assessment for joint/connective tissue problems include
gait, posture, functional assessment (observe activities like transfer to chair, dressing/ADL)
ESR is
rate of sedimentation of RBC, inflammation causes clumping of RBC so higher ESR level an indication of inflammation
antiarthritic drugs: 3 categories
- NSAIDs, non-steroidal anti inflammatory drugs including aspirin
- DMARDs disease modifying anti rheumatic drugs
- glucocorticoids - adrenal corticosteroids
inflammatory connective tissue diseases: 3
- RA
- SLE (systemic lupus erythematosus
- Scleroderma
serum lab tests:
- ESR
- Uric Acid
- ANA (antinuclear antibody)
3 goals of rheumatic disease
- suppress inflammation and the autoimmune response
- control pain
- maintain or improve joint mobility
osteoarthritis definition
chronic, causes cartilage deterioration in synovial joints and vertebrae.
osteoarthritis affects
weight bearing joints: hips and knees
osteoarthritis pain: when?
worse with activity, better with rest, not usually at night
crepitus during ROM activity
sign of OA
herberden: definition
enlarged upper joints of the fingers/DIP joints
bouchard: definition
enlarged lower joints of the fingers/PIP joints
radiographic/X Rays show
osteophytes - (bone spur) bony growth at the end of a bone
MRI show
cartilage, synovium and bone
osteoarthritis interventions:
no treatment to stop degeneration of joints so
- educate
- reduce pain and inflammation
- maintain function
NSAID risk
GI complications
arthroplasty and osteoarthritis:
surgical repair of the joint
intra-articular injections
hyaluronic acid - acts as synovial fluid in joint space
corticosteroids - methylprednisolone
hot or cold treatment timing
20 minutes on/off
gout: definition
urate crystals deposited in joints, problem with purine metabolism > hyperuricemia (high uric acid in blood)
primary gout: definition
genetic, overproduction of uric acid or decreased urate excretion in the kidney
secondary gout definition
also hyperuricemia, diabetic ketoacidosis (DKA), starvation
tophi: definition
urate/uric acid crystals deposited in peripheral areas like great toe, hands or ear.
acute gouty arthritis: definition
recurrent attacks of joint inflammation/ acute arthritis
diagnostics for gout: 4
- uric acid test, 6.8 is gout
- 24 hour urine collection
- x-ray
- aspiration of fluid from inflamed joint to see crystals
gout ice or heat?
ice
gout medications
chochicine (colcrys) - interfere with function of WBC so no inflammatory response
chochicine (colcrys) side effects
diarrhea, take with meals,
gout nursing interventions
- pain mgmt - cold compression
- hydration - avoid kidney stones
- diet - avoid pureens (organ meat, alcohol, red meat)
- healthy weight
rheumatoid arthritis unilateral?
no, affects both sides at same time
RA sign
morning stiffness for an hour before pain
RA causes
- rheumatoid factor (RF) antibodies form against IgG
2. synovial membrane destruction leads to pannus
RA signs
deformities of hands and feet
fatigue
weight loss
Raynaud’s
arthrocentesis
RA diagnostic, synovial fluid analysis
swan neck deformity
deformed position of the finger due to RA
RA labs
RF high Anti CCP high ESR high ANA high RBC lower
DMARDs
methotrexate - anti inflammatory, give with folic acid supplement, s/e aplastic anemia
saline eye drops for
RA
connective tissue types include
bone, blood and organs
ESR diagnose? evaluate treatment?
not to diagnose, evaluate
intercritical symptoms?
no
gout in the great toe called
podagra
uric acid level signals gout
6.8
gout and kidney stones (uric acid filtered by kidneys)
purines make up 15 percent of uric acid, uric acid > gout and kidney stones
colchicine/Colcrys timing
must be taken within 24 hours of onset of acute gout attack
XOI (Xanthine Oxidase Inhibitors) treat
gout by blocking uric acid formation
XOI side effects
anti diabetes meds: hypotension, hypoglycemia
Uricosuric treat
gout by lower/inhibit renal reabsorption of uric acid so excreted out in urine, decrease serum uric acid
Uricosuric risk
kidney stones
Uricosuric not to be taken with
aspirin and thiazide diuretics
gout hydration amount and reason
2L to prevent kidney stones
osteoarthritis level of activity
moderate
osteoarthritis s/s
stiff joints b/c loss of synovial fluid
crepitus
no inflammation
worse pain bad weather
osteoarthritis and WBC
WBC WNL b/c no systemic inflammation, just local swelling
osteoarthritis assessment
morning stiffness: 30 minutes
tylenol / acetaminophen
max 4000 mg/ 4g
osteoarthritis hot or cold
temperature treatments hot and cold
osteoarthritis meds
COX2 Inhibitors / celecoxib / celebrex for local inflammation
COX2 Inhibitors / celecoxib / celebrex side effects
cardiovascular problems, MI, CVA, high BP
autoimmune local?
systemic
systemic example
dry mucus membranes, wrist pain, cold feet
RA unilateral
bilateral
RA assessment
morning stiffness 1 hour
Rheumatoid Factor RF specific to RA
no, all inflammation have high RF
arthrocentesis fluid color
synovial fluid s/b clear, not cloudy or milky (b/c antibodies in it)
any med that treats inflammation risk
infection b/c WBC inhibited
Tumor Necrosis Factor (TNF) treat
RA
Tumor Necrosis Factor (TNF) side effects
TB so manteaux test before, no live vaccines
dairy and inflammation
can cause it
SLE risk factors
15-40 YO, black and hispanic women,
SLE cause
anti-DNA antibodies, blood vessels attacked/inflamed
SLE and kidneys
lupus nephritis
SLE and skin
rash, photosensitivity, butterfly rash,
Scleroderma definition
connective tissue disease, hardening of the skin
Scleroderma effects
loss of skin elasticity incl lungs, esophagus and GI tract hardening
Scleroderma interventions
impaired swallowing and constipation
RA s/s
bilateral joint pain, weight loss, joint deformed, tinnitus, GERD
SLE s/s
fever, nephritis
ANA serum test to
diagnose
ESR blood test to
evaluate treatment
pannus is
highly vascular granulation tissue
SLE usually linked to
Scleroderma
Rheumatoid Arthritis (RA) vs Osteoarthritis (OA) similarities
- RA and OA both forms of arthritis which is pain in the joints
- both chronic
- both
RA vs OA type of disease
RA autoimmune
OA “wear and tear” over time, degenerative, destroys cartilage in synovial joints and vertebrae
RA vs OA symptoms
RA joint pain, inflammation, stiffness
OA joint pain, non inflammatory, stiffness
RA vs OA location
RA inflammation in pairs of smaller joints, both hands, both ankles, etc
OA weight bearing joints (back, hip, knee)
RA vs OA timing
RA worse in morning for at least 1 hour
OA morning for 30 minutes, gets worse with activity during day
RA vs OA systemic symptoms
RA, systemic fatigue, weight loss, weakness
OA, localized