Arthritis & Connective Tissue Diseases

arthritis

inflammation or damage to joints

who is affected by arthritis

more common in older adults and females

3 types of arthritis

1. osteoarthritis (OA) → wear and tear

2. rheumatoid arthritis (RA) → autoimmune joint disease

3. SLE → systemic autoimmune disease

osteoarthritis

degenerative joint disease caused by wear and tear

who gets osteoarthritis

• older adults

• inceased risk with obesity and joint injury

what is happening with osteoarthritis

cartilage breaks down and bones begin to rub together

joint changes with osteoarthritis

• cartilage breakdown

• bone spurs form

• joint space narrows

results of osteoarthritis

• pain

• decreased movement

• stiffness

pain and osteoarthritis

• worse with activity

• relieved by rest (early)

• may occur at rest (late)

stiffness and osteoarthritis

• after rest

• less than 30 minutes in morning

joint changes and osteoarthritis

• crepitus (grating)

• decreased ROM

• joint instability

common joints impacted by osteoarthritis

• knees, hips

• spine

• hands

osteoarthritis diagnosis is based on …

clinical findings

what clinical findings are markers for osteoarthritis

• pain worse with activity

• morning stiffness less than 30 mins

• decreased ROM

imaging for osteoarthritis

x-ray

• joint space narrowing

• bone spurs (osteophytes)

non drug care for osteoarthritis management (first line)

• weight loss

• exercise (low impact)

• joint protection

medications for osteoarthritis management

• NSAIDs (GI bleed risk)

• topical agents (preferred)

• corticosteroid injection

nursing focus with osteoarthritis management

• pain management

• promote mobility

• prevent disabiltiy

when is surgery needed for osteoarthritis

• severe pain

• loss of function

• decreased ability to perform ADLs

• joint replacement (hip/knee)

supportive devices for osteoarthritis

• braces/splints

• proper footwear

complementary therapies for osteoarthritis

• acupuncture

• relaxation techniques

• some supplements (use with caution)

patient teaching with osteoarthritis

• do NOT replace medical treatment

• always discuss supplements with provider

nursing assessment with osteoarthritis

• location and severity of joint pain

• effect on ADLs

• joint movement and stability

common problems with osteoarthritis

• pain

• decreased mobility

• decreased ability to perform ADLs

osteoarthritis goals of care

• maintain joint function

• improve independence

• manage pain

nursing interventions with osteoarthritis

• promote function

• pain relief

• joint protection

• patient teaching

how to promote function with osteoarthritis

• Exercise (low-impact)

• ROM and strengthening

• Use assistive devices

pain relief and osteoarthritis

• Heat → stiffness

• Ice → swelling

joint protection and osteoarthritis

• Balance rest and activity

• Proper body mechanics

• Braces / splints if needed

patient teaching for osteoarthritis

• Weight loss if needed

• Fall prevention

• Safe home environment

expected outcomes with osteoarthritis

• Pain is controlled

• Maintains joint function

• Able to perform daily activities (ADLs)

rheumatoid arthritis (RA)

autoimmune disease that causes chronic joint inflammation

what happens during RA

immune system attacks joint lining leading to joint damage and deformity

who is at risk for RA

more common in women and usually starts in middle adulthood

RA joint inflammation

• Synovial membrane becomes inflamed

• Joint fills with fluid

RA progression

• Cartilage and bone are damaged

• Joint becomes deformed

key feature of RA

chronic inflammation

key findings of RA

• Symmetric joint involvement

• Small joints: hands & feet

• Warm, swollen, painful joints

• morning stiffness for more than an hour

common hand changes with RA

• Ulnar drift

• Swan neck deformity

• Boutonnière deformity

effects of hang changes in RA

• ↓ grip strength

• Difficulty with ADLs

systemic effects of RA

General

• Fatigue

• Weight loss

• Low-grade fever

Other Effects

• Rheumatoid nodules

• Dry eyes (Sjögren’s)

• ↑ cardiovascular risk

Complications

• Anemia

• Lung involvement

key labs for RA diagnosis

• Rheumatoid factor (RF)

• Anti-CCP (most specific)

• ↑ ESR / CRP → inflammation

RF (rheumatoid factor)

autoantibody that supports RA diagnosis

anti-CCP

autoantibody that is most specific for RA

ESR

inflammation marker

CRP

inflammation marker

imaging for RA

X-ray: 

• Joint damage

• Erosions

goals of RA treatment

• Control inflammation

• Prevent joint damage

• Maintain function

medications for RA

• DMARDs (FIRST-LINE)

• Methotrexate (most common)

  • Slows disease progression

when are biologic agents used for RA

used if DMARDs are not effective

other medicaitons used for RA and what are they used for

• Corticosteroids → short-term

• NSAIDs → pain only

care approach for RA

• Long-term management

• Team-based care

• Patient education

supportive care for RA

• Maintain joint function

• Prevent deformity

• Encourage mobility

surgery for RA (if severe)

• Synovectomy

• Joint replacement

RA nursing assessment

• Joint pain, swelling, stiffness

• Morning stiffness duration

• Effect on daily activities (ADLs)

• Psychosocial impact

common problems with RA

• Pain

• ↓ mobility / joint function

• Fatigue

• Emotional impact (depression)

RA nursing goals of care

• Control pain and inflammation

• Maintain joint function

• Promote independence

how to promote function with an RA patient

• Exercise (ROM + strengthening)

• Encourage daily movement

• Prevent joint stiffness

balance rest and activity for RA

• Scheduled rest periods

• Avoid overexertion

joint protection and RA

• Use assistive devices

• Avoid repetitive stress

• Splints for support

daily living with RA

• Modify tasks (energy conservation)

• Use adaptive equipment

medication teaching with RA

• Take meds consistently

• Monitor side effects

psychosocial support with RA

• Chronic disease → emotional impact

• Encourage support systems

key considerations for arthritis in older adults

• OA is common → may miss other arthritis types

• Comorbidities affect diagnosis and treatment

medications considerations for arthritis in older adults

• ↑ risk of side effects (especially NSAIDs)

• Polypharmacy is common

functional and psychosocial gerontologic considerations

• Pain → ↓ mobility

• Risk for depression and inactivity

• Need for strong support system

safety risk gerontologic considerations with arthritis

• ↑ fracture risk

• Corticosteroids → ↓ bone density

systemic lupus erythematosus (SLE)

systemic autoimmune disease that affects multiple body systems

what happens in SLE

immune system attacks body tissues which causes inflammation and organ damage

key features of SLE

• affects skin, joints, and organs

• periods of flares and remission

who is at risk for SLE

• More common in women

• Typically, younger adults

general symptoms of SLE

• Fatigue

• Fever

• Weight loss

skin symptoms of SLE

• Butterfly rash

• Photosensitivity

• Hair loss (alopecia)

• Oral ulcers

SLE joint manifestation

• Joint pain

• Symmetric (like RA)

• Non-erosive

cardiopulmonary SLE manifestations

• Pleurisy

• Pericarditis

neurologic SLE manifestations

• Headaches

• Seizures

• Confusion

hematologic SLE manifestations

• Anemia

• ↑ bleeding risk

kidney manifestations with SLE

MOST IMPORTANT

• Lupus nephritis

• Proteinuria

• Can lead to renal failure

other risks with SLE

• Blood clots (↑ stroke, DVT)

• Infection risk

key lab for SLE diagnosis

ANA (almost always positive)

other findings for SLE diagnosis

• Anti-dsDNA

• Low complement levels

• Abnormal CBC (anemia, ↓ WBCs, ↓ platelets)

SLE diagnosis is based on

• Multiple symptoms + labs

SLE management goals

• Prevent organ damage

• Control flares

• Maintain remission

3 types of medications for SLE management

1. antimalarials

2. corticosteroids

3. immunosuppressants

antimalarials and SLE

first line!

• hydroxychloroquine → reduces flares

corticosteroids and SLE

used during flares

immunosuppressants and SLE management

for severe organ involvement

nursing assessment of SLE

• Fatigue, pain, and joint symptoms

• Signs of flare (fever, ↑ symptoms)

• Organ involvement (kidney, lungs, neuro)

• Effect on daily activities (ADLs)

common problems with SLE

• Pain and fatigue

• ↓ function

• Risk for organ damage

• Skin integrity issues

SLE goals of care

• Control symptoms and flares

• Protect organs

• Maintain function and independence

how to prevent flares during SLE

• Identify and avoid triggers

• Avoid sunlight (UV exposure)

• Manage stress

what to do during an SLE flare

• Rest

• Reduce activity

• Support system

medication management with SLE

• Take meds consistently

• Do NOT stop abruptly

• Monitor side effects

daily living and SLE

• Balance activity and rest

• Energy conservation

• Maintain independence

psychosocial support and SLE

• Chronic disease → emotional impact

• Encourage support systems

special considerations with SLE

• Pregnancy planning

• Medication safety

expected outcomes with SLE interventions

• Prevents or reduces disease flares

• Maintains energy and daily function

• Protects skin (sun protection)

• Adapts activities to current ability

OA cause and main target

wear and tear, joints

OA pattern and pain

asymmetric, worse with activity

OA morning stiffness and joint damage

< 30 minutes, bone on bone damage