Arthritic and Connective Tissue Disorders

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Arthritic and Connective Tissue Disorders

• Osteoarthritis
• Rheumatoid arthritis
• Osteomyelitis

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Objectives for this Lecture

• Differentiate between the conditions of
• - osteoarthritis
• - rheumatoid arthritis
• - osteomyelitis
• On the basis of
• Aetiology
• Pathophysiology
• Clinical features
• Management

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Objectives Cont.d

• Explain the rationales for the collaborative and
  nursing management of the three conditions
• Develop a plan of care to meet the common needs
  of clients suffering the above 3 conditions

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Case Study

• Wolfgang is a 57 year old labourer who attends
  your clinic for investigations into his painful
  right knee. The pain has been present for three
  years and is related to movement. You notice no
  swelling, or redness, although crepitus is
  palpated on movement.

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M.S. Assessment

• Limitation in normal range of motion
• (or increased mobility)
• Signs of inflammation
• Crepitus
• Condition of surrounding tissues
• Muscular strength
• Symmetry of involvement

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Degenerative Joint Disease

• Primary
• Secondary (trauma, iatrogenic)
• Incidence
• age 40 90
• 70 100
• Risk Factors
• Avoid
• Getting old
• Obesity
• Repetitive overuse

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Osteo. PathophysiolgyIngredients

• Cartilage 1. Smooth surface
• 2. Load distribution
• Collagen Strength
• Proteoglycans 1. Elasticity
• 2. Stiffness

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Osteo. Patho stages

• Enzymatic degradation
• Proteoglycan and collagen loss
• Loss of tensile strength
• Surface ulcerations
• Loss of articular cartilage
• Exposure of underlying bone
• Osteophyte development

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Clinical Manifestations

• Gradual onset
• Pain on use
• Pain at rest
• Stiffness
• lt range of motion
• Crepitus
• Joint enlargement
• hips, knees, lumbar cervical, vertebrae,
  interphalangeal

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Medical Management of Osteo

• Assessment/Diagnosis
• - history
• - physical
• - radiologic
• - lab. studies

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Medical Management of Osteo. Cont.d

• Pharmacology
• - Aspirin
• - Paracetamol
• - NSAIDS
• - Steroids
• Surgery
• - Arthroscopy
• - Osteotomy
• - Joint arthroplasty

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Nursing Management

• Possible Problems/Assessments
• Chronic pain
• Impaired physical mobility
• Self care deficit
• Impaired home maintenance
• Anxiety related to loss of function
• Disuse syndrome
• Depression related to chronic pain

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Nursing Management Cont.d

• Teaching
• - exercise balance
• - weight loss
• - sleep-firm mattress

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Case Study 2

• Jodie a 42 year old began noticing vague
  arthralgias, fatigue and poor appetite about 1
  year ago. Lately she has noticed increasing
  generalised stiffness in the mornings and aching
  in her hands and wrists. These joints also have
  become swollen and her G.P. tells her she may
  have RA

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Rheumatoid Arthritis

• Definition
• A chronic systemic inflammatory disorder
  characterised by persistent synovitis of multiple
  joints.
• Incidence
• 1 of total population in all races
• Women three times men

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Pathophysiology of RA

• T cell infiltration to synovial membrane
• Release of cytokines
• Further macrophage activity
• B cells produce autoantibodies to IgG
• (Rheumatoid Factors)
• Antigen-antibody immune complexes
• Polymorphs monocytes lymphocytes

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Patho. Of RA Cont.d

• Phagocytosis of immune complexes
• Lysosomal enzymes released
• NET RESULT DESTRUCTION OF JOINT TISSUE
• Hyperplasia/hypertrophy synovium
• Vasodilation
• New blood vesselspannus

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Clinical Manifestations of RA(Articular)

• Systemic manifestations could be first
• Joint swelling
• Stiffness
• Warmth
• Tenderness and pain
• Polyarticular (PIP, MCP, wrists, knees, ankles)

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RA Articular Clinical Features(Cont.d)

• OVER TIME
• Deformities joints supporting structures
• Typical ulnar deviation
• wrist involvement nearly universal knees

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Extra-articular Features of RA

• Fatigue
• Weakness
• Anorexia and weight loss
• Low grade fever
• Anaemia
• Muscle atrophy
• Rheumatoid nodules
• Vasculitis
• Pleural disease
• Scleritis Sjogrens syndrome

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Diagnosic Criteria for RA(most have time frames)

• Morning stiffness
• Arthritis swelling, 3 or more joints
• Arthritis of wrist, MCP or PIP
• Symmetric arthritis
• Rheumatoid nodules
• Positive serum RF
• Characteristic radiology (hands wrists)

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Collaborative Care(medical-nursing)

• Diagnosis
• - history
• - physical assessment
• - lab. diagnostic studies
• - RF factor
• - CBC anaemia
• - ESR
• - Synovial fluid
• - X-Ray

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Collaborative Care(Cont.d)

• Therapy
• GOALS
• Relieve pain
• Reduce inflammation
• Slow down or stop joint damage
• Improve clients sense of well-being ability to
  function

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Therapeutic Regimes

• Rest and exercise
• Pharmacology
• - aspirin
• - other NSAIDS
• - corticosteroids
• - disease modifying drugs
• (Gold salts, antimalarials)

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Other Therapies

• Plasmapharesis
• Total lymphoid irradiation
• NURSING PROBLEMS
• Pain
• Fatigue
• Altered role performance
• Body image disturbance

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OSTEOMYELITIS

• Definition
• Infection of bone via either
• Extension of soft tissue infection
• Direct bone contamination
• Haematogenous spread
• Predisposing
• debilitation

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Pathophysiology

• Staph. Aureus 70-80
• Proteus Pseudomonas
• E Coli
• Inflammation
• Thrombosis
• Bone abscess
• Sequestrum
• Involucrum formation

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Clinical Features

• Septicaemia
• Local pain
• Sinus

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Assessment

• Local examination
• Vital signs
• X-rays
• Blood studies
• Prevention is the overall goal and key to
  successful management

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Medical Management

• Immobilization
• Warm wet soaks
• Antibiotics

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Nursing Management

• Possible Assessment Findings (statements)
• Pain related to inflammation
• Impaired Physical mobility related to pain
• Potential for infection extension