Joint Disorder (Osteoarthritis & Rheumatoid Arthritis Flashcards
a slowly progressive non-inflammatory disorder of the synovial joint
Osteoarthritis
Expected to increase greatly as the population ages
Osteoarthritis
More common in elderly
Osteoarthritis
What is osteoarthritis?
- a slowly progressive noninflammatory disorder of the synovial joint
- Expected to increase greatly as the population ages
Causes of osteoarthritis
-medications (stimulate collagen; corticosteroids)
- inflammation
-diabetic neuropathy
-joint instability
-trauma
digesting enzymes in joint synovium
stimulate collagen
what is stimulate collagen
digesting enzymes in joint synovium
Pathophysiology of osteoarthritis
-aging (cartilage destruction)
-genetics
-decreased estrogen at menopause
- obesity
-occupational
describe the type of occupational that could lead to osteoarthritis
job that require frequent kneeling
Clinical Manifestations of Osteoarthritis (specifically joints )
-joint pain
-pain with rest or sleep (advanced)
-joint stiffness
joint pain occurs in
-groin
-buttock
-outside of the thigh or knee
After periods of rest or static position
joint stiffness
joint stiffness resolves within
joint stiffness relieves within 30 minutes
grating sensation due to lose particles of cartilage
crepitation
What is joint stiffness
-after periods of rest or static position
-resolves within 30 minutes
-crepitation
what are the 2 nodes in the clinical manifestations of osteoarthritis
-Heberden’s nodes
-Bouchard’s nodes
distal interphalangeal (DIP) joints
Heberden’s nodes
due to osteophyte formation and loss of joint space
Heberden’s nodes
Describe the heberden’s nodes
-distal interphalangeal (DIP) joints
-due to osteophyte formation and loss of joint space
proximal interphalangeal (PIP) joints
Bouchard’s nodes
Describe the Bouchard’s nodes
proximal interphalangeal (PIP) joints
What’s the difference between heberden’s nodes and bouchard’s nodes
Heberden’s nodes is distal interphalangeal joints while the bouchard’s nodes is proximal interphalangeal joints
Diagnostics of osteoarthritis
-Bone scan
-MRI
-CT Scan
-ESR
What are the management of osteoarthritis?
-Rest and joint protection
-Heat and cold application
- Nutritional therapy & exercise
Rest and joint protection in the management of osteoarthritis
not more than a week to prevent stiffness
Heat and cold application in the management of osteoarthritis
-cold for acute inflammation
- heat therapy for stiffness
Nutritional therapy in the management of osteoarthritis
-weight control
- movement therapies (yoga, tai chi)
Surgical management of osteoarthritis
Reconstructive joint surgery
Medical Management of Osteoarthritis
-Aspirin
- Capsaicin cream
-NSAIDS
- Acetaminophen
- Opioids
- Disease Modifying Osteoarthritis Drugs (DMOADs)
it prolonged bleeding time
Aspirin
it blocks pain
Capsaicin cream
risk for bleeding/GI irritations
NSAIDS
Slow the progression of osteoarthritis or support join healing
Disease modifying osteoarthritis drugs
Purpose of aspirin in osteoarthritis
prolonged bleeding time
Purpose of capsaicin cream in osteoarthritis
blocks pain
example of NSAIDS drugs in osteoarthritis
Diclofenac/Misoprostol (Arthrotec)
Mechanism of action of disease modifying osteoarthritis drugs
slow the progression of osteoarthritis or support joint healing
chronic, systemic autoimmune disease
rheumatoid arthritis
inflammation of connective tissue in the diarthrodial (synovial) joints
rheumatoid arthritis
marked by periods of remission and exacerbation
rheumatoid arthritis
increases with age, peaking between ages 30 and 50
rheumatoid arthritis
What is rheumatoid arthritis
-chronic, systemic autoimmune disease
-inflammation of connective tissue in the diarthrodial (synovial) joints
-marked by periods of remission and exacerbation
-increases with age, peaking between ages 30 and 50
etiology of rheumatoid arthritis
-idiopathic
-autoimmune
-combination of genetics and environmental triggers
what triggers the combination of genetics and environmental in the rheumatoid arthritis
-smoking
-genetics
pathophysiology of rheumatoid arthritis
AUTOIMMUNE ETIOLOGY
-presence of autoantibodies (rheumatoid factor) against this abnormal IgG
-autoantibodies combine with IgG to form immune complexes that deposit on synovial membranes
-activates inflammatory response
-neutrophils release proteolytic enzymes
-causes damage articular cartilage and thickening of synovial lining
Clinical Manifestations of Rheumatoid Arthritis
-joint pain & inflammation
-limitation of motion
- occurs symmetrically
- affect the small joints of the hands and feet
-stiffness after activity
-morning stiffness
-ulnar drift (zigzag deformity)
-swan neck deformity
- boutonniere deformity
-Hallux Valgus
last from 60 minutes to several hours or more
morning stiffness
describe the characteristics of morning stiffness
morning stiffness last from 60 minutes to several hours or more
toe deformity
Hallux Valgus
What is Hallux Valgus
toe deformity
Also known as zigzag deformity
ulnar drift
Types that affect the small joints of the hands and feet
-proximal interphalangeal (PIP)
-metacarpophalangeal (MCP)
-metatarsophalangeal (MTP)
Diagnosis of Rheumatoid Arthritis
-CBC count
- History and physical findings
-Erythrocyte Sedimentation Rate
-Rheumatoid Factor
-Synovial fluid analysis
Reveals a slightly cloudy, straw colored fluid
Synovial fluid analysis
Purpose of Synovial fluid analysis
Reveals a slightly cloudy, straw colored fluid
What are the types of disease-modifying antirheumatic drugs
-Methotrexate
-Corticosteroids
-NSAIDS
Purpose of disease-modifying antirheumatic drugs
-immunosuppressants
-decrease risk for joint erosion and deformity
what is disease-modifying antirheumatic drugs?
immunosuppressants and decrease risk for joint erosion and deformity
has lower risk for toxicity
methotrexate
What is methotrexate?
-has lower risk for toxicity
-requires frequent laboratory monitoring
- can be given with other DMARDs
for symptom control; pain and inflammation
corticosteroids
this drug is for pain & inflammation
NSAIDs
Purpose of corticosteroids in DMADs
for symptom control; pain & inflammation
Corticosteroids is given in ___
intra-articular injections
Surgical Management of Rheumatoid Arthritis
-Synovectomy
-Arthroplasty
Removal of the inflamed joint tissue (synovium)
Synovectomy
Done using Arthroscopy
Synovectomy
What is Synovectomy
-Removal of the inflamed joint tissue (synovium)
-done using arthroscopy
Total joint replacement
Arthroplasty
Removal of the worn-out or damaged parts of joint and replaced with an artificial joint (prosthesis)
Arthroplasty
What is Arthroplasty?
-Total joint replacement
- Removal of the worn-out or damaged parts of joint and replaced with an artificial joint (prosthesis)
Nursing Management of Rheumatoid Arthritis
PROTECTION OF SMALL JOINTS
-maintain joint in a neutral position to minimize deformity
-use the strongest joint available for any task
-distribute weight over many joints instead of stressing a few
-change positions frequently.
How to distribute weight over many joints instead of stressing a few
-slide objects instead of lifting them
- hold packages close to the body for support
what is crepitation
grating sensation due to lose particles of cartilage
