Arthritis and Connective Tissue Diseases Flashcards
What is osteoarthritis?
Most common form of joint disease in North America
Progresses slowly
Noninflammatory/synovial joints
Formation of new joint tissue in response to cartilage destruction
women affected more than men
joint pain/stiffness
decreases after rest/intensifies after activity
as disease progresses pain with rest also
pain due to soft tissue involvement
crepitation (grating sensation)
What are clinical manifestations of osteoarthritis?
deformity: specific to involved joint
appears as early as 40
tends to be seen in family members
Knee OA often leads to joint malalignment
altered gait
Advanced hip OA may cause one leg to be shorter
What diagnostic studies are used for patients with osteoarthritis?
X-rays are helpful in confirming disease and staging the progression of joint damage
Bone density
Bone scan
CT, MRI
How do you treat osteoarthritis?
manage pain-Analgesic-Tylenol, topical salicylates NSAIDS Rest but also positioning and exercises Weight reduction if needed TENS unit Surgery
What does SLE typically affect?
skin muscle lining of lungs heart nervous tissue kidneys
What happens with SLE?
multi-system autoimmune inflammatory disease
production of large variety of autoantibodies
multiple influences
genetic
hormonal
environmental
immunologic
can be mild to severe
accumulation of circulating immune complexes
chronic unpredictable course
waxes and wanes
What are the dermatologic manifestations of SLE?
alopecia butterfly rash discoid erythema palmar erythema mucosal ulcers
What are manifestations in the central nervous system of SLE?
stroke seizures peripheral neuropathy psychosis organic brain syndrome
What are manifestations in the cardiopulmonary system of SLE?
endocarditis myocarditis pericarditis pleural effusion pneumonitis Raynaud's phenomenon
What are manifestations in the hematopoietic system of SLE?
anemia leukopenia lymphadenopathy splenomegaly thrombocytopenia
What are manifestations in the urinary system of SLE?
glomerulonephritis
hematuria
proteinuria
What are manifestations in the gastrointestinal system of SLE?
abdominal pain
diarrhea
dysphagia
nausea and vomiting
What are manifestations in the musculoskeletal system of SLE?
arthritis
myositis
synovitis
What are manifestations in the reproductive system of SLE?
menstrual abnormalities
How do you diagnose SLE?
History Physical exam Laboratory studies ANA anti-Sm
What criteria do you need for a diagnosis of SLE?
malar rash
discoid rash
photosensitivity
oral ulcers
arthritis: nonerosive, involvement of two or more joints characterized by tenderness, swelling and effusion
Serositis: pleuritis or pericarditis
Renal disorder: persistent proteinuria or cellular casts in urine
Neurologic disorder: seizures or psychosis
Hematologic disorder: hemolytic anemia, leukopenia, lymphopenia, or thrombocytopenia
Immunologic disorder: positive LE preparation; anti-DNA antibody or antibody to Sm nuclear antigen or false-positive serologic tests for syphilis
Antinuclear antibody
What collaborative care do you have for SLE?
Early diagnosis
Prompt recognition of serious organ involvement
Manage active phase
Prevent complications
What is the pharmacological treatment of SLE
NSAIDS Anticoagulants Warfarin (Coumadin) Anti-malarial medications Hydroxychloroquine (Plaquenil) Corticosteroids Prednisone Solumedrol Immunosuppressive medications Azathiopine (Imuran) Cyclophosphamide (Cytoxan)
What are goals for patients with SLE?
Provide pain relief
Comply with therapeutic regimen to achieve Maximal symptom management
Demonstrate awareness of and avoid activities that exacerbate condition
Maintain optimal role function and positive image
What is Rheumatoid Arthritis
Chronic systemic autoimmune disease
Characterized by inflammation of the connective tissue of synovial joints
Periods of remission and exacerbations
Extra-articular manifestations
What are clinical manifestations of Rheumatoid Arthritis?
Joints insidious onset pain stiffness limitation of motion inflammation symmetrical affects small joints of hands and feet
What are extrarticular manifestations of Rheumatoid Arthritis?
rheumatoid nodules
Sjogren’s syndrome - targets moisture producing glands - leads to dry mouth and eyes
Felty syndrome - swollen and elevated WBC
What are complications of Rheumatoid Arthritis?
Joint destruction Flexion contractures Joint deformities Cataract development Bone destruction Ulcerations Progressive hoarseness
How do you diagnose Rheumatoid Arthritis?
History and physical findings
Laboratory tests
Synovial fluid analysis
X-rays
What is the pharmacologic treatment of Rheumatoid Arthritis?
Immunosuppressants Methotrexate (Rheumatrex) Sulfasaline (Asulfidine) Antimalarial Hydroxychloroquine (Plaquenil) Biologic/targeted therapy Etanercept (Enbrel) Infliximab (Remecade)
What are acute interventions for patient with Rheumatoid Arthritis?
Pain management
Help them to be as independent as possible
What are goals for patients with Rheumatoid Arthritis?
Have satisfactory pain relief
Minimal loss of functional ability of affected joints
Participating in and carrying out the therapeutic regimen
Maintain a positive self image
Perform self-care activities to great potential
What are clinical manifestations of systemic sclerosis?
Raynaud’s phenomenon
Skin and joint changes
What are skin changes with systemic sclerosis?
sweat glands become compressed
loses hair
fat goes away
blood vessels are being compressed (decrease in circulation)
What are three soft tissue rheumatic syndromes?
myofascial pain syndrome
fibromyalgia syndrome
chronic fatigue syndrome
What is fibromyalgia syndrome?
It is questionable if it is genetic
s/s: Pain, sleep issues, fatigue
Diagnostic studies: nothing specific
Treatment: treat symptoms and psychologic issues, yoga, better nutrition
disease is life-long; may only be able to decrease or alleviate symptoms
Wat is chronic fatigue syndrome?
debilitating fatigue
diagnosis is of exclusion
nursing care: supportive management
Drugs: NSAIDS, antihistamines, tricyclic antidepressants, sleep meds
