Arthritis and connective Tissue Disease Flashcards
Affects of Osteoarthritis on cartilage?
- cartilage becomes:
- Dull, yellow, and granular
- Soft and less elastic
- Less able to resist wear with heavy use
Risk factors for Osteoarthritis?
females, obese, frequent bending or stooping, older patients, genetic predisposition
Early joint changes of osteoarthritis?
articular cartilage degeneration
Later joint changes of osteoarthritis?
bone thickening
Osteoarthritis Clinical Manifestations in the joints?
Pain, stiffness and deformity
Osteoarthritis Clinical Manifestations- joint pain?
- mild pain to disabling
- worse with joint use
- Early stages:
- rest relieves pain
- Later stages:
- pain with rest
- sleep disturbed
Osteoarthritis Clinical Manifestations- joint stiffness?
- Occurs with rest
- Early morning
Osteoarthritis Clinical Manifestations- joint deformity?
not loss of function, swelling and crepitation
Osteoarthritis Nursing Management - Assessment?
- Joint pain, stiffness
- Affect on daily life
- Prior treatment
Osteoarthritis Nursing Management - joint examination?
- assess the good side first for baseline
- tenderness, swelling, decreased ROM,
Nonpharmacologic pain management - Osteoarthritis
- Rest/Exercise
- Heat/Cold
- CAM-acupuncture, yoga, massage,
- Nutrition supplements-glucosamine, chondroitin
What effect does glucosamine, chondroitin have when used to tx osteoarthritis?
increases collagen and decreases pain
Osteoarthritis Drug therapy for mild to moderate joint pain?
- Acetaminophen (1000 mg every 6 hours)
- Topical agent (e.g., capsaicin cream [Zostrix])
- Topical salicylates (e.g., Aspercreme)
- Hyaluronic acid (HA)
Osteoarthritis Drug therapy for moderate to severe joint pain?
Nonsteroidal anti-inflammatory drug (NSAID)
Rheumatoid Arthritis Pathophysiology?
- Chronic, systemic autoimmune disease
- Symmetrical
- Inflammation in synovial joints
- Periods of remission and exacerbation
Nonspecific manifestations of RA?
- precede onset of arthritic complaints.
- Fatigue, anorexia, weight loss, generalized stiffness
Rheumatoid Arthritis (RA) Clinical Manifestations: Pain and Stiffness?
- Joint pain
- ↑ with motion
- Varies in intensity
- May not be proportional to degree of inflammation
- Stiffness after periods of inactivity
- Morning stiffness 60 mins to several hrs
Two most common Rheumatoid Arthritis (RA) Extraarticular Manifestations?
Rheumatoid nodules and Sjogren’s syndrome
What are Rheumatoid nodules?
- firm, non-tender mass on surface
- not removed because they recur or may burst and cause infection
Characteristics of Sjogrens’ Syndrome?
- decrease in lacrimal and salivary gland secretions
- dry mouth, burning/itching eyes, and photosensitivity
Complications of RA?
- Flexion contractures and hand deformities
- Cause diminished grasp strength
- Affect patient’s ability to perform self-care tasks
Comparison of RA and Osteoarthritis - Age at onset?
RA: young to middle age
Osteoarthritis: usually > 40
Comparison of RA and Osteoarthritis - Gender?
RA: - female > male, > 60 no difference OA: - < 50, men > female, - > 50, female > male
Comparison of RA and Osteoarthritis - Weight?
RA: lost or maintained wt
OA: often overweight
Comparison of RA and Osteoarthritis - affected joinits?
RA: small joints affected first, usually bilateral, symmetrical joint involvment
OA: weight bearing joints, often asymmetrical
Comparison of RA and Osteoarthritis - Disease?
RA: systemic disease w/ exacerbations and remissions
OA: localized disease w/ variable, progressive course
Comparison of RA and Osteoarthritis - pain characteristics?
RA: stiffness lasts 1hr to a day and may decrease with use
OA: stiffness occurs on arsing but usually subsides after 30 mins. pain gradually worsens with joint use and disease progression, relieved by rest
RA Acute Intervention-Primary Management Goals?
- Decrease inflammation/Manage pain
- Maintain joint function/prevent deformity
Acute interventions to maintain joint function/prevent deformity?
- Medications
- Nonpharmacologic pain relief measures
- Heat/cold therapy
- Rest/exercise
- Splints
- Morning stiffness
- Joint protection
- Psychologic support
Rheumatoid Arthritis Drug Therapy for mild to moderate disease - DMARDs?
- Methotrexate (Rheumatrex)-CBC and chem panel monitoring
- Sulfasalazine (Azulfidine)
- Hydroxychloroquine (Plaquenil)
- Leflunomide (Arava)
Rheumatoid Arthritis Drug Therapy for mild to moderate disease - Biologics?
- Tumor necrosis factor inhibitors
- Etanercept (Enbrel)
- Infliximab (Remicade)
- Monitor for infection, avoid live vaccinations
- Rituximab (Rituxan)-monoclonocal antibody-targets B cells
Rheumatoid Arthritis Drug Therapy - Corticosteroid therapy?
- Often used until DMARDs effective
- Intraarticular injections-relieve pain/inflammation
- Long-term use should not be a mainstay, there is a risk of osteoporosis, avascular necrosis
What is Gout?
- a form of arthritis caused by the accumulation of uric acid in the joints
- usually in the big toe
Characteristics
- Joint Inflammation
- Swollen, red, painful
- Motion limited
- Deformity-tophi
Gout Interprofessional Care?
- Rest
- Drug therapy
- NSAIDs
- Antiinflammatory-colchicine
- Recurrent gout-allopurinol, probenecid
- Nutritional therapy
- Eliminate purine (if needed)
- Low-purine Diet
- Mayo clinic gout diet
What is Systemic Lupus Erythematosus?
- Chronic, multisystem, inflammatory autoimmune disease
- Etiology unknown
- Variability within and among persons
Which disease is called “the rich mans’ disease” and why?
- Gout
- comes from a diet high in protein and alcohol
Systemic Lupus Erythematosus Drug Therapy?
- NSAIDs
- Hydroxychloroquine (Plaquenil)
- Corticosteroids (for acute flares)
- Immunosuppressive drugs
What is important for a nurse to assess in Systemic Lupus Erythematosus?
pain and fatigue daily
Which disease is known as the “disease of 1000 faces”?
Systemic Lupus Erythematosus
S/S of Systemic Lupus Erythematosus?
joint pain/swelling, rash (butterfly rash on face), sun sensitivity, finger changes color in the cold, hair loss, mouth sores, dyspnea, chest pain, blood clots miscarriages
Risk factors for Systemic Lupus Erythematosus?
women, 20-30 yrs of age
