold compress

3. Stiffness: warm compress

4. Health teaching:
OA – proper diet & weight reduction
GA – avoid purine rich food
RA – avoid infection

5. Deformity:
OA – Heberden’s & Bouchard’s
GA – crystal
RA – boutonnière’s (flexion of proximal) & swan
neck (distal), ulnar deviation

6. Surgery:
Osteotomy
- corrects the alignment of bone
- removal of piece/wedge

Arthroplasty
- joint replacement