Transcript Rheumatoid Diseases

Rheumatoid Diseases
Osteoarthritis
Rheumatoid Arthritis
Systemic Lupus Erythematosis
Scleroderma
Osteoarthritis
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Definition: *wear and tear,
progressive, non-systemic,
Degenerative Joint Disease (DJD)
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Pathophysiology
Note top slide only
Identify which joints
are primarily
affected with
osteoarthritis.
What factors
contribute to the
development of
osteoarthritis?
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
What signs and
symptoms does
the person with
osteoarthritis
experience?
Normal Knee
structure
Moderately
advanced
osteoarthritis
Advanced
osteoarthritis
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
Carpometacarpocarpal joint of
thumb with subluxation of the
first MCP
Genuvarus
Herberden’s nodes
Osteoarthritis
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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
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
Manifestations of RA
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Systemically ill
Hematologic
Pulmonary/CV
Neurologic
Ocular (Sjorgen’s)
Skin
MS, deformity, pain
Pain!
Pain!
Pain
Assessment
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Fatigue,
weakness, pain
Joint deformity
Rheumatic
nodules
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Pathophysiology
– IgG/RF (HLA)=
antigen-antibody
complex
– Precipitates in
synovial fluid
– Inflammatory
response
Joints changes with RA
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Early Pannus
• Granulation,
inflammation at
synovial
membrane,
invades joint,
softens and
destroys
cartilage
Diagnostic Tests
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ESR elevated
+ RA, ^ RA titer
Dec. serum
complement
Synovial fluid
inflammation
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Joint and bone
swelling,inflammation
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
Joint Changes
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Bilateral,
symmetrical, PIP’s,
MCP’s
Thumb instability
Swan neck,
boutonniere
deformity
Tensynovitis
Multans deformity
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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
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Nursing
Diagnosis
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– Comfort
– Physical mobility
– Self image
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Goals
Team Approach
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Pain
management
Exercise
Surgery
Teaching
Medications
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ASA *cornerstone
NAISD
Steroids (burst therapy)
Remitting agents
– antimalarial (plaquinal) *eye effects
– Penicillamine
– gold *dermatitis, blood dyscrasia
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Immunosuppressive agents
Joint Protection: Do’s and Don’t’s
Case Presentation
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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
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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
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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
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Nursing
diagnosis
Goal to control
inflammation
Emotional
support
Life Planning
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Medications
Avoid UV
Reduce stress
Monitor/manage
to prevent
complications
Scleroderma
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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 “hidebound” face of
person with
scleroderma
Tissue hardens;
claw-like
fingers; fibrosis
Assessment of Scleroderma
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Female 4:1
Pain, stiffness,
polyartheritis
Nausea, vomiting
Cough
Hypertension
Raynauld’s
syndrome
Scleroderma cont.
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Esophageal
hypomotility leads to
frequent reflux
GI complaints
Lung-pleural
thickening and
pulmonary fibrosis
Renal
disease...leading
cause of death!
CREST Syndrome
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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
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R/O autoimmune
disease
Radiological:
pulmonary fibrosis,
bone resorption,
subcutaneous
calcification, distal
esophageal
hypomotility
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What are the KEY
components of
care for the
individual with
Scleroderma?
Scleroderma: Patient Care
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Do’s
– Avoid cold
– Provide small,
frequent feedings
– Protect fingers
– Sit upright post
meals
– No fingersticks
– Daily oral hygiene
Ankylosing Spondylitis
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Definitions;
polyarteritis of
spine
Affects mostly
men
Associated with
HLA positive
antigen
Signs and
symptoms
– Morning backache,
flexion of spine,
decreased chest
expansion
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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
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Do’s
– Maintain spine
mobility
– Pain
management
– Proper
positioning
– Meds for pain,
inflammation
Other Collagen Diseases
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Reiter’s Syndrome
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– Reactive arthritis
associated with
enteric disease
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Polyarteritis
Nodosa
– Inflammation,
necrosis of walls
small to medium
sized arteries
– Like SLE
Lyme Disease
– Caused by spirochete,
borrelia burgdorferi
 Dermatomyositis
– 3 stages
– Affects skin and
• Initial rash
voluntary muscles
• disseminated
• Late
– Antibiotics effective
Rheumatoid Review
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Sjogrens
JRA