Pathophysiology
Degenerative Joint Disease
Osteoarthritis: Cartilage & Bone Ends Deteriorate
Joint pain and stiffness with activity that improves with rest
Localized imflammatory response
Osteoarthritis
Anti-CCP Antibodies
Erythrocyte Sedimentation Rate
C-reactive protein
Rheumatoid Factor Antibody
Lab Test for Rheumatoid:
Antibodies to Cyclic Citrullinated Peptide - usually POSIVITE for RA years before manifestations develop. More SENSITIVE for RA thatn rheumatoid factor ATB
ESR/CRP - Indicate inflammation
NonPharmacological Treatment
Heat (Hot Showers for Joint Stiffness)
Cold applications for swelling
Message/Acupuncture/Aromatherapy
Exercise as tolerated
How to maintain joint function?
Weight loss if overweight
Exercise
Range-of-motion
Risk Factors for Osteoarthritis
Modifiable: Excess weight, Joint injury r/t repetitive stress on joints
Non-modifiable: Age, Genetics
Sensation of pins and needles( aka Parasthesia) r/t the inflammation in the joints which can compress nearby nerves
Rheumatoid Arthritis
Shows the damage of arthritis
X-Ray: determines degree of joint destruction, reveals bony erosions and narrowing joint spaces
Why Exercise is Important
Strengthens the muscle and eases the workload of the joint
Reduces joint pain, improve flexibility (for smoother movement), maintain bone density, and overall enhance quality of life by increasing mobility
Goals of Care for Rheumatoid Arthritis
Early Goal: Minimize disease activity and achieve remission
As RA Progressess:
Reduce inflammation
Relieve symptoms: Reduce pain and other symptoms
Prevent joint damage: Slow or stop joint damage and deformity
Improve function: Maintain or improve joint function
Chronic, Progressive Inflammatory Autoimmune Disease Attacks Joints producing an Inflammatory Synovitis
Rheumatoid Arthritis
Swelling of the joints
Osteoarthritis: Usually milder
Rheumatoid Arthritis: Swelling often accompanied by redness, tenderness, and warmth due to the body's immune system attacking the joint lining, and can affect multiple joints symmetrically (both sides of the body)
Shows damage to cartilage, bone, and soft tissues in the joints.
MRI
Considered better to diagnose than XRAY because it shows more detail but more expensive
Strong Anti-inflammatory medication
What is Corticosteriod
A nurse is collecting data about pain in a client who has rheumatoid arthritis. Which question should the nurse ask first?
A. What does it feel like
B. How does it change with time
C. How severe is your pain
D. Where is your pain
D
FIRST identify where the pain is located THEN Describe the pain THEN does it change over time THEN severity
Risk Factors for Rheumatoid Arthritis
Females 30-50 years, Use of Oral Contraceptives, Genetics, Infections, Gum Disease
Environmental Factors: Air Pollution, Tobacco Smoke
Heberden Nodes: Distal Interphalangeal Joints
Bouchard Nodes: Proximal Interphalangeal Joints
Found in Osteoarthritis
When cartilage breaks down, the body responds by growing new bone at the joint, creating bony growths called nodes
What kind of surgical procedure can be done
Joint Replacement Surgery: option for both types of arthritis, considered last resort treatment option - when arthritis significantly impacts quality of life
Goal of the Surgery: To Reduce Pain and Improve Mobility
May still get flare ups of RA AFTER joint surgery
Topical treatments
Capsaicin: Interacts with nerve endings in the skin, (desensitizing them), reduces the perception of pain (blocks the pain signals from reaching the brain)
Bengay (salicylates + menthol)
A nurse is reinforcing teaching with a client who has oasteoarthritis of the hip and knee. Which of the following information should the nurse include? Select all that apply
A. Apply heat to joints to alleviate pain
B. Ice inflamed joints for 30 min following activity
C. Reduce the amount of exercise done on days with increased pain
D. Elevate the knees with a pillow while in bed
E. Massage can alleviate pain of joints
A, C, E
A:Heat will provide temporary relief of pain
B:Over 20 minutes can cause reactive vasodilation as your body tries to make sure your tissues receive blood supply
C: Prevents harm to joints
D:OK short time but not all night can lead to contracture or circulatory isses
Which type of Arthritis is more Common?
Osteoarthritis
Early: Bilateral/Symmetrical Joint Inflammation, Redness/Warmth/Swelling, Low Grade Fever, Weaness, Fatiugue
Late: Joint Deformity
Occurs in Rheumatoid Arthritis
Post-Op Problems after Joint Replacement Surgery
Infection: Redness/Swelling/Purulent Drainage/Warmth
DVT: Compression Stockings/SCDs
Pain: Opiods, monitor for constipation
Mobility: Get up ASAP/Consult PT
PharmacologicalTreatment
OA: Acetaminophen, NSAIDs, Corticosteroids, Glucosamine & Chondroitin (Repair and Maintain Cartilage, Steroid Injections
RA: DMARDs slow progression, suppress immunse system reaction to RA
Hydroxychloroquine: Interfere with the immune system's response, preventing the release of inflammatory chemicals that contribute to joint damage in rheumatoid arthritis
Cytotoxic Meds (Methotrexate): reduces the production of inflammatory proteins
Biologic Response Modifiers: specifically targeting and blocking certain inflammatory chemicals (cytokines) in the immune system (Enbrel, other drugs ending in MAB= Monoclonal Antibodies Recognize specific proteins on cells. They can either kill the cancer cells or stop them from growing.
Called Biologics because they are made from living organisms. Mixtures of proteins, sugars, nucleic acids, or living cells and tissues
How to Increase Flexibility in the Joints
Yoga
Tai Chi
Pilates