Lupus erythematosus, systemic (SLE)

• Lupus erythematosus

• 695.4 Lupus erythematosus
• PT diagnoses/treatment diagnoses that may be associated with immune disorders affecting movement
  • 315.4 Developmental coordination disorder
  • 718.07 Articular cartilage disorder, ankle and foot
  • 718.03 Articular cartilage disorder, forearm
  • 718.04 Articular cartilage disorder, hand
  • 718.45 Contracture of joint, pelvic region and thigh
  • 719.39 Palindromic rheumatism involving multiple sites
  • 719.4 Pain in joint
  • 719.70 Difficulty in walking involving joint site unspecified
  • 728.2 Muscular wasting and disuse atrophy, not elsewhere classified
  • 729.9 Other and unspecified disorders of soft tissue
  • 729.1 Myalgia and myositis, unspecified
  • 729.9 Other disorders of soft tissue
  • 736.9 Acquired deformity of limb site unspecified
  • 780.7 Malaise and fatigue
  • 781.2 Abnormality of gait
  • 782.3 Edema
  • 786.0 Dyspnea and respiratory abnormalities
  • 786.05 Shortness of breath

• L93.0 Discoid lupus erythematosus
• L93.2 Other local lupus erythematosus

• 4D: Impaired joint mobility, motor function, muscle performance, and range of motion associated with connective tissues dysfunction
• 4E: Impaired joint mobility, motor function, muscle performance, and range of motion associated with localized inflammation
• 7B: Impaired integumentary integrity associated with superficial skin involvement

Description

• A long term autoimmune disease that attacks the body’s tissues and organ systems as if they were foreign substances
• Affects skin, joints, kidneys, brain, and other organs
• Although SLE is most common form, there are others: discoid or cutaneous lupus, drug-induced systemic lupus, neonatal lupus, and subacute cutaneous lupus
• Onset often vague with misdiagnosis

Essentials of Diagnosis

• Must be made by a physician and confirmed by medical diagnostic testing
• According to the American College of Rheumatology (ACR)2 4 of 11 of the following must be present:
  • Malar rash: a rash over the cheeks and nose, often in the shape of a butterfly
  • Discoid rash: a rash that appears as red, raised, disk-shaped patches
  • Photosensitivity: a reaction to sun or light that causes a skin rash to appear or get worse
  • Oral ulcers: sores appearing in the mouth
  • Arthritis: joint pain and swelling of two or more joints in which the bones around the joints do not become destroyed
  • Serositis: inflammation of the lining around the lungs (pleuritis) or inflammation of the lining around the heart that causes chest pain, which is worse with deep breathing (pericarditis)
  • Kidney disorder: persistent protein or cellular casts in the urine
  • Neurological disorder: seizures or psychosis
  • Blood disorder: anemia (low red blood cell count), leukopenia (low white blood cell count), lymphopenia (low level of specific white blood cells), or thrombocytopenia (low platelet count)
  • Immunologic disorder: abnormal anti-double-stranded DNA or anti-Sm, positive antiphospholipid antibodies
  • Abnormal antinuclear antibody (ANA)

General Considerations

• Diagnosis for more occult problems may take time and require intensive medical diagnostic testing
• May result in secondary problems
  • Aerobic capacity and muscle endurance impairment
  • Sarcopenia
  • Weakness/impaired muscle performance
  • Musculoskeletal problems
  • Neuromuscular problems
  • Weight loss indicating the need for physical therapy
• Because lupus and other immune disorders frequently refer ...