Transcript 09. Intervention for Clients with Connective Tissue Disease and

Interventions for
Clients with
Connective Tissue
Disease and Other
Types of Arthritis
Rheumatology
Connective tissue disease
(CTD) is a major focus of
rheumatology.
Rheumatic disease is any
disease or condition
involving the
musculoskeletal system.
Arthritis means
inflammation of one or
more joints.
Rheumatology (Continued)
Noninflammatory
arthritis is not
systemic.
Inflammatory
arthritis
– Rheumatoid
arthritis
– Systemic lupus
erythematosus
Osteoarthritis
Most common type
of arthritis
Joint pain and loss of
function
characterized by
progressive
deterioration and
loss of cartilage in
the joints
Osteophytes
Collaborative Management
History
Physical assessment
and clinical
manifestations
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Joint involvement
Heberden's nodes
Bouchard’s nodes
Joint effusions
Atrophy of skeletal muscle
Assessments
Psychosocial
Laboratory assessment of
erythrocyte sedimentation
rate and C-reactive protein
(may be slightly elevated)
Radiographic assessment
Other diagnostic assessments
– MR imaging
– CT studies
Chronic Pain
Interventions:
Pain control may be
accomplished at home
with drug and
nonpharmacologic
measures.
Surgery may be
performed to reduce
pain.
Comprehensive pain
Chronic Pain (Continued)
Rest, positioning,
thermal modalities,
weight control, TENS,
complementary and
alternative therapies,
stem cell therapy
Surgical management
Total Hip Arthroplasty
Preoperative care
Operative procedures
Postoperative care
– Prevention of
dislocation, infection,
and thromboembolic
complications
– Assessment of bleeding
– Management of anemia
Care of Total Hip Arthroplasty
Assessment for
neurovascular
compromise
Management of pain
Progression of
activity
Promotion of selfcare
Impaired Physical Mobility
Interventions:
Goal: to achieve
independent function
Therapeutic exercise
Promotion of activities
of daily living and
ambulation
Teaching about health
and how to use
assistive devices
Rheumatoid Arthritis
A most common connective
tissue disease and the most
destructive to the joints
Chronic, progressive,
systemic inflammatory
autoimmune disease
primarily affecting the
synovial joints
Autoantibodies (rheumatoid
factors) formed that attack
healthy tissue
Collaborative Management
Assessment
Physical assessment
and clinical
manifestations
– Early disease
manifestations
– Late disease
manifestations
– Joint involvement
– Systemic complications
– Associated syndromes
Assessments
Psychosocial
assessment
Laboratory
assessment:
rheumatoid factor,
antinuclear antibody
titer, erythrocyte
sedimentation rate,
serum complement,
serum protein
Drug Therapy for RA
Mild disease
Nonsteroidal anti-inflammatory
drugs (NSAIDs), for instance,
celecoxib, rofecoxib, valdecoxib
with cox-2 inhibiting properties
Disease modifying antirheumatic
drugs (DMARDs), such as
hydroxychloroquine,
sulfasalazine, and minocycline
(Continued)
Drug Therapy for RA
(Continued)
Moderate to severe disease
Methotrexate
Leflunomide
Biological response modifiers
such as etanercept, infiximab,
adalimumab, anakinra
Nonpharmacologic Modalities
in the Treatment of RA
Plasmapheresis
Complementary and alternative
therapies
Promotion of self-care
Management of fatigue
Enhancement of body image
Health teaching
Lupus Erythematosus
Chronic, progressive,
inflammatory connective tissue
disorder can cause major body
organs and systems to fail.
Many clients with SLE have some
degree of kidney involvement.
Collaborative Management
Physical assessment and clinical
manifestations
– Skin involvement
– Musculoskeletal changes
– Systemic manifestations including
pleural effusions or pneumonia and
Raynaud’s phenomenon
Assessments for Lupus
Psychosocial results can be
devastating.
Laboratory
– Skin biopsy (only significant test to
confirm diagnosis)
– Anti-Ro (SSA) test
– Complete blood count
– Body system functions
Progressive Systemic
Sclerosis
Referred to as systemic
scleroderma, meaning hardening
of the skin
Diffuse cutaneous scleroderma
Limited cutaneous scleroderma
(Continued)
Progressive Systemic
Sclerosis (Continued)
Clients have CREST syndrome:
– Calcinosis
– Raynaud’s phenomenon
– Esophageal dysmotility
– Sclerodactyly
– Telangiectasia
Drug therapy slows disease
progression but is often
unsuccessful.
Gout
Also called gouty
arthritis, a systemic
disease in which urate
crystals deposit in the
joints and other body
tissues, causing
inflammation
Primary gout
Secondary gout
Collaborative Management
Acute gout
Chronic gout
Drug therapy
Diet therapy
Lyme Disease
Reportable systemic infectious
disease caused by the spirochete
Borrelia burgdorferi, resulting from
the bite of an infected deer tick
Stages I and II
If not treated in early stages,
chronic complications such as
arthralgias, fatigue, memory and
thinking problems present in later
stages
Fibromyalgia Syndrome
Chronic pain syndrome, not an
inflammatory disease
Pain typically located at trigger
points
Physical therapy treatment
Drug therapy with NSAIDs
Muscle relaxants
Home exercises, including walking,
swimming, rowing, biking, and water
exercise