Unit 16 Arthritis and Connective Tissue Disease Flashcards
How can arthritis generally be described and what are the major symptoms?
progressive and leads to disability
Pain and may include join swelling, limited movement, stiffness, weakness, fatigue, and disability
What is the generally goal with arthritis?
PT comfort, increase mobility, and prevent progression
Describe Gout.
-Metabolic disorder
-Hyperuricemia (elevated level of uric acid in blood)
>or= to 6.8 mg/dl -diagnosed gout
- Periods of exacerbations and remissions
- Could be primary (genetic) or secondary (medications or disease that increases uric acid)
- Extremely painful
- Risk for development of tophi and kidney stones because of increased uric acid
What are the risk factors for gout?
Common in males
Increased age
Increased BMI
Increased Uric acid levels
What are the defining characteristics of Gout?
- Acute pain
- Swelling
- Erythema
- Renal damage
- Tophi (crystallized uric acid on surface of joints, think of the toe picture)
-Great Toe (*podagra: gout of the foot, redness, swelling); other joints and cartilage
What two anti-inflammatory and pain medications are used in the treatment for Gout exacerbation? Describe them.
-colchicine
Interferes with the function of WBCs in initiating and maintaining inflammatory response
For acute stage, works very fast
SE: GI upset, *diarrhea, N/V, abd. pain, *aplastic anemia, can increase digoxin levels, muscle pain
Take with meals, avoid grapejuice
-NSAIDs (indomethacin and ibuprofen) does nothing for uric acid levels
Name the 2 Uricosuric medications taken to treat gout, prophylactically .
-probenecid
inhibits renal absorption of urates and increases renal excretion- decreases serum uric acid
SE: kidney stones, GI upset, aplastic anemia, flushing.
**action is decreased by salicytats(aspirin)
-colbenemid (combo Rx)
made of colchicine and probenecid
What are the xanthine oxidase inhibitors(XOI) medications use to treat Gout prophylactically? Name Describe them.
xanthine oxidase inhibitors(XOI) -febustat interrupts the breakdown of purines -allopurinol prevents uric acid in the blood by blocking uric acid formation
SE: increases action of anti-diabetic agents, hypotension, hepatitis, rash, bone marrow depression, N/V, increases theophylline toxicity, hypoglycemia
What category of medication can be used to treat gout and HTN that are good for the elderly?
ARBs
ex: artans
- promotes urinary excretion
What are the goals for treatment of Gout?
Pain management, dietary modifications, prevention of deformity, decrease exacerbations
What are nursing interventions for Gout?
- Prevention of exacerbations
- Medications
- Weight loss strategies
- Control hypertension
- Hydration (to flush system)
- Avoid alcohol use
- Avoid excess intake of purines
- Maintain uric acid level less than 6.8
- Prevent deformity and maintain musculoskeletal function
- Ice, no heat
What is Osteoarthritis (OA)?
-a chronic, progressive disorder that cause cartilage deterioration in synovial joints and vertebrae
What medications block the renal excretion of uric acid (which is bad)?
Aspirin and thiazide diuretics
What are the major risk factors for OA?
Age
Obesity
Overuse
What is the main problem in OA?
progression leads to disability
What are the main goal for OA?
Maintain mobility
Pain management
Improve joint function
Prevent disability
What are the clinical manifestations/defining characteristics of OA?
- Pain
- Joint Stiffness (occurs during periods of long rest, static position, and repetitive activity)
- Loss of movement and function
- Early morning stiffness resolves in less than 10-30 minutes
- Crepitus
- Local inflammation
- Not auto-immune
- Limited ROM
- Herberden’s DIP and Bouchard’s nodes PIP
Where are main sites that osteoarthritis occurs?
Shoulders, elbows, knees, hips
What are the diagnostics available for OA?
X-ray
H&P
Arthroscopy (slightly painful w/minimal swelling, consent needed, local anesthesia) endoscope going into the joint space, invasive
What are the Interventions for OA?
>Non-pharmacological: Nutritional supplementation Exercise: Yoga, T'ai Chi, swimming Positioning, ROM Joint support with splint (never put on all day) Balance rest with activity Heat & Cold
> Pharmacological management
Arthroplasty in severe cases
(surgical reconstruction or replacement of joint)
What are the pharmacological therapies for OA? Describe them.
-Acetaminophen- max dose 2600mg/day (over 4000 causes liver damage)
-Topical creams
-NSAIDs
(take misoprostol with GI complications, protects GI tract.)
-COX 2-Inhibitors (cyclooxygenase suppressant)
(celecoxib)
highly effective for joint pain
SE: CV disease and GI stress
Viscosupplemenation- injection of fluid
What are teaching plan points for PTs with osteoarthritis?
Balance rest and activity Improve activity intolerance Self-care Home safety How to use medications Therapeutic exercise program Community wellness programs
Describe Rheumatoid Arthritis.
- Autoimmune System Disease
- Has remissions and exacerbations
- Extra-articular manifestations (problems occurring outside the joints)
- Felty and Sjogren’s syndrome (dries mucus membrane)
- Progressive disability
- Loss of tendon and muscle contractility
- Systemic symptoms
- Attacks bodies own collagen
- Bi-lateral joint pain
What are the defining characteristics of RA?
- Early morning stiffness lasting 30-45 minutes
- Swelling, warmth, erythema and pain in affected joints
- Loss of function
- Joints feel spongy/bogey on palpation
- Bilateral and systemic symptoms (including fever, weight loss, fatigue)
- Deformities of metatarsals and PIP
- Signs and symptoms with exacerbations
What is Felty’s syndrome?
(S)plenomegaly (A)nemia (N)eutropenia (T)hrombocytopenia (A)rthritis
What is the American College of Rheumatoid Arthritis diagnostic criteria for RA?
4 of 7 of the following criteria for at least 6 weeks:
- Morning stiffness that lasts 30-45 min
- Swelling in three or more joints*
- Swelling in hand joints*
- Symmetric joint swelling*
- Erosions or decalcification seen on hand x-rays
- Rheumatoid nodules
- Presence of serum RF (Rheumatoid factor)
What are diagnostic tests for RA?
- ESR (erythrocyte sedimentation rate; blood test revealing inflammatory activity)
- Serum Rheumatoid factor
- Antinuclear antibody (ANA)
- C-reactive protein
- RBC and complements C3 and C4 (decreased)
- X-ray bony erosions and narrowed joint spaces
- Arthrocentesis- complement and inflammatory cells
What are the goals of treatment for RA?
Pain relief, decrease inflammation, slow progression of disability, address psychosocial needs
What markers will be elevated in RA?
Inflammatory markers
What are interventions for RA?
>Non-pharmacological pain relief >Nutrition: anti-inflammatory diet -Whole grain -Fresh fruits and vegetables -Legumes -Seeds and nuts -Avoid excessive high glycemic load calories including simple sugars -Animal products in moderations -Dietary supplementation: omega 3 fatty acids >Psychosocial self care >Pharmacological management (PT's will always need to take them)
What are the 3 Pharmacological categories of Disease modifying agents used to treat RA?
- Disease modifying anti-rheumatic drugs (DMARDs)
- Biologic Therapy (serious infection risk, no live vaccines)
- Antimalarial therapy
Name and describe the Rx’s that are Disease modifying anti-rheumatic drugs (DMARDs).
-methatrexate
drug of choice, rapid anti-inflammatory
SE: myelosuppression, aplastic anemia, and GI toxicity, infection risk
**teratogenic (Rx harmful to fetus)
- sulfasalazine
- leflunomide
Name and describe the Biological therapy medications for RA.
- etanercept
- adalimumab
- infliximab
-All 3 injectable
SE: bacterial sepsis, invasive fungal infections, and TB
*Manteaux testing before starting treatment is recommended
Name and describe the antimalarial therapy Rx and describe it.
-hydroxychloroquine
anti-inflammatory works with methotrexate
improves long term outcomes
SE: BM suppression, GI ulcers, infection risk, rashes, alopecia, and bladder toxicity
What are the pharmacological treatments for anti-inflammatory symptom treatment of RA?
NSAIDs Glucocorticoids Antibiotics Gold salts Antidepressants Sleep aids
What are good self-care points for RA PTs?
Pain management Medication regimen Alternate rest with activity Maintain body alignment Positive self image Joint protection Self-help groups
What is Systemic Lupus Erythematous (SLE)?
- Chronic inflammatory autoimmune disease
- Characterized by exacerbations and remission
- Exaggerated production of autoantibodies (against DNA) and antigens
- Difficult to Dx
autoimmune
Who is at a higher risk for Systemic Lupus Erythematous (SLE)?
Young women
What are clinical manifestations/defining characteristics of Systemic Lupus Erythematous (SLE)?
-Fatigue
-Reynaud’s phenomena
-Myalgia’s/arthralgia’s (joint pain caused by Rx’s)
-Cutaneous: Scleroderma:
>CREST syndrome *
>Butterfly rash
>Discoid lesions
>Photosensitivity
-GI system esophageal dysfunction
-Glomerulonephritis*
What are the diagnostics for Systemic Lupus Erythematous (SLE)?
**Antinuclear antibody (ANA) INCREASED (confirmatory for SLE)
- ESR increased
- Lupus cell prep
- Anti-DNA antibody -presence
- Anti-Sm antibody prosence
- Anti-Ro (SSA)
- Skin biopsy (cellular changes)
- American College of Rheumatology criteria
What are the goals for a PT with SLE?
Improve QOL, pain management, rest and activity, adequate nutrition, self-care
What are interventions for Systemic Lupus Erythematous (SLE)?
- Maintain skin integrity
- Management of fatigue and stress
- Promotion of adequate nutrition
- Sunscreen and protective clothing
- Monitoring of strict I and Os
- Assessment of Infection
- Pharmacologic management
What is the pharmacologic management of a PT with Systemic Lupus Erythematous (SLE)?
> Immunosuppressants/cytotoxic
- azathioprine
- cyclophosphamide steroids: systemic and topical
> NSAIDs
DMARDS
Antimalarial (fatigue, moderate skin, and joint problems)
Anticonvulsants (for possible seizures)
What PT teaching can be done regarding Systemic Lupus Erythematous (SLE)?
Alternate rest with activity When to contact HCP Improve QOL Home safety Joint protection Adequate nutrition Support groups Medication management
What is primary gout characterized by?
hyperuricemia
What do Rheumatic disorders affect?
joints, bones, muscles and connective tissues
What is the first choice Rx for RA [symptoms]?
NSAIDs
