Overview

Arthralgia or arthritis is experienced by 95 percent of SLE patients at some time during the course of the disease. Articular pain is the initial symptom in about one-half of patients eventually diagnosed with SLE. Morning stiffness and joint and muscle aching can also occur. Joint pain may be migratory; it is typically symmetric but is asymmetric in many patients. Joints may become warm and swollen. X rays of the joints usually do not show erosion or destruction of bone.

Proliferation of the synovium in lupus is more limited than in rheumatoid arthritis, 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 reducible deformities such as Jaccoud's arthropathy and osteonecrosis. In SLE patients, osteonecrosis may develop as a steroid complication, which causes bone death in the hips or other joints. Subcutaneous nodules are rarely seen. Tendinitis and carpal tunnel syndrome are seen occasionally. Tendon rupture is very rare.

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 the patient's selfmanagement techniques for controlling pain.

3. Teach the patient to apply heat or cold as appropriate.

4. Instruct the patient in use of prescription and nonprescription pain medications.

5. Teach the patient to apply splints or braces, if ordered by physician.

Potential Musculoskeletal Manifestations morning stiffness and aching joint pain warm, swollen joints rarely, ulnar deviation of the fingers with swan neck deformities and subluxations

Generalized myalgia and muscle tenderness, especially over the shoulders, is more likely to be fibromyalgia than lupus.

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 the patient that an inflamed joint should not bear weight and suggest that the patient avoid strenuous activity.

4. If needed, assist the patient in obtaining crutches, a walker, or a cane.



Source: National Institutes of Health, U.S.Dept of Health and Human Services