FACES OF ARTHRITIS

RHEUMATOID ARTHRITIS
OSTEOARTHRITIS
TREATMENT OPTIONS

ARTHRITIS IS MANY DISEASES

Complex musculoskeletal disorder consisting of 100+ different

diseases or conditions

Leading cause of disability in the United States

Affects people of all ages, races and genders

Annual cost of $65 billion

Two most common forms are osteoarthritis and rheumatoid

arthritis

ARTHRITIS FACTS

60% of people affected are under age 65

50% of elderly are not affected

Early diagnosis and treatment can reduce consequences

Medications, exercises and proper management can

improve quality of life

Rheumatoid Arthritis

RHEUMATOID ARTHRITIS (RA)

Progressive autoimmune systemic disease

Inflammation of the membranes lining the joints

Inflammation of tissues around organs of the body,

the eyes and lungs

Pain, stiffness, warmth, swelling and severe joint damage.

Onset: young to middle age

CAUSES OF RA
Cause is unknown

Genetic factors
Environmental factors
Hormones
Bacteria and viruses
Stress of physical/emotional trauma
Smoking

SYMPTOMS OF RA

Fatigue, anorexia, low grade fever

Muscle and joint pain and stiffness
Usually symmetrical: affects joints on both sides of the body
Inflammation of lungs (pleuritis) and heart (pericarditis)
Anemia and increased WBCs
Blood vessel inflammation (vasculitis)
Rheumatic nodules under the skin and also around the heart
and lungs

TREATMENT OF RA

Early aggressive treatment is important

Patients with antibodies to rheumatoid factor (RF) or cyclic

citrullinated proteins (Anti-CCP) have greater risk

Disease modifying medications (DMARDS): Methotrexate

and Humira (biologic)

Goal: reduce joint inflammation and pain, maximize joint

function, and prevent destruction and deformities

RHEUMATOID ARTHRITIS

QUESTIONS?

OSTEOARTHRITIS
MOST COMMON FORM OF
ARTHRITIS

OSTEOARTHRITIS (OA)

Chronic progressive degenerative joint disease, low grade

inflammation

Breakdown and destruction of joint cartilage

Primarily affects weight bearing joints: hips, knees and ankles

Limits joint mobility, causes pain and bone spurs

OSTEOARTHRITIS
RISK FACTORS

Age: most common over age 65

Previous joint trauma

Obesity

Joint abnormalities
Heredity

TREATMENT OF OA

Exercise and weight loss

Assistive devices and avoidance of joint stress

Thermal treatments

Complementary medicine and dietary supplements

TREATMENT OF OA

Analgesics/anti-inflammatory meds such as NSAIDS and

COX-2 inhibitors, creams and gels

Corticosteroids: orally and/or injected into joint

Visco-supplement injection gels

Experimental: stem cell injections into knee joint (Regenexx)

Surgical interventions

SURGICAL TREATMENTS

Arthroscopic treatments
used to remove debris from joints

Major surgery
full or partial joint replacement

Goals
to relieve pain
restore motion
increase stability of joint

ARTHROSCOPIC KNEE SURGERY

Trimming of torn pieces of

cartilage

Removal of loose fragments of

bone or cartilage

Removal of inflamed synovial

tissue

Removal or repair of torn

meniscal cartilage
Reconstruction of a torn anterior
cruciate ligament (ACL)

TOTAL KNEE REPLACEMENT

(TKR)

GOALS OF TKR SURGERY

Decrease pain

Increase mobility

Increase stability of knee

Improve activities of daily living

Improve quality of life

REHABILITATION

Able to bend knee at a right angle

Straighten knee fully

Strengthen muscles around knee

Use of continuous passive motion machine (CPM) and/or

early and frequent ambulation

CONTINUOUS PASSIVE MOTION

MACHINE (CPM)

Has prescribed treatment time and degree of flexion

Provides passive muscle motion

Optimum joint extension

Decreases stiffness and aids venous return

NURSING CARE
Skin care of incisional site
Provide pain management and other medications
Assess VS and respiratory status
Post op teaching and assist with ADLs
Monitor assistive devices such as CPMs
Encourage prescribed level of activity

HIP SURGERY
MOST COMMON TYPES

OPEN REDUCTION INTERNAL FIXATION (ORIF)

TOTAL HIP REPLACEMENT (THR)

OPEN REDUCTION INTERNAL

FIXATION: ORIF
Use of plates or screws to stabilize bone fractures
and allow healing to occur
Less invasive than THR, usually hip bone and socket are healthier
Must keep hip/leg in good alignment post op

Intertrochanteric hip fracture with

a metal plate and screws

TOTAL HIP REPLACEMENT

Artificial prostheses are used to replace the femoral

head and acetabulum

ball

cup

stem

TOTAL HIP REPLACEMENT

TOTAL HIP REPLACEMENT

Non-cemented

Cemented

POST HIP REPLACEMENT

ASSESSMENT

TOTAL HIP PRECAUTIONS

Maintain

total hip precautions

for 3 months

Do not bend hip past 90 degrees

Do not bring leg across

middle of the body

Do not let leg roll inward

GOAL

Prevention of dislocation through

PROPER POSITIONING in immediate postop period
and throughout rehabilitation

ABDUCTOR WEDGE

Used to maintain proper positioning

COMPLICATIONS
SYMPTOMS OF DISLOCATION

Acute groin pain

Shortened extremity

Popping sound/sensation heard

and/or felt

ASSISTIVE DEVICES

WEIGHT BEARING STATUS

TWB Total Weight Bearing: full weight

WBAT Weight Bearing As Tolerated, to degree of comfort

PWB Partial Weight Bearing: 50% weight bearing

TDWB Touch Down Weight Bearing: touch floor for

stability/balance

NWB Non-Weight Bearing: no floor contact

REVIEW: OSTEOARTHRITIS AND

RHEUMATOID ARTHRITIS

OSTEOARTHRITIS

RHEUMATOID ARTHRITIS
Rapid

onset, begins at any age

affects large and small

joints, often on both sides of the
body

Slow onset over years

Joints ache & are tender. Affects

one side of body, weight bearing
joints, and/or the spine.

Stiffness for short periods in a.m.

and returns at end of day and after
activity

No systemic body symptoms

Degenerative joint disease wear

and tear of cartilage

Painful,

Morning

stiffness lasts longer than

1 hour
Affects

whole body: fatigue,

general feeling of being ill

Systemic

inflammatory disease,
affects synovium lining the joints
and other body organs

DEEP VEIN THROMBOSIS

(DVT)

Blood flows slowly in the veins and has a longer time

to clot. Incidence of DVT is very high unless
precautions are taken

DEEP VEIN THROMBOSIS (DVT)

RISK FACTORS
Injury
Surgery
History of thrombosis or
varicose veins
Decreased muscle tone
Changes in activity

Age over 40
Hormone therapy
Tumors
Infection
pregnancy

PREVENTION OF DVT
Anticoagulant therapy
ROM, position changes
CPM for TKR
TED stockings
Ambulation
Adequate fluid intake
Assess lower extremities each shift

SIGNS OF DVT
Swelling
Warm to touch
Pain in affected area
Fever
Increased spasticity

There

may be no signs at all!

ANTICOAGULATION THERAPY
Surgical patients are at high risk for DVT
Teaching about Anticoagulant Therapy important
DVT

is a preventable but often under diagnosed condition

since 50%* of patients have no symptoms

Anticoagulant Medications may be monitored by lab tests

Heparin PTT
Lovenox AF-Xa level
Coumadin PT/INR

*CDC/DVT 2013

DISCHARGE ISSUES

Home safety assessment, including family/caregiver teaching

Medication teaching
Medic Alert Bracelet for anticoagulant Rx
Follow up labs

Precautions for post THR/TKR

Physical Therapy
Positioning and exercise program

Activity plan as ordered by physician

NURSING DIAGNOSES

Impaired physical mobility r/t hip or knee replacement as

evidenced by inability to ambulate independently

Alteration in comfort r/t hip or knee replacement as evidenced

by surgical pain

Others?

QUESTIONS?