ARTHIRITIS

RHEUMATOID ARTHRITIS
•Chronic systemic inflammatory disease
•Destruction of connective tissues and synovial membrane
•Permanent deformity
•RA affects persons of all races.
Sex: Common in women.
Age: The onset is mid 20s to 30 years
GENERAL DISTRIBUTION OF RA
1. Symmetric arthritis of the small joints of hands ( MCP, PIP)
2. Feet
3. Wrists (all compartments)
4. Knees
5. Ankles
6. Elbows
7. Glenohumeral and acromioclavicular joints
8. Hips
9. Articulations of the cervical spine
DIAGNOSTIC CRITERIA
1. Morning stiffness
2. Symmetrical soft tissue swelling
3. Rheumatoid nodules
4. The presence of rheumatoid factor
5. Radiographic erosions
RADIOGRAPHIC CHANGES
•Soft tissue swelling and early erosions in the proximal interphalangeal
joints.
•Symmetrical narrowing of the joints.
•Prominent juxta-articular osteopenia in all interphalangeal joints in a
patient with rheumatoid arthritis of the hands.
•Well-defined bony erosions in the carpal bones and metacarpal bases
in a patient with rheumatoid arthritis of the hands.
•Subluxation in the metacarpophalangeal joints, with ulnar deviation, in
a patient with rheumatoid arthritis of the hands.
•Subluxation at the third metacarpophalangeal joint and marginal
erosions at the heads of the second to fourth metacarpals
•Marked ankylosis of most of the carpal bones in a patient with
rheumatoid arthritis of the hands.
•Partial collapse of fused carpal bones with subluxation at the
radiocarpal joint in a patient with rheumatoid arthritis of the hands
•Boutonniere Deformity
•Swan neck deformity
•Lateral view of the cervical spine in a patient with rheumatoid arthritis
shows erosion of the odontoid process
Diagnostic:
• RA Factor
• ↑ ESR
• Synovial Biopsy (+) inflammation
Management Goals:
• Relief of pain
• Reduction of inflammation
• Protection from systemic involvement
 • Maintenance of function
• Control of systemic involvement
Medical Management:
• NSAIDS
• DMARDS – Disease –Modifying Antirheumatic Drugs(methotrexate, gold
compounds)
• Glucocorticoids (low dose prednisone)
Nursing Care:
• Immobilize affected joints
• Apply heat or cold therapy as prescribed
• Avoid weight bearing on inflamed joints
• Encourage ROM exercises
• Prevent contractures

GOUTY ARTHRITIS
• Urate crystal deposits in joints leading to destruction of cartilage.
• Pathophysiology
Primarily caused by overproduction or underexcretion of uric acid or
combination of both
• Primary gout
• Secondary gout
ASSESSMENT
Typical manifestations include:
– Pain, usually monarticular
– Joint swelling and inflammation
– Pruritus or skin ulceration over the affected joint
– Severe disease may produce signs of renal involvement
– Podagra, an acute attack of gout in the great toe, > 50% of all acute
attacks
– Recurrent attacks have longer duration; more likely polyarthritic
– ascending, asymmetric pattern
– other areas affected include the heels, ankles, knees, fingers, wrists,
elbows, shoulders, hip, sacroiliac and the spine
STAGES
• Asymptomatic hyperuricemia
• Acute gouty arthritis
• Interval gout
• Chronic tophaceous gout
DIAGNOSTIC EVALUATION
• BASELINE LABORATORY TESTS:
– complete blood cell count
– Urinalysis
– serum creatinine
– blood urea nitrogen
– serum uric acid measurements
• SYNOVIAL FLUID ANALYSIS
• Confirms the diagnosis of gout by the presence of:
– polymorphonuclear leukocytes
• intracellular monosodium urate crystals : needle-shaped and
negatively birefringent
• RADIOGRAPHY
• Periarticular soft tissue swelling
– first radiographic sign of an acute gouty attack
 MANAGEMENT
• Treatment goals:
– Termination of the acute attack
– Prevention of recurrent attacks
– Prevention of complications associated with the deposition of
urate crystals in tissues
Pharmacologic Management
• Termination of acute attacks
– NSAIDs
– Colchicine
– Intra-articular injections of corticosteroids
• Prevention of recurrent attacks
– Probenecid
– Allopurinol
NURSING CARE
• Apply ice to affected joints and elevate affected limbs
• Maintain strict bedrest
• Teach client about:
– The prescribed meds regimen
– The need to increase fluid to 3L/day
– Dietary modifications to limit foods high in purine

OSTEOARTHRITIS
• Degenerative Joint Disease
• Wear and tear
• Affects weight bearing joints
• knees, toes, lower spine
PATHOPHYSIOLOGY

SIGNS/SYMPTOMS
• Pain worsens as day progresses
• Minimal am stiffness
• Decreased ROM
• Crepitus
• Bony enlargement
• Restricted movement
• Joint instability
• Severe medial compartment arthritis
 • Bone angulation deformity
• Patient demonstrating varus deformity of right knee and a valgus deformity
of left knee
GOALS OF TREATMENT
• Relieve pain and inflammation
• Retard disease progression
• Control comorbidity
• Minimize risk of therapy
TREATMENT
• Non-pharmacologic
• Pharmacologic
• Intra-articular
• Surgery
Non-pharmacologic Treatment
• Social support
• Education
• Assisted devices
• Weight reduction
• Heat/Ice
• Muscle strengthening/ROM exercises
Pharmacologic Treatment
• OTC
– APAP
– NSAIDs
– Capsaicin
– Glucosamine
• NSAIDs
• Opiod analgesics, tramadol
Intra-articular Therapy
• Corticosteroids
– Do not use if joint infected or unstable
– Not recommended > 4 times/year
• Viscosupplementation
– Hyaluronic acid
• Efficacious in reducing pain; do not slow OA progression
• High placebo response
• Expensive
SURGERY
• Reserved as last line
• Average life span 10-12 years