Rheumatoid and Osteoarthritis Flashcards
Define osteoarthritis
- Slow progressive non-inflammatory disorder of the diarthrodial joints
- Not considered a normal part of aging process- but age does influence development
- Cartilage destruction can begin between ages 20 and 30
- Symptoms common at ages 50-60
- “my hips really bad, I need a hip replacement”
- Can be inflamed at some point
Etiology and Pathophysiology of osteoarthritis
- Single cause for OA has not been identified: has to do with cartilage and cartilage getting damaged
- OA results from cartilage damage that triggers a metabolic response at level of chondrocytes
- Cartilage becomes: thick, yellow, and granular; soft and less elastic; less able to resist wear with heavy use
Discuss the osteoarthritis
- Wide space between bones in first picture
- Space between bones is less in second picture
- Narrow space between bones, causing pain at this point in 3rd picture, described as bone on bone, hurting even when laying in bed, hurting all the time
- Steroid injections help
- Being overweight would put more strain and pressure on the joints
Clinical Manifestations of Osteoarthritis
Joint pain:
- Predominant symptom ranging from mild discomfort to significant disability
- Pain worsens with joint use
- Early stages: rest relieves pain
- Later stages: pain with rest and sleep is disturbed because of pain and increased joint discomfort
- Localized
- Be careful throughout the day, do a bit of work then rest the joint, no strenuous work all day
- As cartilage wears more and more, it becomes more painful
- Osteo: localized, in the one joint, other may be impacted but not the exact same, CRP and ESR would be normal levels since they are localized
- Rheumatoid: systemic
- Joint stiffness occurs after periods of rest or statis position
- Early morning stiffness usually resolves within 30 minutes
- Overactivity can cause mild joint effusion (swollen, fluid build up); temporarily increases stiffness
Define Herberden’s and Bouchard’s
- These nodes are associated with OA- not to be confused with rheumatoid nodules or tophi from gout
- Build up at the joints, almost like scar tissue building up
- Distal: Heberden’s
- Middle: bouchard’s
- Hands in alignment
Define Rheumatoid Arthritis
- Chronic, systemic autoimmune disease
- Inflammation of connective tissue in diarthrodial (synovial) joints
- Periods of remission and exacerbation
- Frequently accompanied by extra-articular manifestations
- Occurs globally, affecting all ethnic groups—more women than men
- Something triggered the body to go into immunity overdrive
- Attacking own body, weakened immune system or overdrive
- Inflammation in both hands, going to be symmetrical
- Period of remission, symptoms go away, and exacerbation, symptoms flare up
- Extra articular manifestations: symptoms outside of the joints because it is attacking the whole body
Etiology and Pathophysiology of RA
- Cause of RA is unknown
- Two possibilities currently: autoimmune response, genetic factor; patient reports precipitated by an event - infection and stressors (cascade of destruction ensues as body mounts attack)
Discuss the RA
- Synovium is inflamed with oste
- B. destruction of cartilage, loses stability, causes more swelling, destruction of tissue
- C. begins to erode the bone and attack, causes more swelling
Extra Articular Manifestations of RA
- keratoconjunctivitis: dry eyes
- Swollen lymph glands
- Myositis: sore muscles
- Raynaud’s syndrome: impaired blood flow in cold weather, immediately turns blue
Complications of RA
- Joint destruction begins as early as first year of disease without treatment
- Flexion contractures and hand deformities
- Cause diminished grasp strength
- Affect patient’s ability to perform self-care tasks
- Want to start them on medication to prevent destruction of joints by suppressing immune system in some way
Clinical Manifestations of RA
- Onset is typically insidious
- General stiffness may precede onset of joint symptoms
- Symptoms occur symmetrically
- Patient experiences joint stiffness after periods of inactivity
- Morning stiffness may last from 60 minutes to several hours or longer
- Increased pain when moving
- Joints become tender, painful, and warm
- Joint pain ↑ with motion
- Varies in intensity
- May not be proportional to degree of inflammation
Nursing Assessment
- Full hx
- Physical
Nursing Diagnoses
- chronic pain
- impaired physical mobility
- disturbed body image
- ineffective self-health management
- self-care deficit
Nursing Goals for RA and OA
- Reduction of inflammation
- Management of pain
- Maintenance of joint function
- Perform self-care
- Prevention or minimization of joint deformity
- Maintain a positive self-image
Nursing Interventions for OA and RA
- Rest and Joint Protection
- Patient must understand importance of balancing rest and activity
- Maintain good body alignment during rest
- Encourage positions of extension, avoid positions of flexion
- Modify activities to put less stress on joints
- During periods of acute inflammation, affected joint should be:
- Rested
- Maintained in a functional position (with splints or braces if necessary)
- Immobilization time should be as limited as possible
- Heat and Cold Applications:
- May help reduce pain and stiffness
- Heat is used more often than ice
- Ice appropriate for acute inflammation
- Heat therapy is especially helpful for stiffness to loosen muscles.
- Hot packs, whirlpool baths, ultrasound
Comparison of the two
