| **PSYCHOSOCIAL ASPECTS-CHART**Aspect**Multiple Sclerosis (MS)****Sjogren's Syndrome (SS)****Scleroderma (SSC)****Systemic Lupus Ereth. (SLE)**Women Diagnosed75%90%80%90%Cognitive40-80%; mostly mild-mod.,    short-term memory word finding difficulty.Memory, attention or severe    Alzheimer's 2/3-3/4 cognitive or psychological problems.N/AOMS, seizures, strokePsychiatric/Behavioral/CNSPrimarily depressive.Mild or moderate-depression,    hypomania, severe depression- 10%Possible organic, inflammatory    cause of depressive syndromePersonality disorders psychoses,    seizures, migraine, frightening hallucinations, depression.Variable CourseVery variable- diagnosis usually    in early adulthood.Most women diagnosed    postmenopause.Very variable- local mild skin    problem to death systemic- CREST mild form.Very variable.Genetic30% identical twins 5%-other    first degree relatives.Children of mothers with SS-    serious heart defects possible.Hereditary aspect possible- needs    more exploration.30%- identical twins, 5%- other    first degree relatives.RxInterferon A&B Copolymer    Symptomatic Rx.Moisture replacement, NSAIDS,    estrogen replacement postmenopause.Steroids not effective D-    penicillamine, cytoxan, methotrexate, colchicine, ASA.Avoid infections, sun, steroids.FatigueMost common MS symptom.Debilitating fatigue late AM    early PM, or early AM.Common.Very common, often indicates    flare-up is coming; present- almost all- also malaise and fever.PainNeurologic.Similar to RA or SLE.Painful joints.Joint pain.ReproductivePostpartum increase in disease    activityN/AMay be delay in conception or    infertility, low birth weight, ill health in pregnancy "all in your head."Postpartum increase in flare-ups;    problems during pregnancy, if renal disease is present. Menses may cease during flare-ups    affecting fertility. Spontaneous abortions and prematurity.DiagnosisMaybe difficult, history, neuro    exam, MRI, etc.Difficult.Difficult.Difficult sometimes- Raynaud's +    edema + hard skin.Sexual DysfunctionCommon- decreased vaginal    sensation & lubricationVaginal dryness dyspareunia.Vaginal lubrication decreased.Vaginal lubrication decreased-    many 2� problems- pain, depression.Prevalence250-350,00050,000300,000- combined forms 700,000.50,000 diffuse.OtherLoveland study- women labeled    hysterical, emotional.N/AAlopecia, altered pigmentation,    RA, lung, cardiac, liver.Alopecia, fever, rashes,    photosensitivity, arthritis, pleurisy, symptoms worse between ovulation and menses.FeaturesFatigue; sensory and mobility    impairment, visual dysfunction, bladder, bowel, sexual dysfunction."Chipmunk faces" 1�    moisture decreased 2� connective tissue also joint swelling.Skin hardening. Onset often in    40s. No racial predilection.Onset 13-40 yrs, 3x more common    among Blacks than Caucasians Arthralgias- most common-often symmetric.
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