ARTHRITIS

 The word arthritis comes from the Greek arthron meaning "joint" and the Latin itis
meaning "inflammation". The plural of arthritis is arthritides. Arthritis affects the
musculoskeletal system, specifically the joints. It is the main cause of disability among
people over fifty-five years of age in industrialized countries.

 It is an inflammation of the joint.

TYPES OF ARTHRITIS

• Rheumatoid Arthritis
– Chronic disease characterized by inflammatory change in the body’s
connective tissue
- Idiopathic, autoimmunity, heredity
- Exacerbations are linked in physical stress

Clinical Manifestations:

- morning stiffness >15 minutes

- pain in motion or direct tenderness in at least one joint
- swelling unrelated to bony overgrowth at least one joint for al least 6
weeks
- swelling observed in a second joint within a 3 month interval
- symmetrical joint swelling, excluding distal intarphalangeal joint
- positive subcutaneous nodules over bony prominence
- positive sheep cell agglutination
- poor mucin clot on synovial fluid analysis
- characteristic changes of synovial fluid analysis, synovial membrane
on biopsy
- Increase Erythrocyte Sedimentation Rate

 (+) 7 criteria with continuous joint swelling for 6 weeks – Classic RA

 (+) 5 criteria with swelling for 6 weeks – Definitive Diagnosis of RA
 (+) 3 criteria with continuous swelling for 4 weeks – Probable RA

Diagnostic Procedure

- (+) Rheumatoid Factor

- (+) C – Reactive Protein
- (+) ANA (Anti – Nuclear Antibody) Test

Nursing Interventions

- Analgesics as prescribed
- Aspirin – Drug of Choice
- NSAIDS – Celecoxib, Phenylbutasone, Diclofenac, Indomethacin
- Corticosteroids – for acute cases
- Warm and cold compress, heat paraffin 52 – 54 degree Celsius
- Rest and positioning
- ROM exercises
- Advice patient to remain active
 Pathophysiology

• Osteoarthritis

- Degenerative joint disease

- Greater than 50 years
- Repeated injury
- Rice Mice
- Weight bearing joints - spine, hips and knees

Types:
Primary
- Degeneration of articular cartilage
Secondary
- Wear and tear disease
- Obesity
- Stress on joints

- Surface of joint becomes rough and wears away

- Joint space narrows
- Surfaces rub together
- Bone spurs
- Bone cyst

Clinical Manifestations

• Dull aching pain

• Crepitus
– Grating, bone against bone
• Joint enlargement
• Limited motion
 • Stiffness and pain
– AM
– Aggravated
• Cold damp weather
• Failing barometric pressure
- Fatigue
- Loss of coordination
- Stiffness and pain
- Herberden’s nodes
- Bony overgrowths
- Redness
- Swelling
- Aching
- Starts in one finger and spreads to the others
- Disfigurement of hands

Nursing Management

o First line
• Acetaminophen
• Topical agents
• Second line
– NSAIDS
• New generation
– Celebrex
– Vioxx
• Less GI problems
• Intrarticular injections
– Steroids
– Short-term lubricant

Health Teachings

• Take medications for pain/inflammation

• Maintain joints in non-flexed position
• Hot/cold packs
– Decrease muscle spasms /pain relief
• Warm shower/baths
– Relieves stiffness in AM
• Relaxation techniques
• Exercise program
• Not to pain/fatigue
• Weight loss
• Assistive devices
• Avoid activities that add stress to the joint
• Avoid repetitive movements
• Home safety
Pathophysiology

• Gouty Arthritis

• Metabolic bone disorder

• Inflammatory joint reaction
– Accumulation of uric acid crystals
• Purine metabolism error
– Build up of uric acid crystals
• Large toe primary site
– Instep, ankles, knees, elbows, and hands
• Last about 10 days
 Clinical Manifestations

• Usually one joint

• Red, warm shiny, swollen sensitive to slightest tough
• Elevated temperature
– 100-103 F
• Tophi

Diagnosis

• Hyperuricemia
• Uric acid crystals in the synovial fluid
• Serum uric acid greater than 7 mg /100 mL
• 24 hour urine shows uric acid

Nursing Management

- Pain reliever
– ASA, Motrin
• Rest
• Heat or cold
• Medication
– Uricosuric ( Zyloprim)
• Decreases serum uric acid levels
– NSAIDS
• Diet management
– Limit high purine food

Pathophysiology
ARTHRITIS
(Philippine Orthopedic Center)

Submitted By:
Ortilano, Irish Jocelle G.
BSN IV - 6