Joint Disorder (Osteoarthritis & Rheumatoid Arthritis Flashcards by Kate Carmie

a slowly progressive non-inflammatory disorder of the synovial joint

Osteoarthritis

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Expected to increase greatly as the population ages

Osteoarthritis

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More common in elderly

Osteoarthritis

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What is osteoarthritis?

a slowly progressive noninflammatory disorder of the synovial joint
Expected to increase greatly as the population ages

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Causes of osteoarthritis

-medications (stimulate collagen; corticosteroids)
- inflammation
-diabetic neuropathy
-joint instability
-trauma

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digesting enzymes in joint synovium

stimulate collagen

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what is stimulate collagen

digesting enzymes in joint synovium

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Pathophysiology of osteoarthritis

-aging (cartilage destruction)
-genetics
-decreased estrogen at menopause
- obesity
-occupational

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describe the type of occupational that could lead to osteoarthritis

job that require frequent kneeling

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Clinical Manifestations of Osteoarthritis (specifically joints )

-joint pain
-pain with rest or sleep (advanced)
-joint stiffness

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joint pain occurs in

-groin
-buttock
-outside of the thigh or knee

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After periods of rest or static position

joint stiffness

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joint stiffness resolves within

joint stiffness relieves within 30 minutes

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grating sensation due to lose particles of cartilage

crepitation

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What is joint stiffness

-after periods of rest or static position
-resolves within 30 minutes
-crepitation

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what are the 2 nodes in the clinical manifestations of osteoarthritis

-Heberden’s nodes
-Bouchard’s nodes

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distal interphalangeal (DIP) joints

Heberden’s nodes

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due to osteophyte formation and loss of joint space

Heberden’s nodes

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Describe the heberden’s nodes

-distal interphalangeal (DIP) joints
-due to osteophyte formation and loss of joint space

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proximal interphalangeal (PIP) joints

Bouchard’s nodes

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Describe the Bouchard’s nodes

proximal interphalangeal (PIP) joints

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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

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Diagnostics of osteoarthritis

-Bone scan
-MRI
-CT Scan
-ESR

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What are the management of osteoarthritis?

-Rest and joint protection
-Heat and cold application
- Nutritional therapy & exercise

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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