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Rheumatoid Arthritis

Rheumatoid Arthritis

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Published by FreeNursingNotes
Arthritis notes
f you have questions please email me> freenursingnotes@yahoo.com
Arthritis notes
f you have questions please email me> freenursingnotes@yahoo.com

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Published by: FreeNursingNotes on Nov 26, 2009
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01/10/2013

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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.Feet3.Wrists (all compartments)4.Knees5.Ankles6.Elbows7.Glenohumeral and acromioclavicular joints8.Hips9.Articulations of the cervical spine
DIAGNOSTIC CRITERIA
1.Morning stiffness2.Symmetrical soft tissue swelling3.Rheumatoid nodules4.The presence of rheumatoid factor5.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 apatient with rheumatoid arthritis of the hands.
Well-defined bony erosions in the carpal bones and metacarpal basesin a patient with rheumatoid arthritis of the hands.
Subluxation in the metacarpophalangeal joints, with ulnar deviation, ina patient with rheumatoid arthritis of the hands.
Subluxation at the third metacarpophalangeal joint and marginalerosions at the heads of the second to fourth metacarpals
Marked ankylosis of most of the carpal bones in a patient withrheumatoid arthritis of the hands.
Partial collapse of fused carpal bones with subluxation at theradiocarpal 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 arthritisshows 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, goldcompounds)
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 orcombination of both
Primary gout
Secondary gout
ASSESSMENTTypical 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 acuteattacks
 – 
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 andnegatively 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

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