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ARTHRITIS
• Arthritis is inflammation of a joint.
• The most prevalent types of arthritis are osteoarthritis, rheumatoid arthritis, and gout.
OSTEOARTHRITIS
• Osteoarthritis (OA), the most common form of joint (articular) disease in North
America, is a slowly progressive noninflammatory disorder of the diarthrodial (synovial)
joints.
• Systemic manifestations (fatigue, fever) are not present in OA, whereas they are
present in inflammatory joint disorders such as rheumatoid arthritis.
• Manifestations range from mild discomfort to significant disability, with joint pain
being the major symptom.
• Symptoms are initially managed conservatively through medication, joint rest, heat
and cold, nutrition, and exercise.
• Teaching should include information about nature and treatment of OA, pain
management, posture and body mechanics, use of assistive devices, principles of joint
protection and energy conservation.
RHEUMATOID ARTHRITIS
• Rheumatoid arthritis (RA) is a chronic, systemic disease with inflammation in
connective tissue of the diarthrodial (synovial) joints, often remission and exacerbations.
• Onset is typically insidious with fatigue, weight loss, and generalized stiffness.
• Articular signs include pain, stiffness, limitation of motion, and inflammation (e.g.,
heat, swelling, tenderness). Joint stiffness after periods of inactivity is common.
• As RA progresses, muscle atrophy and destruction of tendons around joint cause one
articular surface to slip past the other (subluxation).
• RA can affect nearly every body system. Most common extraarticular signs are
rheumatoid nodules and Sjögren’s and Felty syndromes.
o Treatment goals include reduction of inflammation, management of pain,
maintenance of joint function, and prevention/correction of joint deformity
o Initial care usually involves drug therapy and education.
ANKYLOSING SPONDYLITIS
• Ankylosing spondylitis (AS) is a chronic inflammatory disease
primarily affecting the axial skeleton (sacroiliac joints, intervertebral disk spaces, and
costovertebral articulations).
• Extraarticular inflammation can affect eyes, lungs, heart, kidneys, and peripheral
nervous system.
• Care is aimed at maintaining maximal skeletal mobility while decreasing pain and
inflammation. Heat applications, exercise, and medications are often recommended.
PSORIASIS
• Psoriasis is a common benign, inflammatory skin disorder with a possible genetic
predisposition.
• Approximately 10% of people with psoriasis for reasons unknown develop psoriatic
arthritis, a progressive inflammatory disease.
REACTIVE ARTHRITIS
• Reactive arthritis (Reiter’s syndrome) occurs more commonly in young men and is
associated with a symptom complex that includes urethritis (cervicitis in women),
conjunctivitis, and mucocutaneous lesions.
• Large joints (knee and hip) are frequently involved, causing severe pain, erythema,
and swelling.
• This condition requires prompt treatment with antibiotics to prevent joint destruction.
• Nursing care includes assessment and monitoring of joint inflammation, pain, and
fever.
LYME DISEASE
• Lyme disease is a spirochetal infection transmitted by bite of an infected deer tick.
• In late disease, arthritis pain and swelling may occur in large joints.
• Antibiotics are used for active disease and to prevent late disease.
GOUT
• Gout is caused by an increase in uric acid production, underexcretion of uric acid, or
increased intake of foods containing purines, which are metabolized to uric acid by the body.
• Risk factors are obesity (in men), hypertension, diuretic use, and excessive
alcohol consumption.
• Affected joints may appear dusky or cyanotic and are extremely tender.
Inflammation of great toe (podagra) is a common initial problem.
• Treatment includes drug therapy for pain management and to terminate an acute attack.
• Future attacks are prevented by drugs, weight reduction as needed, and possible
avoidance of alcohol and food high in purine (red and organ meats).
• Extremely variable in its severity, ranging from a relatively mild disorder to rapidly
progressive and affecting many organ systems.
• Commonly affected are the skin (butterfly rash over nose, cheeks), muscles
(polyarthralgia with morning stiffness), lungs (tachypnea), heart (dysrhythmias), nervous
tissue (seizures), and kidneys (nephritis).
• Nursing care emphasizes health teaching and importance of patient cooperation for
successful home management.
SYSTEMIC SCLEROSIS
• Systemic sclerosis (SS), or scleroderma, is a connective tissue disorder with fibrotic,
degenerative, and occasionally inflammatory changes in the skin, blood vessels,
synovium, skeletal muscle, and internal organs.
• Manifestations range from diffuse cutaneous thickening with rapidly progressive and
fatal visceral involvement, to the more benign variant of limited cutaneous SS.
• No specific drug(s) have been proven effective for treating SS. However many drugs can be
used in treating the various manifestations of SS.
• Physical and occupational therapy maintains joint mobility, preserves muscle strength, and
assists in maintaining functional abilities.
POLYMYOSITIS AND DERMATOMYOSITIS
• Polymyositis (PM) and dermatomyositis (DM) are diffuse, idiopathic,
inflammatory myopathies of striated muscle that produce bilateral weakness, usually most
severe in proximal or limb-girdle muscles.
• The exact cause of PM and DM is unknown; theories include infectious agent, neoplasms,
drugs or vaccinations, and stress.
• Patients with DM and PM experience weight loss and increasing fatigue, with gradual
weakness of muscles that leads to difficulty in performing routine activities.
• DM and PM diagnosis is confirmed by EMG findings, muscle biopsy, and serum enzyme
levels.
• The nurse should assist the patient to organize activities and use pacing techniques to
conserve energy.
SJÖGREN’S SYNDROME
• Sjögren’s syndrome is an autoimmune disease that targets moisture-producing
glands, leading to xerostomia (dry mouth) and keratoconjunctivitis sicca (dry eyes).
• Lymphocytes attack and damage the lacrimal and salivary glands in this syndrome.
• Regions of pain are often within taut bands and fascia of skeletal muscles. With pressure,
trigger points are thought to activate a pattern of pain.
FIBROMYALGIA SYNDROME
• Fibromyalgia syndrome (FMS)
is a chronic disorder characterized by widespread, nonarticular musculoskeletal pain and
fatigue with multiple tender points.
• Nonrestorative sleep, morning stiffness, irritable bowel syndrome, and anxiety may also be
noted.
• The cause and pathology of FMS are being studied. It is known to be a disorder of central
processing with neuroendocrine/neurotransmitter dysregulation.
• Treatment is symptomatic and requires a high level of patient motivation, including rest,
medication, relaxation strategies, and massage.
• It is often difficult to distinguish between CFS and FMS, as many of the clinical features are
similar.
• This condition does not appear to progress. Most patients recover or at least gradually
improve over time.