Download - Rheumatoid Diseases Osteoarthritis Rheumatoid Arthritis Systemic Lupus Erythematosis Scleroderma
Rheumatoid Diseases
Osteoarthritis
Rheumatoid Arthritis
Systemic Lupus Erythematosis
Scleroderma
Osteoarthritis
Definition: *wear and tear, progressive, non-systemic, Degenerative Joint Disease (DJD)
Pathophysiology
Identify which joints are primarily affected with osteoarthritis.
What factors contribute to the development of osteoarthritis?
Note top slide only
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
Normal Knee structure
Moderately advanced osteoarthritis
Advanced osteoarthritis
What signs and symptoms does the person with osteoarthritis experience?
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
Deformities with Osteoarthritis
Genuvarus
Herberden’s nodes
Carpometacarpocarpal joint of thumb with subluxation of the first MCP
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
Rheumatoid Arthritis
Chronic systemic, inflammatory disease characterized by recurrent inflammation of diarthroidal joints and related structures.
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
Manifestations of RA
Systemically ill Hematologic Pulmonary/CV Neurologic Ocular (Sjorgen’s) Skin MS, deformity, pain
Pain!
Pain!
Pain
Assessment
Fatigue, weakness, pain
Joint deformity Rheumatic
nodules
Pathophysiology– IgG/RF (HLA)=
antigen-antibody complex
– Precipitates in synovial fluid
– Inflammatory response
Joints changes with RA Early Pannus
• Granulation, inflammation at synovial membrane, invades joint, softens and destroys cartilage
Diagnostic Tests ESR elevated + RA, ^ RA titer Dec. serum
complement Synovial fluid
inflammation
Joint and bone swelling,inflammation
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
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
Assessment
Deformities that may occur with RA
Synotenovitis
Ulnar drift
Swan neck deformity
Boutonniere deformity
Mutlans deformity (rapidly progressing RA)
Hitch-hiker thumb
Genu valgus
Hammer toes
Subcutaneous nodules (disappear and appear without warning)
Interventions
Nursing Diagnosis– Comfort– Physical mobility– Self image
Goals Team Approach
Pain management
Exercise Surgery Teaching
Medications ASA *cornerstone NAISD Steroids (burst therapy) Remitting agents
– antimalarial (plaquinal) *eye effects– Penicillamine– gold *dermatitis, blood dyscrasia
Immunosuppressive agents
Joint Protection: Do’s and Don’t’s
Case Presentation
Comparison to ‘usual’ course Diagnostic tests Nursing diagnosis Therapies
– Medications used– Exercise– Joint Protection
Systemic Lupus Erythematous (SLE)
Chronic multisystem disease involving vascular and connective tissue Lupus help
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
Characteristic butterfly rash associated with SLE, especially discoid lupus erythematous
Barry’s lupus
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.
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
Management SLE
Nursing diagnosis
Goal to control inflammation
Emotional support
Life Planning
Medications Avoid UV Reduce stress Monitor/manage
to prevent complications
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
Typical “hide-bound” face of person with scleroderma
Tissue hardens; claw-like fingers; fibrosis
Assessment of Scleroderma
Female 4:1 Pain, stiffness,
polyartheritis Nausea, vomiting Cough Hypertension Raynauld’s
syndrome
Scleroderma cont.
Esophageal hypomotility leads to frequent reflux
GI complaints Lung-pleural
thickening and pulmonary fibrosis
Renal disease...leading cause of death!
CREST Syndrome
Calcinosis Raynaud’s
phenomena Esophageal
hypomotility Sclerodactyl (skin
changes of fingers) Telangiectasia
(macula-like angioma of skin)
Crest Syndrome
More on CREST
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?
Scleroderma: Patient Care
Do’s– Avoid cold– Provide small,
frequent feedings– Protect fingers– Sit upright post
meals– No fingersticks– Daily oral hygiene
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
Ankylosing Spondylitis
Insidious onset
Morning backache
Inflammation of spine; later spine
ossification
Oh my back hurts!
Comparison of changes with ospeoporosis and Ankylosing spondylitis
Identify a PRIORITY nursing concern related to ankylosing spondylitis
Management Ankylosing Spondilitis
Do’s– Maintain spine
mobility– Pain
management– Proper
positioning– Meds for pain,
inflammation
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