Download - Rheumatoid Diseases Osteoarthritis Rheumatoid Arthritis Systemic Lupus Erythematosis Scleroderma
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Rheumatoid Diseases
Osteoarthritis
Rheumatoid Arthritis
Systemic Lupus Erythematosis
Scleroderma
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Osteoarthritis
Definition: *wear and tear, progressive, non-systemic, Degenerative Joint Disease (DJD)
Pathophysiology
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Identify which joints are primarily affected with osteoarthritis.
What factors contribute to the development of osteoarthritis?
Note top slide only
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Structural changes with Osteoarthritis
Early
Cartilage softens, pits, frays
Progressive
Cartilage thinner, bone ends hypertrophy, bone spurs develop and fissures form
Advanced
Secondary inflammation of synovial membrane; tissue and cartilage destruction; late ankylosis
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Normal Knee structure
Moderately advanced osteoarthritis
Advanced osteoarthritis
What signs and symptoms does the person with osteoarthritis experience?
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Assessment
Onset of pain is insidious, individual is healthy!
Pain is aching in nature; relieved by rest!.
Local signs and symptoms: swelling, crepitation of joint and joint instability, asymmetrical joint involvement
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Deformities with Osteoarthritis
Genuvarus
Herberden’s nodes
Carpometacarpocarpal joint of thumb with subluxation of the first MCP
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Osteoarthritis
Diagnostic Tests– None specific– Late joint changes,
boney sclerosis, spur formation
– Synovial fluid inc., minimal inflammation
– Gait analysis
Nursing diagnosis Interventions
determined by complications– Supportive devices– Medications (no
systemic treatment with steroids)
– Dietary to dec. wt.– Surgical
Intervention (joint replacement)
– Teaching
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Rheumatoid Arthritis
Chronic systemic, inflammatory disease characterized by recurrent inflammation of diarthroidal joints and related structures.
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Comparison of RA and OARA
Cause unknown
Remissions
*Body parts affected, systemic, small joints, symmetrical
Females, age 20-30; 3-1 ratio
OA
Cause “wear and tear”, weight
Non-systemic, weight bearing joints
Middle-aged and elderly, males 2-1 affected
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Manifestations of RA
Systemically ill Hematologic Pulmonary/CV Neurologic Ocular (Sjorgen’s) Skin MS, deformity, pain
Pain!
Pain!
Pain
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Assessment
Fatigue, weakness, pain
Joint deformity Rheumatic
nodules
Pathophysiology– IgG/RF (HLA)=
antigen-antibody complex
– Precipitates in synovial fluid
– Inflammatory response
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Joints changes with RA Early Pannus
• Granulation, inflammation at synovial membrane, invades joint, softens and destroys cartilage
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Diagnostic Tests ESR elevated + RA, ^ RA titer Dec. serum
complement Synovial fluid
inflammation
Joint and bone swelling,inflammation
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Mod advanced Pannusjoint cartilage disappears, underlying bone destroyed, joint surfaces collapse
Fibrous AnkylosisFibrous connective tissue
replaces pannus; loss of joint otion
Bony AnkylosisEventual tissue and joint calcification
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Joint Changes
Bilateral, symmetrical, PIP’s, MCP’s
Thumb instability Swan neck,
boutonniere deformity
Tensynovitis Multans deformity
Subcutaneous nodules
Genu valgum Pes plano valgus Prominent
metatarsal heads Hammer toes
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Assessment
Deformities that may occur with RA
Synotenovitis
Ulnar drift
Swan neck deformity
Boutonniere deformity
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Mutlans deformity (rapidly progressing RA)
Hitch-hiker thumb
Genu valgus
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Hammer toes
Subcutaneous nodules (disappear and appear without warning)
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Interventions
Nursing Diagnosis– Comfort– Physical mobility– Self image
Goals Team Approach
Pain management
Exercise Surgery Teaching
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Medications ASA *cornerstone NAISD Steroids (burst therapy) Remitting agents
– antimalarial (plaquinal) *eye effects– Penicillamine– gold *dermatitis, blood dyscrasia
Immunosuppressive agents
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Joint Protection: Do’s and Don’t’s
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Case Presentation
Comparison to ‘usual’ course Diagnostic tests Nursing diagnosis Therapies
– Medications used– Exercise– Joint Protection
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Systemic Lupus Erythematous (SLE)
Chronic multisystem disease involving vascular and connective tissue Lupus help
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Characteristics of SLE
Types: Discoid, SLE
Incidence Periods remission
and exacerbation Stress factor
Assessment– Low grade fever– Discoid erythema– MS involvement– Pericarditis– Raynauld’s– RENAL– CNS– Digestive,anemia
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Characteristic butterfly rash associated with SLE, especially discoid lupus erythematous
Barry’s lupus
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SLE characterized by periods of remission and exacerbation. Stimulated by sunlight, stress, pregnancy, infections like strep and some drugs. Some drugs like apresoline, pronestyl, dilantin, tetracycline, phenobard may cause a lupus-like reaction which disappears when drug is stopped.
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Diagnostic Tests
LE cell ANA, titer Anti-DNA Complement
fixation ESR Other
Criteria to Dx.– malar, discoid
rash– photosensitivity– arthritis– renal disorder– immunological
disorder– DNA, ANA
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Management SLE
Nursing diagnosis
Goal to control inflammation
Emotional support
Life Planning
Medications Avoid UV Reduce stress Monitor/manage
to prevent complications
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Scleroderma
Definition: progressive sclerosis of skin and connective tissue; fibrous and vascular changes in skin, blood vessels, muscles, synovium, internal organs. become “hide bound”
CREST syndrome: benign variant of disease
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Typical “hide-bound” face of person with scleroderma
Tissue hardens; claw-like fingers; fibrosis
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Assessment of Scleroderma
Female 4:1 Pain, stiffness,
polyartheritis Nausea, vomiting Cough Hypertension Raynauld’s
syndrome
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Scleroderma cont.
Esophageal hypomotility leads to frequent reflux
GI complaints Lung-pleural
thickening and pulmonary fibrosis
Renal disease...leading cause of death!
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CREST Syndrome
Calcinosis Raynaud’s
phenomena Esophageal
hypomotility Sclerodactyl (skin
changes of fingers) Telangiectasia
(macula-like angioma of skin)
Crest Syndrome
More on CREST
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Diagnosis/Treatment Scleroderma
R/O autoimmune disease
Radiological: pulmonary fibrosis, bone resorption, subcutaneous calcification, distal esophageal hypomotility
What are the KEY components of care for the individual with Scleroderma?
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Scleroderma: Patient Care
Do’s– Avoid cold– Provide small,
frequent feedings– Protect fingers– Sit upright post
meals– No fingersticks– Daily oral hygiene
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Ankylosing Spondylitis
Definitions; polyarteritis of spine
Affects mostly men
Associated with HLA positive antigen
Signs and symptoms– Morning backache,
flexion of spine, decreased chest expansion
Diagnosis Nursing
Diagnosis
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Ankylosing Spondylitis
Insidious onset
Morning backache
Inflammation of spine; later spine
ossification
Oh my back hurts!
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Comparison of changes with ospeoporosis and Ankylosing spondylitis
Identify a PRIORITY nursing concern related to ankylosing spondylitis
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Management Ankylosing Spondilitis
Do’s– Maintain spine
mobility– Pain
management– Proper
positioning– Meds for pain,
inflammation
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Other Collagen Diseases Reiter’s Syndrome
– Reactive arthritis associated with enteric disease
Lyme Disease– Caused by spirochete,
borrelia burgdorferi– 3 stages
• Initial rash• disseminated• Late
– Antibiotics effective
Polyarteritis Nodosa– Inflammation,
necrosis of walls small to medium sized arteries
– Like SLE Dermatomyositis
– Affects skin and voluntary muscles
Sjogrens JRA
Rheumatoid Review