Unit 3 - Arthritis Flashcards
The word arthritis means “joint swelling” but arthritis isn’t just aches and pains. Arthritis has an enormous impact on quality of life.
It consists of…
more than 100 different conditions that can affect the joints.
Is arthritis a disease of the elderly?
Arthritis is not just a disease of the elderly; it can strike anyone at any time.
Arthritis costs
How much? In what? It is one of Canada's... Second only to? Ahead of?
more than $4 billion annually
in health care expenses and lost workday
most costly chronic conditions,
second only to cardiovascular disease
and ahead of cancer
Is arthritis common in Canada?
It one of the top three most common chronic diseases in Canada.
Compare/contrast disease rate in men/women
Arthritis effects nearly twice as many Canadian women as men.
Compare/contrast disease rate in
aboriginal women/non-aboriginal women
Aboriginal women are effected the most, with 70% aged 65 and older living with the disease, compared to 50% of non-aboriginal women in the same age group.
Rates of pain in arthritis
Over one-third (36%) of people with arthritis
deal with
severe to moderate pain,
compared with only 13% of people with non-arthritic conditions.
What is the most common type of arthritis?
Degenerative Arthritis
Degenerative Arthritis includes?
osteoarthritis and degenerative disc disease
Degenerative Arthritis etiology
Describe condition
Etiology (4)
erosion of the cartilage by
inflammation + breakdown
injury
or prolonged use
or excessive “wear and tear” on a joint
Degenerative Arthritis complications
4
bone underneath the worn cartilage thickens and may develop spurs
the joint can become swollen and painful
the loss of cartilage causes
loss of free movement of the joint
loss of shock absorption in weight bearing joints
Degenerative Arthritis main risk factor
more common as we age
Degenerative Arthritis
most common sites affected?
may also affect?
most common in the back, hips and knees
may effect
neck, shoulders,
fingers and toes, especially the halluxes
Degenerative Arthritis SX
Onset?
How are joints affected?
Describe pain (3)
slow onset over a period of years
may effect one or more joints
often asymmetrical
pain, swelling and stiffness of effected joints lasting more that 2 weeks
pain gets worse the more the joint is used
rest provides relief of pain and discomfort
Diagnosis of Degenerative Arthritis (2)
physical examination
x-rays
Goals and Treatments for Degenerative Arthritis:
maintain function and preserve joints
pain control
anti-inflammatories
Degenerative Arthritis pain control (6)
topical creams and gels
non-narcotic analgesic e.g. acetaminophen
non-steroidal anti-inflammatories (NSAIDs);
e.g. ASA, ibuprofen, naproxen
COX 2 inhibitors
e.g., celecoxib (Celebrex)
oral corticosteroids
e.g., prednisone
opiates
Degenerative Arthritis injx - where?
intra-articular injection
Degenerative Arthritis injx - what? (2)
corticosteroids
viscosupplementation (hyaluronic acid)
Degenerative Arthritis - viscosupplementation (hyaluronic acid) describe (3)
used for mild to moderate OA
a clear gel-like substance that lubricates cartilage and restores its viscoelasticity or ability to absorb shock
new and expensive
Degenerative Arthritis - complementary treatments? (2)
complementary supplements
e.g., glucosamine, chondroitin sulfate
Degenerative Arthritis - last resort Tx
surgery for joint replacement especially hips and knees
Inflammatory Arthritis includes?
SJ LARP
Social justice live action role playing (game)
lupus erythematosus ankylosing spondilitis rheumatoid arthritis psoriatic arthritis scleroderma
juvenile arthritis
Inflammatory Arthritis - Etiology
Inflammatory arthritis is sometimes called?
sometimes called rheumatological disease, connective tissue disease or autoimmune disease
Inflammatory Arthritis - Etiology
Cause?
exact cause is unknown but thought that infection, possibly viral agents and heredity play a part
Inflammatory Arthritis - Etiology
Starts with?
Resulting in?
starts a faulty immune response
that attacks the synovium lining of the joints
resulting in destruction of cartilage and bone
Inflammatory Arthritis - Etiology
The faulty immune response may also?
attack other tissues in the body
Inflammatory Arthritis - SX
Onset?
How are joints affected?
Describe pain (3)
may have a slow or sudden onset
may effect several joints at once in a symmetrical pattern, often smaller joints first
may be chronic and steady or be more severe at times with periods of remission in between
aching, pain, stiffness, warmth, and swelling in joints
may have general symptoms of fatigue, fever or weight loss
Inflammatory Arthritis - SX
Does it affect joints only?
may effect other body systems: cardiac pulmonary renal neurological integumentary
Inflammatory Arthritis - DX (5)
history and physical exam
bloodwork, often extensive
imaging: x-rays, CT scan, MRI
synovial fluid analysis
often needs referral to a rheumatologist
Inflammatory Arthritis - Goals
early diagnosis and treatment to avoid severe damage to the joints
Inflammatory Arthritis - TX
5 types of meds that are used
non-steroidal anti-inflammatories (NSAIDs)
COX 2 inhibitors
corticosteroids
disease-modifying anti-rheumatic drugs (DMARDs)
biologic response modifiers (“biologics” or BRMs)
Inflammatory Arthritis - TX
NSAIDs
S/E (1)
Examples (2)
ALL can cause GI bleeding or upset
e.g. ASA, ibuprofen
Inflammatory Arthritis - TX
COX 2 inhibitors
Example
e.g. celecoxib (Celebrex)
Inflammatory Arthritis - TX
Corticosteroids
Administration routes (3) S/E (1)
IV, oral or intra-articular injection
IV and oral preparations cause immunosuppression
Inflammatory Arthritis - TX
Disease-modifying anti-rheumatic drugs (DMARDs)
What do they do?
S/E?
slows the rate of inflammation
cause immunosuppression
Inflammatory Arthritis - TX
Disease-modifying anti-rheumatic drugs (DMARDs)
7 Drugs
GLAM HSC
gold therapy (Myochrisine)
leflunomide (Arava)
azathioprine (Imuran)
methotrexate (MTX)
hydroxychloroquine (Plaquenil)
sulfasalazine (Azulfidine)
First line Tx, significant S/E in 25% of people
cyclosporine
Inflammatory Arthritis - TX
Biologic response modifiers (“biologics” or BRMs)
What do they do?
S/E?
block specific hormones to control inflammation
cause immunosuppresion
Inflammatory Arthritis - TX
Biologic response modifiers (“biologics” or BRMs)
3 drugs
newest drugs and very expensive
Remicade
Enbrel
Humira
Gout - Etiology
What type of disorder is gout?
gout is a disorder of the body metabolism creating either over production of (10% of cases), or too little excretion of uric acid (90% of cases)
normally purine in the diet is broken down by the body’s metabolism into uric acid and excreted by the kidneys
Gout - Etiology
What does the build up of uric acid in the blood cause?
the build up of uric acid in the blood causes
uric acid crystals to deposit in tissue
Gout - Etiology
Where does uric acid deposit?
most common site is the hallux but may affect any joint
Gout - Etiology
What causes it? (4)
may be hereditary
or as a result of other disorders e.g. renal disease psoriasis cancer treatment
Gout - SX (5)
pain swelling redness warmth may be accompanied by fever
Gout - SX
Onset
onset is sudden and often effects only one joint
Gout - SX
Describe pain
pain is sustained, very intense and will last from 3 to 10 days if untreated
Gout - SX
Complications (2)
may become chronic causing erosion and severe deformity of a joint similar to rheumatoid arthritis
uric acid crystals can form deposits in soft tissue called ‘tophi’ that can irritate and swell locally
Gout - DX (3)
blood test for uric acid
analysis of aspirated synovial fluid from effected joint
24 hour urinalysis for uric acid
Gout - Goals
THREE!!! of them
provide symptom relief in acute phase of attack
prevent further attacks and joint damage
prevent the formation of kidney stones or tophi (uric acid crystal deposits in soft tissue)
Gout - TX
Acute Phase
NSAIDs
e.g., indomethacin
steroids
oral or intra-articular injection
colchicine (causes nausea and diarrhoea)
Gout - TX
For Prevention of Reoccurrence
probenecid or sulfinpyrazone increase the excretion of uric acid by the kidneys
allopurinol decreases the over production of uric acid by the body
low purine diet (decrease intake of seafood, liver and gravy) to decrease the production of uric acid
Effects of Arthritis on the Lower Limb
General (4)
pain and swelling leads to decreased range of motion (ROM)
disuse leads to stiffness, decreased muscle strength and weakened ligaments
prolonged disuse leads to contractures and joint deformities
overuse leads to injury of weakened structure
Effects of Arthritis on the Lower Limb
Toes
deformities of toes:
o claw, hammer or mallet toes
o hallux rigidus and hallux valgus
o subluxation of metatarsal heads
Effects of Arthritis on the Lower Limb
Rear foot and ankle
rear foot and ankle deformities leading to:
o pronation
o supination
Effects of Arthritis
on
Common Foot Pathologies of SKIN (3)
altered or stiff gait can lead to callus formation
o medially or laterally
o on one or both feet
toe deformities can create areas of pressure causing callus or skin breakdown:
o tips of toes
o metatarsal heads
o dorsum of toes (PIPs and DIPs)
stiff toes can be hard to dry and lead to maceration and skin breakdown between or under toes
Effects of Arthritis
on
Common Foot Pathologies of NAILS (1)
altered areas of pressure can lead to nail thickening and/or deformity
Effects of Arthritis on the Lower Limb
The effects are?
ongoing and progressive
Effects of Arthritis on General Health and Mobility
pain and fatigue lead to decrease exercise tolerance
joint deformity leads to altered gait and decreased mobility
difficulty with ADL can lead to psychological effects of depression and social isolation
General Treatments and Interventions for Arthritis
control pain
prevent or minimize joint deformity
maintain function and mobility
good nutrition and weight management
General Treatments and Interventions for Arthritis
Physical and occupational therapists work with and teach clients how to:
(Just memorize a few?)
use correct body mechanics for joint preservation
use splints correctly for joint protection
do ROM exercises
use heat and cold
safely build up endurance and strength
pace and arrange activity to conserve energy
modify their environment to maximize functioning
General Treatments and Interventions for Arthritis
Social Workers help clients manage
stress and emotional needs
financial issues
transportation or home services needs
Nursing Foot Care for Clients with Arthritis
AX
Identify (6)
any history of arthritic disease
client’s understanding of condition and any current treatments
if taking med(s) that cause immunosuppression
other health care providers involved e.g. rheumatologist, physiotherapist
any risk factors or foot abnormalities related to arthritis
how well client is coping
Nursing Foot Care for Clients with Arthritis
Planning (4)
realistic goals for treatment
in consultation with client
and based on their preferences for treatment
interventions
in consultation with client
including education and referrals
plan foot care to not interfere with other treatments
delay treatment in an acute attack if necessary
Nursing Foot Care for Clients with Arthritis
Intervx - General (2)
refer client to doctor if you identify any joint pain, redness or swelling that has not been diagnosed
question the client about any changes
Nursing Foot Care for Clients with Arthritis
Intervx - Footwear (2)
identify any areas of pressure from footwear and work with client to minimize or prevent skin breakdown
refer client for footwear or orthotic modification as needed
o
Nursing Foot Care for Clients with Arthritis
Intervx - Footcare (1)
exercise particular caution to protect fragile skin during foot and nail care
Nursing Foot Care for Clients with Arthritis
Intervx - Teaching (2)
teach client how to manage self care of feet using creative problem solving as needed (e.g. using reaching aid or q-tips to dry well between toes)
consider increased risk of infection with immunosuppression when teaching client to monitor minor injury
Nursing Foot Care for Clients with Arthritis
Evaluation (3)
evaluate effectiveness of interventions including teaching and referrals
identify changes in client’s behaviour or lack of change (e.g. they have new shoes and insoles but aren’t wearing them)
document changes to care plan along with any new goals or interventions
Role of the Foot Care Nurse as a Member of the Health Care Team
SCARF
Supportive Communication Advocating Referrals Follow-Up
Role of the Foot Care Nurse as a Member of the Health Care Team
SCARF
Suportive (2)
demonstrate support for whatever treatment and caregivers are currently in place
encourage clients to ask questions and be active participants in their own care
Role of the Foot Care Nurse as a Member of the Health Care Team
SCARF
Communication (2)
if concerns are urgent or more detail is required consider a phone call, letter or fax to clarify communication
keep a record of communications
Role of the Foot Care Nurse as a Member of the Health Care Team
SCARF
Advocating (4)
Advocate for:
clients to have a family physician to mange degenerative arthritis or gout
clients to have a rheumatologist to manage inflammatory arthritis
Home Care assessment through family physician if needed
call Health Links or Manitoba Medical Association for a list of physicians taking new clients
Role of the Foot Care Nurse as a Member of the Health Care Team
SCARF
Referrals
Family physician
- diagnosis and treatment of joint pain, swelling or redness that does not start to resolve in 2 to 3 days, has not been diagnosed or is recurrent
- questions about making changes to their medications
“The Arthritis Society”
- questions about treatment options
- financial assistance available locally
- programs and services
e. g., Arthritis Self-Management classes
Role of the Foot Care Nurse as a Member of the Health Care Team
SCARF
Follow-Up (1)
document referrals and ask the client about outcomes at subsequent visits
