auti=oimmune

8/13/2019 auti=oimmune

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RHEUMATICDISORDERSRheumatoid Arthritis,

Systemic Lupus Erythematosus,Scleroderma,Fibromyalgia


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Rheumatic Disorders/Diseases include

Osteoarthritis (OA)degenerative joint diseaseRheumatoid arthritis (RA)

autoimmune disease

Systemic Lupus Erythematosus (SLE)disturbed immune regulation

Sclerodermadiffuse connective tissue disease

Arthritisinflammation of a joint

Fibromyalgiachronic pain syndrome


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Rheumatic Diseases

Onset acute or insidiousMay have periods of remission or

exacerbationTreatment may be simple or complexMay have permanent changes anddisability


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Pathophysiology

Most commonly affected area? The joint All involve some degree of inflammationand degeneration

Clinical ManifestationsPainJoint swellingLimited movementStiffnessWeaknessFatigue


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Diagnostic StudiesX-rays

Cat ScansMRI

Gerontologic ConsiderationsIdentify patients lifestyle, IndependenceOther chronic or acute conditionsPattern of onset

Clinical severityPharmacology

ADLs


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Rheumatoid Arthritis Autoimmune disease of unknown origin Affects more women than men

PathophysiologyReaction occurs primarily in synovial tissueCauses edema, increase of synovial membrane andpannus formationResults in loss of articular surface and joint motion,

and muscle fiber degenerationTendon and ligament elasticity and contractility arelost


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Clinical manifestations

Bilateral joint painBilateral Swelling

Warm jointsErythema of jointsLoss of function

Joint stiffness (greater in the morning)Deformities of the hands and feet


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RA Medical Management

Provide pain reliefReduce joint inflammation

Protect articular surfacesMaintain or improve joint functionControl systemic involvement


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Pharmacologics

NSAIDSDisease Modifying Rheumatic Agents(DMARDS)

Biologic Response Modifiers (BRM)HCQ antimalarial drugMTX methotrexateCorticosteroidsResearch drugs

(vaccines, ICE)


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RA NURSING DIAGNOSIS

Chronic painFatigueSleep deprivationImpaired Physical MobilityChronic Low Self EsteemRisk for Ineffective Therapeutic RegimenManagement


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SURGICAL Management of RA

Tendon transfer and OsteotomySynovectomy

ArthrodesisJoint replacementNursing Management (pre- post op)


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SYSTEMIC

LUPUSERYTHEMATOSIS

(SLE)Exaggerated production ofautoantibodies resulting fromdisturbed immune regulationB and T cells contribute to immuneresponse


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SLEClinical Manifestations

Involves musculoskeletal system with arthralgias andarthritisJoint swellingTendernessPain on movementMorning stiffnessInsidious or acuteChronic rash

butterfly-shaped rash across bridge of nose


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SLE medical managementFor acute disease

Control increased disease activityControl exacerbations that involve organsystem

For chronic diseasePeriodic monitoringRecognizing clinical changes

GoalsPrevent progressive loss of organ functionMinimize disease related disabilitiesPrevent complications


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SLE

AssessmentFever, fatigue, weight loss, pericarditis,erythematous rashes, friction rub

DiagnosticsC-Reactive protein, Antinuclear antibodies(ANAs) assay, blood test revealing anemia,leukocytosis, thrombocytopenia

PharmacologyCorticosteroidsNSAIDsImmunosuppressive agents


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SCLERODERMAHARD SKIN

Relatively rarePoorly understoodCause unknown

PathophysiologyBegins with skin involvementInitial inflammatory response causes edema withtaut, smooth, shiny skinThis leads to loss of elasticity and movementEventually becomes nonfunctional also occurs inblood vessels, major organs, and body systems


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SclerodermaClinical ManifestationsStarts insidiously with swelling in the hands,becoming increasingly hard and

rigid, dryextremities stiffen andlose mobility, face is masklike

Changes within body moreimportant than visible changes affecting heart, lungs, kidneys


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SclerodermaDiagnostic Findings

No conclusive test to diagnose

Medical Management

Tx depends on clinical manifestationsCounselingSupport measureModerate exerciseNo proven effective medication for sclerodermaMeds used to treat organs


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Scleroderma


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OTHER AUTOIMMUNEDISORDERS

SpondyloarthropathiesSystemic inflammatory disorder of theskeleton and associated with inflammatorybowel disease ( Chrohns Disease)Inflammation at site of attachmentTends to occur during young adulthood

Affects more men than womenStrong familial tendency


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ANKYLOSING SPONDYLITIS

Disease of young menMorning backache orstiffnessCostovertebral arthritisFused or inflamed vertebraeChronic pain
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Types ofSpondyloarthropathies

Ankylosing Spondylitis

1. Affects cartilaginous joints of the spine andsurrounding tissues

2. Back pain is characteristic feature

3. Leads to respiratory complications andcompromises


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Reactive Arthritis(Reiters Syndrome)

called reactive because it occurs after aninfection

Presents with triad of symptoms:1. Arthritis2. Conjunctivitis3. Urethritis

Dermatitis andulcerations of themouth and penis


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Types of Spondyloarthropathies

Medical management1. Treat pain

2. Maintain mobility by suppressinginflammation3. Maintain good body positioning and

posture4. Maintain ROM with exercise and muscle-

strengthening


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Types of SpondyloarthropathiesPharmacologic Management

1. NSAIDS2. Corticosteroid3. Methotrexate

Surgical Management1. May include total joint replacement


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Other Autoimmune Disorders

Polymyalgia Rheumatica (RMA )Morning stiffnessPain in the proximal musculature

Shoulder and pelvis

Systemic symptoms (fever,arthralgias, fatigue, weightloss)Diagnosed by elevated SEDrateWomen older than 50 mostcommon


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PSORIATIC ARTHRITIS15-25% of patients have psoriasis

Morning stiffnessFingernail and toenail lifting

Neck and back pain synovitispolysarthritis

spondylitis


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LYME DISEASEInfected deer tick (Borrelia burgdorferi)Early presentation- flu-like symptoms,weakness, joint pain, HA, fever, bulls -

eye rashTreatment antibiotictherapy

Doxcycline AmoxicillinCefurixime (Ceftin)

auti=oimmune

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