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Rheumatoid Diseases Osteoarthritis Rheumatoid Arthritis Systemic Lupus Erythematosis Scleroderma Osteoarthritis Definition: *wear and tear, progressive, non-systemic, Degenerative Joint Disease (DJD) Pathophysiology Note top slide only

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Rheumatoid diseases l.jpg

Rheumatoid Diseases

Osteoarthritis

Rheumatoid Arthritis

Systemic Lupus Erythematosis

Scleroderma


Osteoarthritis l.jpg
Osteoarthritis

  • Definition: *wear and tear, progressive, non-systemic, Degenerative Joint Disease (DJD)

  • Pathophysiology


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Note top slide only

Identify which joints are primarily affected with osteoarthritis.

What factors contribute to the development of osteoarthritis?


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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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What signs and symptoms does the person with osteoarthritis experience?

Normal Knee structure

Moderately advanced osteoarthritis

Advanced osteoarthritis


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Assessment experience

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 experience

Carpometacarpocarpal joint of thumb with subluxation of the first MCP

Genuvarus

Herberden’s nodes


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Diagnostic Tests experience

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

Osteoarthritis


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Rheumatoid Arthritis experience

Chronic systemic, inflammatory disease characterized by recurrent inflammation of diarthroidal joints and related structures.


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Comparison of RA and OA experience

RA

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 experience

  • Systemically ill

  • Hematologic

  • Pulmonary/CV

  • Neurologic

  • Ocular (Sjorgen’s)

  • Skin

  • MS, deformity, pain

Pain!

Pain!

Pain


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Fatigue, weakness, pain experience

Joint deformity

Rheumatic nodules

Pathophysiology

IgG/RF (HLA)= antigen-antibody complex

Precipitates in synovial fluid

Inflammatory response

Assessment


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Early Pannus experience

Granulation, inflammation at synovial membrane, invades joint, softens and destroys cartilage

Joints changes with RA


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Diagnostic Tests experience

  • ESR elevated

  • + RA, ^ RA titer

  • Dec. serum complement

  • Synovial fluid inflammation

  • Joint and bone swelling,inflammation


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  • Mod experience advanced Pannus

  • joint cartilage disappears, underlying bone destroyed, joint surfaces collapse

  • Fibrous Ankylosis

  • Fibrous connective tissue replaces pannus; loss of joint otion

  • Bony Ankylosis

  • Eventual tissue and joint calcification


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Bilateral, symmetrical, PIP’s, MCP’s experience

Thumb instability

Swan neck, boutonniere deformity

Tensynovitis

Multans deformity

Subcutaneous nodules

Genu valgum

Pes plano valgus

Prominent metatarsal heads

Hammer toes

Joint Changes


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Assessment experience

Deformities that may occur with RA

Synotenovitis

Ulnar drift

Swan neck deformity

Boutonniere deformity


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Mutlans deformity (rapidly progressing RA) experience

Hitch-hiker thumb

Genu valgus


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Hammer toes experience

Subcutaneous nodules (disappear and appear without warning)


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Nursing Diagnosis experience

Comfort

Physical mobility

Self image

Goals

Team Approach

Pain management

Exercise

Surgery

Teaching

Interventions


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Medications experience

  • ASA *cornerstone

  • NAISD

  • Steroids (burst therapy)

  • Remitting agents

    • antimalarial (plaquinal) *eye effects

    • Penicillamine

    • gold *dermatitis, blood dyscrasia

  • Immunosuppressive agents



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Case Presentation experience

  • Comparison to ‘usual’ course

  • Diagnostic tests

  • Nursing diagnosis

  • Therapies

    • Medications used

    • Exercise

    • Joint Protection


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Systemic experienceLupus Erythematous (SLE)

Chronic multisystem disease involving vascular and connective tissue

Lupus help


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Types: Discoid, SLE experience

Incidence

Periods remission and exacerbation

Stress factor

Assessment

Low grade fever

Discoid erythema

MS involvement

Pericarditis

Raynauld’s

RENAL

CNS

Digestive,anemia

Characteristics of SLE


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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 especially discoid lupus erythematousremission 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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LE cell especially discoid lupus erythematous

ANA, titer

Anti-DNA

Complement fixation

ESR

Other

Criteria to Dx.

malar, discoid rash

photosensitivity

arthritis

renal disorder

immunological disorder

DNA, ANA

Diagnostic Tests


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Nursing diagnosis especially discoid lupus erythematous

Goal to control inflammation

Emotional support

Life Planning

Medications

Avoid UV

Reduce stress

Monitor/manage to prevent complications

Management SLE


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Scleroderma especially discoid lupus erythematous

  • 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 especially discoid lupus erythematous

Tissue hardens; claw-like fingers; fibrosis


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Assessment of Scleroderma especially discoid lupus erythematous

  • Female 4:1

  • Pain, stiffness, polyartheritis

  • Nausea, vomiting

  • Cough

  • Hypertension

  • Raynauld’s syndrome


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Scleroderma cont especially discoid lupus erythematous.

  • 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 especially discoid lupus erythematous

  • Calcinosis

  • Raynaud’s phenomena

  • Esophageal hypomotility

  • Sclerodactyl (skin changes of fingers)

  • Telangiectasia (macula-like angioma of skin)

More on CREST


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R/O autoimmune disease especially discoid lupus erythematous

Radiological: pulmonary fibrosis, bone resorption, subcutaneous calcification, distal esophageal hypomotility

What are the KEY components of care for the individual with Scleroderma?

Diagnosis/Treatment Scleroderma


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Scleroderma: Patient Care especially discoid lupus erythematous

  • Do’s

    • Avoid cold

    • Provide small, frequent feedings

    • Protect fingers

    • Sit upright post meals

    • No fingersticks

    • Daily oral hygiene


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Definitions; polyarteritis of spine especially discoid lupus erythematous

Affects mostly men

Associated with HLA positive antigen

Signs and symptoms

Morning backache, flexion of spine, decreased chest expansion

Diagnosis

Nursing Diagnosis

Ankylosing Spondylitis


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Ankylosing Spondylitis especially discoid lupus erythematous

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 spondylitis

  • Do’s

    • Maintain spine mobility

    • Pain management

    • Proper positioning

    • Meds for pain, inflammation


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Reiter’s Syndrome spondylitis

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

Other Collagen Diseases

Rheumatoid Review


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