Connective tissue disorder - Arthritis

How many bnones are in the body

206

What is a joint

Connnection point where two bones join to allow movement

What is a ligament

Connective itissue band that connects bone to bone to allow for stabalization

What is a tendon

Dense CT that connects muscle to bone

What is a synovial joint

Most commmon type of joint thats filled with fluid

What is arthritis

Rheumatic disorder where joint gets inflammaed and is painful, swelling and stifness

Has different types

• Osteoarthritisits

• Rheumatoid arthritis

• Gout

What is osteoarthristis (OA)?

Slow Progressive nonflammatory disorder of synovial joints

When does OA usually occur for women? and why

After menopause and affects hand and knee

Decreased Estrogen at menopause

When does OA occur for men

Most men affected by 70 to 80 years

Where part of the body is OA the most common

HIP

What is the cause of OA?

Biomechnical changes and stresses on the joint

Joint maformation

Past injury

Genetic defect

Common Risk factors for OA

Age

For women, decreased esotrogen

Obesity

Frequent kneeling stooping jogging

Ligament injury

What is the Patho of OA

Articular cartilage breaks down causing narrowing of joing space. Osteophytes form

How does OA clinical manifest itself?

Joint Pain

Does joint pain get worse with joint use?

Yes pain progresses

For those with OA what happens to their joints if they are at rest or are in an unchanged position?

Joint stiffens are they move

Do those with OA have crepitation?

Yes its joints cracking audibly when moving it

Do those with OA have systemic manifestations like fatique or fever from the OA?

No because it’s localized non inflammatory which is different than RA

Do those with OA have early morning stifness that resolves itself in 30 minutes

Yes which is different than RA

Do those with OA have unilaterla/ localized pain

Yes which is different than RA

Which locations are the joints affected for OA

Hips Knees Cervical Vertebrae Lumbar Vertebrae

What is a OA Varus Deformity (Bowlegged)?

Medial Knee

Bowlegged appeance

What is a OA Valgus deformity (knock-knee)

Lateral knee

How do you diagnose OA are there any diagnostic tests?

No specific lab

Look at x rays

Relies mainly on clinical findings and radiologi exams

Synovial fluid analysis

What is the nursing managamnt plan for OA

Not cure it but manage it

Prevent disability

Maintain joint function

Nondrug intervetions are the basis for OA management

Balance rest activity

What are non pharmalogical interventions for acute inflammation of OA?

Rest

Functional Position with splits or braces

If immobile limit to one week bc of stiffness that follows

Modify activites to decrease joint stress

Avoid prolonged standing kneeling or squatting

Use asstive device if needed

What does Heat and Cold application to one struggling with OA

May help reduce pain and stifness

When should you use ice for an OA patient and how does it work

For acute inflammation, causing vasocontriction causing less edema. Ice slows nerve signals

Numbs up the area

When shoudl you use heat for an OA patient and how does it work?

For if they have stiffness, heat allows for vasodilation

For those who suffer from OA but are overweight what is the best course of action

Weight Reduction

Dietary changes

Perform exercise like aerobic range of motion adn muscle strnehgething

For those struggling from OA what are important nutrients to get?

Omega 3

Dairy

What food is heavy in omega 3

Fish

What are some drugs one would take for mild pain for OA

Acteaminopheon

Topical Agent (Capsaicin cream)
OTC cream ( Camphor eucolytus oil, menthol)

TOpical slicylates

For moderate to severe OA pain what medicatioins are used

NSAIDS (Ibuprofin)

COX 2 inhibitor celecoxib (celebrex)

Injectable corticosteroids

When assessing a pt with OA what are things to look for

Joint pain and stiffness

Location, severity, frequency, duration

Impact and ability to perform adls

Asses affected joints

Tenderness, swelling

Crepitation

For those who are ambulatory with OA what are things to do

Adjust home management goals

Include Caregiver , family

REwork home to better suit person

Eliminate scatter rugs

Wear better fitting shoes

Assitive devices

What is a Arthroscopic surgery

Minimally invasive procedure to visiulize irriage and repair interal structures in the joint

Knee OA patients get this done

The first surgery done

What is a joint replacement?

Total Hip Replacement and Total Knee Replacement

To relief pain and give mobility and give quality of life

What is the difference between the anterior and posterioir approach for hip replacement

Anterioir approach is the new better method

Less complicatioins

Greater recovery times

If a Pt has a posterioir approach for hip replacement what are they at most risk for and interventions to prevent it

Disolocation

Use Raised toilet seat, abduction pillow, log roll

Do not cross log behnd hip more than 90 degrees

After hip surgery what are important items to check

Neurovascular check called CSM (circulation sensation movement)

Pain

Wound

When does PT get invovled post op?

Day 0 or 1

Surgeon dictates weight bearing status

Gradual progression to assistive devices to indepdent devices

What is Rheumatoid Arthritis?

Autoimmune disease Chronic inflammation of CT in synovial joints

Does RA have perioids of remission and exacerbation

Yes

Does RA manifest Extraarticular

Yes it spreads to outside of hte joint

What is the age range for RA

INcrease with age

Peaks between age 30 and 50

What is the patho of RA?

Antigen triggers Abnormal IgG actiating RF causing inflammation and destroying caritlage

How does RA initially manifest itself?

Subtle onset that presents like typical immune response

Generalized stiffness that becomes localizied stiffness

As RA progressess what might a person feel

Specific joint pain that may started with a stressful event

Affects small joints

Symptoms occur symmetrically

In the morning how long should a RA pt feel stiff for

60 min to serveral hrs or longer

How does RA manifest in joints

Hand joints typically swollen

Fingers are spindle shaped

Joints are tender painful and warm to touch

Pain increases with motion

How does RA manifest itself in a Extraarticularly

Rheumatoid Nodules form

Sjogrens Syndrom

Depression

What is Sjogrens syndrome

Extraarticular manifestion of RA

Autoimmune disorder where exocrine glands (lacrimal and Salivary) get destryoed

Dry, Dritty Eyes, and photosensitivity

What are diagnositic studies for RA?

H&P

KNow the Duration of symptoms

Joint involvement test

How many stages are there for RA?

4 stages

Each stage gets progressivley worse

What are ways to test for RA?

ESR: Erythrocyte sedimentation rate and CRP (C-reactive protein)

Rheumatoid factors: antibodies of IgG

X rays

What is the disease modifiying therapy Methotrexate

Early treatment for RA

Inhibits inflammatory response

When should you expect results from Methotrexate

4-6 weeks

What are the rare side effects of Methotrexate?

Bone marrow suppression and heptotoxicity

How does Biologic Response Modifiier Tumor Necrosis factor help RA

TNF binds to inhibitors inibbihibint inflammation

How is corticosteriod therapy given for RA

Intraarticular Injection

Are NSAIDS given for RA

Yes

Takes 2 - 3 weeks for full effectiviness

Why is it important to work with OT for people with RA

They can’t walk leading to loss or normal function like getting food meaning they cant eat

Results in weight loss

For those with RA and is taking corticosteroid therapy what is an important nutritional consideration?

Corticosteroid use results in weight gain and spikes blood sugar

Why do RA pts on corticosteroid therapy have hyperglycemia

The steroid stimulate glucose productionby the liver and inhibit peripheral glucose uptake which causing hyperglycemia and causes insulin reistance

What are nondrug therapy for those with RA

Balance of rest and activity

Heat and coldl application

TENS unit

Should those with RA do extention or flexion positions

Do Extension positions

Avoid Flexion positions

What are some other areas of concern for RA

Muscoloskeletal pain can be realted to depression and inactiivty

Polypharmacy due to many meds for joint pain

What is gout, what causes it

Type of arthritis caused by deposit of uric acid crystals in 1 or more joints

What organ goes wrong in order for gout to occur

Kidneys can not properaly excrete uric acid

So kidney deposits it in joints and tissues

Mainly feet and big toe

What race is more likely to have gout

Black individials more than whites

What gender is more liekly oto have gout

Men 3 times more than women

When do women get gout

After menopause so they rarley get gout before

What is the Patho behind Gout

If theres too much or too little uric acid

Drugs can inhibit urinc acid excretion

Immunosupressants can place poeple at at risk for gout

WHat is the two step process for gout to occur

Crystallization

Inflammation

Is a gout site very tender

Yes

How many joints are usually affected by gout at one time

One or More, less than 4

What are some triggers for gout

Trauma, Surgery, Alcohol, Systemic Infection

When do the symptoms of gout start like time of day

Onset at night

Sudden swelling and severe pain senentive to light touch low grad fever

HOw long does it take for gout to stop flaring up

2-10 days

What does it mean to have chronic gout

To have multiple joints involved

Tophi present: Visible deposits of crystals in SQ tissue synovial membrane

Can Tophi appear years after onset

Yes

What lab value causes more instances of gout

HIgh SErium urinc acid causes more episodes and tophi

Is the serveirty of gout variable

Ye can be mild attack to severe episodes

What serum uric acid value is postive for gout

6 mg/dl

What are Diagnoistiing testing for GOut

Serum Uric acid value more than 6mg

24 urine for uric acid

Synovial fluid aspiration

X ray

What is nursing managnet if someone comes to hospital with gout

Control Hyperuricemia and gout with pt education and adhereance

What are drugs for Gout

Anti Inflammatory

NSAIDS

Corticosteroids

What drug is used to prevent gout

Xanthine Oxidase inhibitor: Decreases uric acid production

Common type is Allopurinol

What is important to note about xanthine oxidase inhibitor

Causes renal impairemnt take with food and water

What is PT teaching for those strugginling with gout

Monitoring Uric acid regularly

Limit alcohola nd food high in purine

Aqeduate urine volume

weight reduction

What are high purine foods

Alcohol

Fish, seafood, and shellfish

Deli meat bacon turkey veal vension and organ meats like liver