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Rheumatoid Diseases

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  1. Rheumatoid Diseases Osteoarthritis Rheumatoid Arthritis Systemic Lupus Erythematosis Scleroderma

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

  3. Note top slide only Identify which joints are primarily affected with osteoarthritis. What factors contribute to the development of osteoarthritis?

  4. 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

  5. What signs and symptoms does the person with osteoarthritis experience? Normal Knee structure Moderately advanced osteoarthritis Advanced osteoarthritis

  6. 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

  7. Deformities with Osteoarthritis Carpometacarpocarpal joint of thumb with subluxation of the first MCP Genuvarus Herberden’s nodes

  8. 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 Osteoarthritis

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

  10. Comparison of RA and OA 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

  11. Manifestations of RA • Systemically ill • Hematologic • Pulmonary/CV • Neurologic • Ocular (Sjorgen’s) • Skin • MS, deformity, pain Pain! Pain! Pain

  12. Fatigue, weakness, pain Joint deformity Rheumatic nodules Pathophysiology IgG/RF (HLA)= antigen-antibody complex Precipitates in synovial fluid Inflammatory response Assessment

  13. Early Pannus Granulation, inflammation at synovial membrane, invades joint, softens and destroys cartilage Joints changes with RA

  14. Diagnostic Tests • ESR elevated • + RA, ^ RA titer • Dec. serum complement • Synovial fluid inflammation • Joint and bone swelling,inflammation

  15. Mod 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

  16. 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 Joint Changes

  17. Assessment Deformities that may occur with RA Synotenovitis Ulnar drift Swan neck deformity Boutonniere deformity

  18. Mutlans deformity (rapidly progressing RA) Hitch-hiker thumb Genu valgus

  19. Hammer toes Subcutaneous nodules (disappear and appear without warning)

  20. Nursing Diagnosis Comfort Physical mobility Self image Goals Team Approach Pain management Exercise Surgery Teaching Interventions

  21. Medications • ASA *cornerstone • NAISD • Steroids (burst therapy) • Remitting agents • antimalarial (plaquinal) *eye effects • Penicillamine • gold *dermatitis, blood dyscrasia • Immunosuppressive agents

  22. Joint Protection: Do’s and Don’t’s

  23. Case Presentation • Comparison to ‘usual’ course • Diagnostic tests • Nursing diagnosis • Therapies • Medications used • Exercise • Joint Protection

  24. SystemicLupus Erythematous (SLE) Chronic multisystem disease involving vascular and connective tissue Lupus help

  25. 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 Characteristics of SLE

  26. Characteristic butterfly rash associated with SLE, especially discoid lupus erythematous Barry’s lupus

  27. 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.

  28. LE cell ANA, titer Anti-DNA Complement fixation ESR Other Criteria to Dx. malar, discoid rash photosensitivity arthritis renal disorder immunological disorder DNA, ANA Diagnostic Tests

  29. Nursing diagnosis Goal to control inflammation Emotional support Life Planning Medications Avoid UV Reduce stress Monitor/manage to prevent complications Management SLE

  30. 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

  31. Typical “hide-bound” face of person with scleroderma Tissue hardens; claw-like fingers; fibrosis

  32. Assessment of Scleroderma • Female 4:1 • Pain, stiffness, polyartheritis • Nausea, vomiting • Cough • Hypertension • Raynauld’s syndrome

  33. Scleroderma cont. • Esophageal hypomotility leads to frequent reflux • GI complaints • Lung-pleural thickening and pulmonary fibrosis • Renal disease...leading cause of death!

  34. CREST Syndrome • Calcinosis • Raynaud’s phenomena • Esophageal hypomotility • Sclerodactyl (skin changes of fingers) • Telangiectasia (macula-like angioma of skin) More on CREST

  35. 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? Diagnosis/Treatment Scleroderma

  36. Scleroderma: Patient Care • Do’s • Avoid cold • Provide small, frequent feedings • Protect fingers • Sit upright post meals • No fingersticks • Daily oral hygiene

  37. 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

  38. Ankylosing Spondylitis Insidious onset Morning backache Inflammation of spine; later spine ossification Oh my back hurts!

  39. Comparison of changes with ospeoporosis and Ankylosing spondylitis Identify a PRIORITY nursing concern related to ankylosing spondylitis

  40. Management Ankylosing Spondilitis • Do’s • Maintain spine mobility • Pain management • Proper positioning • Meds for pain, inflammation

  41. 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 Other Collagen Diseases Rheumatoid Review