3360 musculoskeletal disorders

juvenile idiopathic arthritis

autoimmune, causes inflammation in joint synovium and surrounding tissues, periods of exacerbation and remission, diagnosis <16 years old, can impact growth and bone development, symptoms must last at least 6 weeks, can last into adulthood

juvenile idiopathic arthritis incidence

affects 300,000 kids/teens in US, most common pediatric rheumatic disease in this age group, F>M, affects all races/ethnicities, average age of onset 6 years old

juvenile idiopathic arthritis S/S

joint pain, swelling, warmth, stiffness

fatigue, limping, difficulty with gripping, fever, swollen lymph nodes, rash

juvenile idiopathic arthritis diagnosis

PMH, PA, ESR, CRP, ANA, RF, CCP, MRI, x-ray

juvenile idiopathic arthritis pharmacology

NSAIDs, corticosteroids (prednisone), DMARDs (leflunomide), immunosuppressant/DMRD (methotrexate), biologics (enbrel, humira)

juvenile idiopathic arthritis complications

joint damage, growth problems due to disease and use of corticosteroids, uveitis→cataracts, glaucoma, blindness

juvenile idiopathic arthritis nonpharmacological therapy

PT, OT, counseling, joint support/splints

juvenile idiopathic arthritis self-care

exercise, diet high in calcium, heat therapy for morning stiffness, cold therapy for swelling after physical activity

rheumatoid arthritis

chronic autoimmune disorder, lining of joints attacked→painful inflammation, cartilage destruction, bone erosion; periods of exacerbation and remission

rheumatoid arthritis incidence

F>M, F ages 30-60, rare in men <45

typically develops in middle age, associated with lifelong symmetrical joint inflammation, chronic pain and stiffness, leads to progressive joint damage

rheumatoid arthritis risk factors

smoking, obesity, periodontal disease, presence of human leukocyte antigens, family Hx of RA or other autoimmune conditions

rheumatoid arthritis S/S

painful/warm/swollen joints, fatigue, fever, anorexia, joint stiffness worse in mornings and after rest periods lasting >45mins, also affects skin, eyes, lungs, heart, nerve tissue, blood

rheumatoid arthritis diagnostics

PMH, PA, ESR, CRP, ANA, RF, CCP, MRI, x-ray

rheumatoid arthritis pharmacology

NSAIDs, corticosteroids (prednisone), DMARDs (leflunomide), biologics (enbrel, humira)

target synthetic DMARDs if other DMARDs and biologics don’t work

rheumatoid arthritis complications

osteoporosis, rheumatic nodules at pressure points, infarctions from disease and meds, carpal tunnel syndrome, heart problems from hardened arteries, lung disease/inflammation, increased risk of lymphoma

rheumatoid arthritis nonpharmacological therapy

PT, OT, assistive devices, joint replacement surgery

rheumatoid arthritis self-care

exercise, heat therapy for stiffness, cold therapy for swelling, relaxation, smoking cessation

osteoporosis

bones become weak, porous, fragile; increases risk of fractures

osteoporosis risk factors

genetics (HLAs), age >65 years, asian/caucasian, vitamin D deficiency, estrogen deficiency, excessive alcohol use, family Hx of osteoporosis, F>M, underweight, low testosterone, corticosteroids, heparin, long-acting sedatives, antiseizure drugs, thyroid replacement therapy, sedentary lifestyle, smoking

osteoporosis S/S

bone pain, loss of height, stooped posture, frequent fractures

osteoporosis diagnostics

PMH, PA, serum calcium, phosphorus, alkaline phosphatase, vitamin D, bone mineral densitometry, dual energy x-ray absorptiometry/DEXA

osteoporosis lifestyle management

vitamin D/calcium supplements, exercise, avoid smoking and alcohol

osteoporosis drug therapy

bisphosphonates, monoclonal antibodies, recombinant parathyroid hormone

osteoporosis procedures

vertebroplasty, kyphoplasty

osteomalacia

defective bone mineralization→soft bones, pain and tenderness, muscle weakness, low calcium and vitamin D, fractures

paget’s disease

excessive osteoclastic activity→deformity of long bones, pelvic, lumbar vertebrae

arthritis

pain and stiffness in joints due to inflammation

osteoarthritis

degenerative, can affect any joints, mechanical wear and tear injury to articular cartilage

mediated by cytokines IL-1 and TNFa

osteoarthritis risk factors

older age, F>M, obesity, joint injury

osteoarthritis treatment

acetaminophen, NSAIDs, duloxetine, cortisone injection, lubrication injection into joints, realigning bones, joint replacement, knee osteotomy, arthroscopy, arthroplasty

gout/crystal-induced arthritis diagnosis

PMH and PA, family Hx of gout or other inflammatory arthritis, sodium urate crystals in synovial fluid, increased uric acid in serum and 24hr urine, x-rays

gout management

joint immobilization, cold therapy, joint aspiration and intraarticular corticosteroids, low purine diet

gout drug therapy

colchicine, NSAIDs, xanthine oxidase inhibitors (allopurinol/Zyloprim, febuxostat/Uloric), uricosurics (probenecid), pegloticase/Krystexxam, prednisone, methylprednisolone, ACTH

septic arthritis

caused by bacterial infection (staphylococcus aureus, streptococcus, gram negative bacteria), affects larger joints (hip, knee, shoulder, ankle)

septic arthritis S/S

joint pain, swelling, redness, warmth, fever, chills, limited movement

septic arthritis diagnosis

PMH and PA, labs (increased WBC, ESR, CRP), x-ray or MRI

septic arthritis treatment

arthrocentesis/aspiration to reduce swelling and pain

septic arthritis nursing management

assess VS and affected joints, antibiotics as prescribed, pain management, ice and rest, aseptic technique, monitor S/S and report changes, education about medication and follow-up

osteomyelitis

infection of bone tissue that occurs when bacteria (usually staphylococcus aureus) enters bone via open wound

osteomyelitis pathophysiology

microorganism in blood grows->increases pressure but non-expanding bone->ischemia and compromise->severe pain, swelling, redness->bone destruction/death

20% of cases- indirect entry

80% of cases- direct entry though open wound

acute osteomyelitis

lasts <1mo, causes bone pain, swelling, tenderness, warmth, fever, night sweats, chills, nausea, malaise

chronic osteomyelitis

lasts >1mo, doesn’t respond to first abx, persistent/continuous with exacerbations and remissions, more local S/S, complications

osteomyelitis diagnostics

bone/soft tissue biopsy, blood and wound cultures, MRI, CT, x-ray, radionuclide bone scan

osteomyelitis treatment

long-term antibiotics if no bone ischemia, biopsy/culture before abx, surgery

osteomyelitis nursing interventions

pain management, prevent complications, adhere to Tx plan, education

osteomyelitis pain meds

NSAIDs, opioids, muscle relaxants