Inflammation and mobility- MS, Osteoarthritis, Rheumatoid arthritis 1260

What is Multiple Sclerosis

A chronic, progressive autoimmune disease- leading to the demyelination of the CNS

Frequently the disease is relapsing and remitting, symptoms include fatigue weakness, numbness, difficulty coordination, loss of balance, pain and visual disturbances.

Multiple sclerosis pathophysiology

1. Immune system attacks it’s own myelin sheath

2. Inflammation occurs adding to the damage

3. Demyelination: loss of myelin disrupts nerve signals and transmission

4. Axonal Damage: Nerve fibers themselves can also be damaged

Multiple sclerosis types- courses

1. Relapsing- Remitting

   1. Clear relapse with full/ partial recovery- stable between relapses

2. Primary progressive- Steady progression from the onset with minor recovery

3. Secondary progressive

   1. Pattern of relapse but never fully return to normal- begins to have periods without remission

4. Progressive relapsing: Rare

   1. Progressive onset with ACUTE relapses- condition deteriorates fast

Multiple sclerosis risk factors

1. Genetic- 15 fold increase when first degree relative has it

   1. HLA-DR2 gene- more at risk

2. Environmental

   1. Northern latitude

   2. Epstein barr virus

3. Autoimmune diseases

   1. Diabetes type 1, thyroid disease, IBS

MS manifestations

Vision problems, eye pain, nystagmus, muscle weakness, spasticity,

Gait problems, vertigo, poor coordination, bladder and bowel incontinent.

Depression, inflammation

• V — Vision problems

• M — Muscle weakness and spasticity

• S — Sensory changes

• C — Coordination problems

• B — Bladder dysfunction

• F — Fatigue

MS diagnostic tests

Rule out other diseases

MRI for MS plaque or scarring

Evoked potential- test that measures the electrical activity in brain

Lumbar puncture ⬇

Elevation of IgC and the presence of oligoclonal band- indicates MS

Interventions for MS

Promote exercise, relaxation, avoid strenuous activity- aggravates symptoms, Bowel and bladder control ( medication, bowel and bladder program, fluid and fiber)

Swallowing instructions (dysphagia)- reduce risk of aspiration

Memory aids and daily routine to enhance cognitive function

Modify home to promote adl completion-

Treatment of MS goals, drugs and collaborative care

Goal: to delay progression of disease, manage s/s and treat exacerbations- no cure

Disease modifying drugs- reduce autoimmune response

Corticosteroids to reduce inflammation

Rehabilitate

Speech and vision therapy

Range of motion exercises

Adaptive equipment

physical therapy

MS meds

Immunomodulator- slow ms progression, reduce frequency and duration of relapse- infection risk

Corticosteroids: reduce acute inflammation

Antispasmodics- manage spasticiyt- drowsiness, liver damage

Carbamezapine- used for parasthesia

Oxybutynin- bladder dysfunction

MS complications

Falls, UTI, Constipation, Contracture deformities, pressure injuries, constipation, rectal distention, osteoporosis, pneumonia

MS Nursing diagnosis- things we treat

Impaired mobility, risk for injury, impaired bowel and bladder, disturbed thought process, ineffective coping

Goals for patients with MS

Promote physical mobility, avoid injury, bowel bladder control, speech and swallowing mechanisms, coping mechanism

Encourage fluid intake, communication board for dysarthria, coping mechanisms, cluster care to aid in energy conservation

May need eye patch for double vision

What is arthritis

Joint inflammation or destruction that leads to pain and tenderness that can cause an effect on mobility

What is Rheumatoid arthritis

Connective tissue disease➡ affecting multiple organs

Autoimmune, chronic inflammation- systmeic

Gets better as the day goes on- key difference

RA pathophysiology

Autoimmune activation (T and B cells) → Synovial membrane becomes inflamed (synovitis) → Pannus formation (invasive inflammatory granulation tissue) → Cartilage destruction → Bone erosion → Joint deformities and decreased ROM.

RA risk factors

Female at birth

Age

Family History

Nulliparity

Obesity

Tobacco Use

Geographic location

Diet Periodontitis Lung disease

Rheumatoid Arhritis Symptoms

Pain at rest and with movement- Joint discomfort early sign

Joint swelling- swan neck deformation

Ulnar deviation

Limited movement

Stiffness- morning longer than 30 minutes

Weakness/ Fatigue- early sign

RA tests

Rhematoid factors- autoimmune test

CBC, UA, UC

X rays, ct scan, mri

RA interventions

• Nutrition

  • Small frequent meals

  • High protein and iron/vitamins

• Pain

  • Provide comfort measures

  • Admin anti-inflammatory analgesic

• Fatigue

  • Energy conservation

  • Activity with planned rest

RA complications

Joint deformity, disability, chronic pain, Osteoporosis (chronic inflammation= osteoclast stimulation), cardiovascular disease ( chronic inflammation can destroy blood vessels)

RA treatment lifestyle and pharm

Heat/Cold therapy (heat for stiff, cold for pain)

Exercise walking and stretching

NSAID

Steroid

Biologics

Rheumatoid arthritis goals

Relief of pain, slow down progression, prevent joint deformity, reduce immobility, improve coping

Help manage stiffness

What is Osteoarthritis (OA)

OA- slow progressive non-inflammatory degenerative joint disorder

Most common form of arthritis and leading cause of disability in older adults

OA patho

Think Wear and Tear

• Cartilage degradation: Progressive loss of hyaline cartilage causes erosion of articular surfaces.

• Bone changes: Formation of bone spurs (osteophytes) around joints.

• Synovial inflammation: Inflammation of the synovial membrane causes pain and swelling.

• Joint space narrowing: Cartilage loss decreases the space between bones.

• Synovial fluid changes: Reduced lubrication contributes to cartilage erosion, bone-on-bone friction, and loose cartilage fragments within the joint.

• Hyaline cartilage degradation → Joint space narrowing → Bone-on-bone friction → Osteophyte formation + Synovial inflammation.

Osteoarhtrits Assessment- health history

Joint pain that worsens with activity & alleviated with rest (in early stage)

Difficulty sitting to standing

ADLs may be prevented by joint pain

Asymmetry of affected extremities- typically only affects one side

Grating sound

Bowlegged- knockneed

Joint effusion- moved from one area of the joint to the other

Osteoarthritis symptoms

Joint pain after movement- stiffness, pain gets worse as day goes on

Tenderness, loss of flexibilty

Bouchards nodes and herberdens nodes

Crepitus- grating sound when using joint

OA risk factors

Age

Women

Obesity

Joint injuries

Genetics

Bone mass

OA Diagnostic tests

Bone scan

CT/MRI- osteophytes detected

X-Ray are joints narrowing

OA Interventions

ROM exercises

OT/PT

Immobilize affected joint with brace during inflammation

Educate on maintaining appropriate weight

Use moist heat for joint tenderness

Cold therapy for inflammation and pain

Admin prescribed drug therapy

OA Complications

Chronic pain- decreased mobility, joint deformity, falls, joint instability, muscle weakness and atrophy, disability, depression and social isolation, sleep disturbances

These people need to maintain quality of life and minimize disability- wear and tear disease

OA vs RA Patho

OA vs RA complications and manifestations

OA vs RA tests and treatment- non pharm

OA vs RA meds and treatment complications

Obviously RA is going to need immunosuppression drugs as well as anti inflammatory

OA isn’t necessarily going to need the same thing- right think patho and why these must be different OA= mechanical breakdown of the joint- bone spurs- affects one side usually- not a given that it won’t affect the other- more topical treatments because it is not a systemic issue.