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Osteoarthritis / Degenerative joint Disease (DJD)

Osteoarthritis / Degenerative joint Disease (DJD)

-Slowly progressive disorder of articulating joints especially weight-bearing
-commonly affected hand and weight-bearing joints ( knees, hips, feet, and back)
-Disease range from mild to severe

Osteoarthritis / Degenerative joint Disease (DJD)


Cartilage degeneration causes bones to rub against each other, causing pain,
decreasing of the joint
Osteoarthritis / Degenerative joint Disease (DJD)
Risk factors:
- Non- modifiable Factors
• Age
• Genetic predisposition
– Modifiable Factors
• Obesity
• Stress
• Occupation-sports accidents, work related injuries

Osteoarthritis / Degenerative joint Disease (DJD)

1. PE
2. X-ray
3. Joint pain is present with movement and weight-bearing and is relieved by
4. Crepitation ( grating sensation by rubbing together.
Osteoarthritis / Degenerative joint Disease (DJD)
Assessment con’t
5. Heberden’s nodes

-bone growth at the distal interphalangeal joint

Osteoarthritis / Degenerative joint Disease (DJD)
6. Bouchard’s nodes- bone growth over the proximal interphalangeal joints noted.

Osteoarthritis / Degenerative joint Disease (DJD)

• Medical Management
Use of assistive orthotic devices to support inflamed joints
• Isometric and postural exercises
• Analgesics
• Anti-inflammatory/ NSAID
• Corticosteroids may be injected directly into the joint

Osteoarthritis / Degenerative joint Disease (DJD)

Surgical Management
• Osteotomy
• Arthoplasty
• Irrigation of the knee

Osteoarthritis / Degenerative joint Disease (DJD)

• Nursing Management
• Teach client about the importance of weight reduction
• Facilitate during exercise
• Provide rest for involved joints
• Apply warmth as prescribed to relieve muscle spasm and stiffness
• Teach correct posture and body mechanics
• If necessary, teach use of cane in hand on side opposite involved hip or knee

Gout Arthritis
-formation of uric acid deposition ( tophi) in the different parts of the body such as the
great toe / big toe (podagra), ankle, knee, wrist, elbow and earlobes.

Gout Arthritis
Signs and Symptoms
• Acute:
– Pain
– Fever
– Chills
– Redness
– Swelling
– Warmth of the affected joints
– Tenderness
• Chronic:
– Deformity of the area
– Restriction of motion
– Hard lumps (tophi)
Gout Arthritis
• Diagnostic Procedures
– Blood exam
– Urinalysis
– Synovial fluid analysis (aspirate)
– Elevated ESR
– X-ray

Gout Arthritis
• Treatment
– Anti-inflammatory drugs – colchicines and indomethacin
• Urate-lowering agents
– Uricosurics (Probenecid)
– Allopurinol
– Corticosteroids

Gout Arthritis
Nursing Management:
– Encourage patient to restrict consumption of food high in purines (organ meat,
– Encourage pt. to limit alcohol intake.
– Monitor skin surrounding affected joint because it is prone to breakdown
– Encourage pt. to increase fluids to prevent formation of renal stones
– Elevate and protect joint during acute attack.
Rheumatoid Arthritis
• A connective tissue disorder believed to be due to a c-reactive protein
immune response.
• arthritis is a chronic disease, mainly characterized by inflammation of the
lining, or synovium, of the joints. It can lead to long-term joint damage, resulting in
chronic pain, loss of function and disability.
• RA is a systemic disease, which means it can affect other organs in the body.
• RA is referred to as an autoimmune disease.
• It is a chronic disease that continues indefinitely and may not go away.
Rheumatoid Arthritis
• Pathophysiology
– First stage: swelling of the synovial lining, causing pain, warmth, stiffness,
redness and swelling around the joint.
– Second stage: Rapid division and growth of cells, or pannus, which causes the
synovium to thicken.
– Third stage: Inflamed cells release enzymes that may digest bone and cartilage,
often causing the involved joint to lose its shape and alignment, more pain, and loss of
Rheumatoid Arthritis
• The exact cause of rheumatoid arthritis is currently unknown. These
are the factors that may cause Rheumatoid Arthritis:
• Immune System- RA referred to as an autoimmune disease because people
with RA have an abnormal immune system response- that mistakes the body’s
healthy tissue for a foreign invader and attacks it.
• Gender- Women get rheumatoid arthritis two to three times more often then
men. Women develop RA more often than expected in the year after pregnancy
• Genetics
• Infection
• Environmental factors- e.g. smoking
Rheumatoid Arthritis
• Fatigue
• Stiffness- particularly in the morning and when sitting for long periods of
time. Typically, the longer the morning stiffness lasts, the more active your disease
• Weakness
• Flu-like symptoms, including a low-grade fever
• Pain associated with prolonged sitting
• Rheumatoid nodules, or lumps of tissue under the skin- Typically found on
the elbows, they can indicate more severe disease activity.
• Muscle pain
• Loss of appetite, depression, weight loss, anemia, cold and/or sweaty hands
and feet.
Rheumatoid Arthritis
• Diagnosis
– Physical Exam- to determine if there’s any joint swelling or joint tenderness
– Lab Tests- to check the CBC
• Imaging studies
– Radiographs (X-rays) - to check if there is any swelling of the soft tissues and the
loss of bone density around the joints.
– Magnetic Resonance Imaging (MRI)- can detect early inflammation.
– Joint Ultrasound
– Bone Densitometry (DEXA)- used to measure the bone density, joint
Rheumatoid Arthritis
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) - These drugs are used to
reduce inflammation and relieve pain.
• Analgesic Drugs - These drugs relieve pain, but don’t necessarily have an
effect on inflammation.
• Glucocorticoids or Prednisone- These are prescribed in low maintenance
doses to slow joint damage caused by inflammation.
• Disease Modifying Antirheumatic Drugs (DMARDs)-e.g methotrexate These
are used with NSAIDs and/or prednisone to slow joint destruction caused by RA
over time.
• Protein-A Immunoabsorption Therapy- A therapy that filters your blood to
remove antibodies and immune complexes that promote inflammation.
Rheumatoid Arthritis
• Synovectomy- This procedure is used to reduce the amount of inflammatory
tissue by removing the diseased synovium or lining of the joint.
• Arthroscopic Surgery- Surgery that inserts a very thin tube with a light at
the end into the joint through a small incision. It is connected to a closed-circuit
television and allows the surgeon to see the extent of the damage in the joint. It is
most commonly performed on the knee and shoulder.
• Osteotomy- To cut the bones, this procedure is used to increase stability by
redistributing the weight on the joint
• Joint Replacement Surgery or Arthroplasty- Joint replacement surgery
involves the removal of the joint, resurfacing and relining of the ends of bones and
replacing the joint with a man-made component
• Arthrodesis- This procedure fuses two bones together
Rheumatoid Arthritis
• Prognosis
• Early diagnosis and treatment of RA is critical. Studies have shown that early
aggressive treatment of RA can limit joint damage, which in turn limits loss of
movement, decreased ability to work, higher medical costs and potential surgery.
• Early treatment of rheumatoid arthritis results in better outcomes.

Septic Arthritis-infection of the joint space

Septic arthritis- infection of the joint space

Nursing Care same as the other types of Arthritis.


BUERGER’S DISEASE a.k.a Thromboangiitis obliterans-an occlusive vascular

condition usually of a leg or a foot in which the small and medium-sized arteries become
inflamed and thrombotic.
BUERGER’S DISEASE a.k.a Thromboangiitis obliterans
• show diminished circulation in the peripheral vessels

• Detect decreased circulation in the peripheral vessels

• - Locate lesions and rule out atherosclerosis

Raynaud’s Disease
Raynaud’s Disease-ischemia of the extremities of the body, especially the fingers, toes,
ears, and nose, caused by exposure to cold or by emotional stimuli. The attacks
characterized by severe blanching of the extremities, followed by cyanosis then redness,
they are usually accompanied by numbness, tingling, burning, and often pain. Normal
color and are restored by heat.

Ankylosing spondilytis a.k.a

Marie-Strumpell disease
Ankylosing Spondilytis a.k.a
Marie-Strumpell disease
• A chronic inflammatory dis. of unknown origin, first affecting the spine and
adjacent structures, and commonly progressing to eventual fusion ( Ankylosis) of the
involved joint. In extreme cases the pt develops a forward flexion of the spine, called a
“poker spine” or “ bamboo spine”
Ankylosing Spondilytis a.k.a
Marie-Strumpell disease
• family history
• blurring of the bony margins of joint in the early stage
• bilateral sacroiliac involvement
• patchy sclerosis with superficial bony erosions
• eventual squaring of vertebral bodies
• bamboo spine with complete ankylosis
• slightly elevated ESR and creatinine kinase
• negative RF to rule out rheumatoid arthritis

Ankylosing spondilytis a.k.a

Marie-Strumpell disease

Ankylosing Spondilytis a.k.a

Marie-Strumpell disease
• The aim of treatment is to reduce pain and inflammation in the involved joints,
usually with NSAIDs.
• PT for therapy in keeping the spine as erect as possible to prevent flexion
• Surgery

Marfan's Syndrome

Marfan's Syndrome
• is an inherited (autosomal dominant) disorder, caused by a defective gene
involved with the production of fibrillin.
• Fibrillin makes up part of connective tissue in the body, such as the blood
vessels, eye lenses, and ligaments.
• is a progressive genetic disorder that affects the body's connective tissue.
Connective tissue is everywhere in the body, providing structure and support for cells.
Marfan's Syndrome
Signs and Symptoms
• Unusually tall
• Excessively long extremities (dolicostenomelia)
• Arm span exceeds body height
• Unusually long fingers and toes (arachnodactyly)
• long, narrow skull (dolichocephaly)
• Deformity of the breastbone (sternum) and spine
• Excessively flexible joints
• Dislocation of the eye lens (ectopia lentis)
• Enlargement of the aorta near the heart (aortic aneurysm)
• Leakage of the aortic valve of the heart

Marfan's Syndrome
must be based on the Ghent diagnostic nosology.
• Untreated, patients with Marfan's Syndrome commonly die in their 30s or 40s.
Most of the complications associated with Marfan's syndrome can be managed
effectively, as long as they are diagnosed early.
• Marfan recognized that the disease was transmitted by a Mendelian autosomal
dominant inheritance. This means that only one parent must have the abnormal gene in
order for a child to inherit the disease. In some cases, the gene defect is a spontaneous
mutation--meaning it can occur with no family history of the disease.
• Skeletal radiographs showed thoraco-lumbar kyphoscoliosis
Marfan's Syndrome
• Prophylactic surgery - surgical procedure of choice for Marfan's (cardio)
• Exercise - beneficial both physically and emotionally in people with Marfan's
syndrome. The average life expectancy of patients with the disorder is now nearly 70
years, making regular gentle exercise an important general health measure. Most
patients with Marfan's syndrome should exercise regularly through low-intensity,
low-impact activities adapted to meet their specific orthopedic, cardiovascular and
ophthalmologic disabilities
• Avoid Strenuous activities
• Adequate nutrition
• Physical therapy, a brace, or surgery often can correct scoliosis
• Hormonal treatment may help with control of spinal curves and overall
End- thank you!!!