Please Reply to the following 2 Discussion Presentations
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PleaseReplytothe2Presentations.docxPlease Reply to the following 2 Discussion Presentation
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Presentation # 1 Reply to Talia
Fibromyalgia
· Chronic condition characterized by widespread pain.
· Affects 2-4% of people, usually women and patients with a history of rheumatic diseases are at higher risk.
· Not an inflammatory or autoimmune disease. Research suggests there is nervous system involvement or chemical imbalance in the brain.
· There is no cure.
· (Goldenberg, 2023)
· Fibromyalgia is a condition that causes widespread muscle pain.
· May affect all parts of the body.
· Common areas of complaint are the neck, shoulders, back, chest, hips, buttocks, arms, and legs.
· Research suggest the nervous system may be involved.
· There may be imbalances in chemicals in the brain such as dopamine or serotonin.
· (Kang et al., 2022)
· Fibromyalgia is a chronic condition that is not well understood.
· Characterized by widespread and persistent musculoskeletal pain.
· Common symptoms such as fatigue, insomnia, morning stiffness, cognitive impairment, depression, and anxiety persist.
· (Kang et al., 2022
·
Signs and symptoms
· Widespread muscle aches and pain
· Memory Problems
· Depression or anxiety
· Migraines or tension headaches
· Fatigue
· Sleep Disturbances
· (Kang et al., 2022)
Diagnostics
· Used to rule out other causes.
· Does not show on x-ray or lab test.
(Goldenberg, 2023)
Differential Diagnosis
· Systemic Lupus Erythematosus (M32.9)
· Rheumatoid Arthritis (M05.9)
· Polymyalgia Rheumatica (M35.3)
(Goldenberg, 2023)
Diagnosis Criteria
2016 revised American College of Rheumatology diagnostic criteria
Criteria A patient satisfies the modified 2016 fibromyalgia criteria if the following three conditions are met:
1. Widespread pain index (WPI) ≥7 and symptom severity scale (SSS) score ≥5, or WPI of 4∼6 and SSS score ≥9.
2. Generalized pain, defined as pain in at least four of five regions, must be present. Jaw, chest, and abdominal pain are excluded from the generalized pain definition.
3. Symptoms have been generally present for at least 3 months.
4. A diagnosis of fibromyalgia is valid irrespective of other diagnoses. A diagnosis of fibromyalgia does not exclude the presence of other clinically important illnesses.
(Kang et al., 2022)
Treatment Methodologies
· Exercise is the most effective treatment.
· Acupuncture, chiropractic, and massage may help ease symptoms.
· Psychotherapy may help patients manage stress and anxiety.
· Three drugs are FDA-approved for fibromyalgia: duloxetine (Cymbalta) and milnacipran (Savella) adjust brain chemicals to ease widespread pain, and pregabalin (Lyrica), which blocks overactive nerve cells involved in pain.
· Older drugs, such as amitryptiline (Elavil), cyclobenzaprine (Flexeril) and other antidepressants may be used too.
· Opioids and sleep medicines like zolpidem (Ambien) are not recommended for use in treating fibromyalgia symptoms.
(American College of Rheumatology, 2023)
Patient and family education
· Teach self-care to manage symptoms.
· Encourage healthy lifestyle, along with medications, can help reduce pain, improve sleep, and ease fatigue.
· Exercise often starting with walking, swimming, stretching, and yoga
· Teach rest and relaxation techniques. Deep breathing or medication can ease stress.
· Set regular sleep habits, like going to bed at the same time each night.
· Provide education about medications and their side effects.
(Kang et al., 2022)
Presentation # 2 Reply to Dianne
Systemic Lupus Erythematosus (SLE), commonly referred to as lupus, is a chronic autoimmune disease that can affect various organs and tissues in the body (Fanouriakis et al., 2021). It is characterized by inflammation caused by the immune system attacking healthy tissues and multiple systems within the body, including the skin, joints, kidneys, heart, lungs, brain, blood cells, and other organs.
The exact cause of lupus is unknown, but it is believed to involve a combination of genetic, environmental, and hormonal factors. It predominantly affects women, typically appearing between the ages of 15 and 45, although it can occur in both men and children as well.
Lupus is a multisystemic disease with an unknown etiology. There is a high concordance between identical twins suggesting a strong genetic component (Vaillant et al., 2023). Being female has hormonal factors that put women at a significant risk for developing the disease as estrogen stimulates the CD8+ and CD4+ T cells, B cells, macrophages, thymocytes, cytokines, and the expression of HLA which promote inflammation (Vaillant et al., 2023). Several environmental triggers causes demethylation of DNA and alteration of self-antigens such as ultraviolet rays and sun exposure which cause increased cell apoptosis. Medications like procainamide and hydralazine have the highest incidence of causing drug-induced lupus. Viral infections including Epstein-Barr Virus (EBV) have been implicated and the underlying mechanism is thought to be molecular mimicry.
· Immune System: both the innate and adaptive immune systems mistakenly attack healthy tissues by creating autoantibodies leading to inflammation and damage.
· Joints & Muscles: lupus causes joint pain, stiffness, and swelling. It often affects small joints in the hands, wrists, and feet. The inflammation can lead to arthritis symptoms and impaired mobility. Muscle pain and weakness can also occur.
· Skin: photosensitivity, a butterfly rash, scaly or coin shaped lesions and ulcers can occur.
· Kidneys: lupus attacks the kidneys causing nephritis and may lead to kidney damage and impair function, exacerbating or producing high blood pressure, changes in urine production, and swelling.
· Heart & Lungs: inflammation can lead to pericarditis, myocarditis, endocarditis, and pleuritis or pneumonitis.
· Blood & Blood Vessels: lupus can cause anemia, leukopenia, and thrombocytopenia. Blood clotting abnormalities and vasculitis.
· Nervous System: headaches, cognitive dysfunction “lupus fog,” seizures, mood disorders, and peripheral neuropathy.
Treatment
Start NSAIDs for arthritis symptoms
-Prednisone 40 to 60 mg to begin with for thrombocytopenic, hemolytic anemia, purpura, convulsion myocarditis, pericarditis, and nephritis-
-Order antimalarial drugs such as hydroxychloroquine sulfate to treat rashes and joint symptoms caused by lupus. (Cash et. al, 2021).
-If corticosteroids and NSAIDs are not effective, prescribe immunosuppressive agents such as azathioprine, cyclophosphamide, as well as chlorambucil.
Differential Diagnosis
1. Rosacea
a. A long-term inflammatory skin condition that affects the skin and eyes causing redness or flushing of the face, visible broken blood vessels, swollen skin, and acne-like breakouts.
2. Discoid Lupus Erythematosus (DLE)
a. A sub-type of chronic cutaneous lupus erythematosus that is characterized by persistent scaly plaques on the scalp, face, and ears. It can lead to scarring, atrophy, dyspringmentation in affected areas.
3. Rheumatoid Arthritis (RA)
a. A chronic autoimmune disorder that causes inflammation in the joints. Lupus can resemble RA during the early course of SLE (Cash, 2023). Symptoms of RA include joint pain or stiffness, fatigue, fever, weight loss, and eye problems (dryness, irritation).
Lupus Patient and family Education
Importance of consuming healthy nutrition and regular exercise to prevent flare-ups.
Avoiding tobacco
Recognize warning signals of a flare :
Increased fatigue, pain, rash, fever, abdominal discomfort, severe headache.
Understanding triggers for lupus flare :
Emotional stress, infection, missed doses of medications
Follow-up every 3-4 months for evaluation
Call provider or 911 if experiencing chest pain, trouble breathing, and high fever.
