A 20-year old female presents with chief complaint of fatigue, anxiety, and heart palpitations. She has recently given birth to her second child, a daughter. Initial recommendation from her follow up appointment is to rest. The patient’s symptoms worsen and then gradually resolve. Over the next year she has increased fatigue and headaches. She also starts to complain of joint pain in her ankles, knees, elbows, wrists, and fingers. Rest and over-the-counter pain medication relieve her symptoms, but it is difficult for her to find time for much rest due to the responsibilities of caring for a family and working full-time. The winter brings a new intolerance to low temperatures. She states her hands and feet becoming painful and discolored when she is exposed to cold. Her extremities became painful, stiff, and altered in color when exposed to cold temperatures. She also develops a butterfly rash. DX: systemic lupus erythematosus. Rx: prednisone and hydroxychloroquine 1. What is lupus? 2. What key lifestyle changes will the patient need to address to manage her condition? 3. What are the important teaching points for her medications? 4. What are the recommendations to manage her symptoms, to avoid flare-ups, and to monitor her condition? 5. What symptoms, if they occur, should she report immediately to her provider and why? A 48-year old female presents stiffness in both hands in the morning for last 7 months. Stiffness now lasted more than 1 hour every morning and includes hands, wrists and ankles. She also had increasing difficulty standing for long periods at work or at home due to foot and ankle pain. She began taking ibuprofen 800mg 3 times daily and found it helped her get through her day with less pain and stiffness. Three months ago, Joy noticed pain in her right and left shoulders when she would cut or blow dry her client’s hair. She also began feeling extremely tired and short tempered. She had no energy to do her usual activities. Ibuprofen was no longer very effective for her pain or stiffness. One morning, Joy could not lift her arms at all without extreme shoulder pain. She knew it was time to get help. Pt is married with 3 teenagers, and works part time as a hairdresser. Dx: Rheumatoid Arthritis (RA) Rx: methotrexate, Physical Therapy 1. What is rheumatoid arthritis? 2. What are the important teaching points for her medication? What are the recommendations to manage her joint pain during remission? During exacerbation?

1. Lupus, or systemic lupus erythematosus, is a chronic autoimmune disease characterized by inflammation in various parts of the body. It primarily affects women, often starting during their childbearing years. The exact cause of lupus is unknown, but it is believed to involve a combination of genetic and environmental factors. In lupus, the immune system mistakenly attacks healthy tissues, leading to widespread inflammation and damage to organs such as the skin, joints, kidneys, heart, lungs, and brain. Common symptoms include fatigue, joint pain, skin rashes, fever, and sensitivity to sunlight. Lupus is a complex and unpredictable disease that can vary greatly in severity and symptoms from person to person. Treatment typically involves a combination of medications to control inflammation and manage symptoms, as well as lifestyle modifications.

2. Managing lupus requires lifestyle changes to help minimize symptoms and prevent flare-ups. The patient should prioritize rest and relaxation, as fatigue and stress can trigger or worsen lupus symptoms. Adequate sleep, regular exercise, and a balanced diet are also important for overall health and managing symptoms. Avoiding exposure to sunlight and using sunscreen can help protect the skin from lupus-related rashes and photosensitivity. It is important for the patient to communicate with her healthcare provider and create a support system to help manage the demands of caring for a family and working full-time. Making adjustments to work responsibilities and seeking accommodations, if needed, can also be helpful.

3. The patient’s medications, prednisone and hydroxychloroquine, are commonly used in the treatment of lupus. Prednisone is a corticosteroid that helps reduce inflammation and suppress the immune system. It is typically prescribed for short-term use during flare-ups or when symptoms are severe. Hydroxychloroquine is an antimalarial medication that has immunomodulatory effects and helps to control lupus symptoms. Important teaching points for these medications include the proper dosage and administration instructions, potential side effects, and the importance of regular monitoring and follow-up with the healthcare provider. It is crucial for the patient to adhere to the prescribed medication regimen and notify her healthcare provider if she experiences any adverse effects or worsening of symptoms.

4. To manage her symptoms and avoid flare-ups, the patient should continue to prioritize rest and stress management. She should also follow a healthy lifestyle, including regular exercise, a balanced diet, and avoiding triggers such as sunlight exposure. It is important for her to communicate with her healthcare provider and attend regular check-ups to monitor her condition and adjust treatment as needed. Keeping a symptom diary can help identify patterns or triggers for flare-ups. The patient should also be aware of warning signs of a potential flare-up, such as increased fatigue, joint pain, or skin rashes, and seek medical attention promptly if these symptoms occur.

5. Certain symptoms in lupus can indicate a potentially serious complication and should be reported immediately to the healthcare provider. These include severe chest pain, difficulty breathing, sudden and severe headache, seizures, significant changes in vision, or new neurological symptoms. These symptoms may indicate involvement of vital organs or a flare-up that requires immediate medical attention. It is important for the patient to be aware of these warning signs and seek prompt medical care to prevent further complications.