Rheumatoid Arthritis A most common connective tissue disease

Chapter 24 Interventions for Clients with Connective Tissue Disease and Other Types of Arthritis Elsevier items and derived items © 2006 by Elsevier Inc. Rheumatology • Connective tissue disease (CTD) is a major focus of rheumatology. • Rheumatic disease is any disease or condition involving the musculoskeletal system. • Arthritis means inflammation of one or more joints. (Continued) Elsevier items and derived items © 2006 by Elsevier Inc. Rheumatology (Continued) • Non-inflammatory arthritis is not systemic. • Inflammatory arthritis – Rheumatoid arthritis – Systemic lupus erythematosus Elsevier items and derived items © 2006 by Elsevier Inc. Osteoarthritis • Most common type of arthritis • Joint pain and loss of function characterized by progressive deterioration and loss of cartilage in the joints • Osteophytes • Synovitis • Subluxation Elsevier items and derived items © 2006 by Elsevier Inc. Collaborative Management • History • Physical assessment and clinical manifestations – Joint involvement – Heberden's nodes – Bouchard’s nodes – Joint effusions – Atrophy of skeletal muscle Elsevier items and derived items © 2006 by Elsevier Inc. Assessments • Psychosocial • Laboratory assessment of erythrocyte sedimentation rate and C-reactive protein (may be slightly elevated) • Radiographic assessment • Other diagnostic assessments – MR imaging – CT studies Elsevier items and derived items © 2006 by Elsevier Inc. Chronic Pain Interventions: • Pain control may be accomplished at home with drug and nonpharmacologic measures. • Surgery may be performed to reduce pain. • Comprehensive pain assessment should be performed before and after implementing interventions. (Continued) Elsevier items and derived items © 2006 by Elsevier Inc. Chronic Pain (Continued) • Rest, positioning, thermal modalities, weight control, TENS, complementary and alternative therapies, stem cell therapy • Surgical management Elsevier items and derived items © 2006 by Elsevier Inc. Total Hip Arthroplasty • Preoperative care • Operative procedures • Postoperative care – Prevention of dislocation, infection, and thromboembolic complications – Assessment of bleeding – Management of anemia Elsevier items and derived items © 2006 by Elsevier Inc. Care of Total Hip Arthroplasty • Assessment for neurovascular compromise • Management of pain • Progression of activity • Promotion of self-care Elsevier items and derived items © 2006 by Elsevier Inc. Impaired Physical Mobility Interventions: • Goal: to achieve independent function • Therapeutic exercise • Promotion of activities of daily living and ambulation • Teaching about health and how to use assistive devices Elsevier items and derived items © 2006 by Elsevier Inc. Rheumatoid Arthritis • A most common connective tissue disease and the most destructive to the joints • Chronic, progressive, systemic inflammatory autoimmune disease primarily affecting the synovial joints • Autoantibodies (rheumatoid factors) formed that attack healthy tissue • Affects synovial tissue of any organ or body system Elsevier items and derived items © 2006 by Elsevier Inc. Collaborative Management • Assessment • Physical assessment and clinical manifestations – Early disease manifestations – Late disease manifestations – Joint involvement – Systemic complications – Associated syndromes Elsevier items and derived items © 2006 by Elsevier Inc. Assessments • Psychosocial assessment • Laboratory assessment: rheumatoid factor, antinuclear antibody titer, erythrocyte sedimentation rate, serum complement, serum protein electrophoresis, serum immunoglobulins • Other diagnostic assessments Elsevier items and derived items © 2006 by Elsevier Inc. Drug Therapy for RA Mild disease • Nonsteroidal anti-inflammatory drugs (NSAIDs), for instance, celecoxib, rofecoxib, valdecoxib with cox-2 inhibiting properties • Disease modifying antirheumatic drugs (DMARDs), such as hydroxychloroquine, sulfasalazine, and minocycline (Continued) Elsevier items and derived items © 2006 by Elsevier Inc. Drug Therapy for RA (Continued) Moderate to severe disease • Methotrexate • Leflunomide • Biological response modifiers such as etanercept, infiximab, adalimumab, anakinra Elsevier items and derived items © 2006 by Elsevier Inc. Nonpharmacologic Modalities in the Treatment of RA • Plasmapheresis • Complementary and alternative therapies • Promotion of self-care • Management of fatigue • Enhancement of body image • Health teaching Elsevier items and derived items © 2006 by Elsevier Inc. Lupus Erythematosus • Chronic, progressive, inflammatory connective tissue disorder can cause major body organs and systems to fail. • Many clients with SLE have some degree of kidney involvement. Elsevier items and derived items © 2006 by Elsevier Inc. Collaborative Management • Physical assessment and clinical manifestations – Skin involvement – Musculoskeletal changes – Systemic manifestations including pleural effusions or pneumonia and Raynaud’s phenomenon Elsevier items and derived items © 2006 by Elsevier Inc. Assessments for Lupus • Psychosocial results can be devastating. • Laboratory – Skin biopsy (only significant test to confirm diagnosis) – Anti-Ro (SSA) test – Complete blood count – Body system functions Elsevier items and derived items © 2006 by Elsevier Inc. Progressive Systemic Sclerosis • Referred to as systemic scleroderma, meaning hardening of the skin • Diffuse cutaneous scleroderma • Limited cutaneous scleroderma (Continued) Elsevier items and derived items © 2006 by Elsevier Inc. Progressive Systemic Sclerosis (Continued) • Clients have CREST syndrome: – Calcinosis – Raynaud’s phenomenon – Esophageal dysmotility – Sclerodactyly – Telangiectasia • Drug therapy slows disease progression but is often unsuccessful. Elsevier items and derived items © 2006 by Elsevier Inc. Gout • Also called gouty arthritis, a systemic disease in which urate crystals deposit in the joints and other body tissues, causing inflammation • Primary gout • Secondary gout Elsevier items and derived items © 2006 by Elsevier Inc. Collaborative Management • Acute gout • Chronic gout • Drug therapy • Diet therapy Elsevier items and derived items © 2006 by Elsevier Inc. Lyme Disease • Reportable systemic infectious disease caused by the spirochete Borrelia burgdorferi, resulting from the bite of an infected deer tick • Stages I and II • If not treated in early stages, chronic complications such as arthralgias, fatigue, memory and thinking problems present in later stages Elsevier items and derived items © 2006 by Elsevier Inc. Fibromyalgia Syndrome • Chronic pain syndrome, not an inflammatory disease • Pain typically located at trigger points • Physical therapy treatment • Drug therapy with NSAIDs • Muscle relaxants • Home exercises, including walking, swimming, rowing, biking, and water exercise Elsevier items and derived items © 2006 by Elsevier Inc.