Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Most common arthritis type
 Progressive loss of cartilage
 Joint pain, loss of function characterized by
progressive deterioration
 Osteophytes (bone spurs)
 Cartilage disintegrates, bone and cartilage
“float” into joint causing crepitus
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Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 History
 Usually older than 60 years
 Physical assessment/clinical manifestations:
 Joint pain and stiffness
 Crepitus
 Heberden's nodes
 Bouchard’s nodes
 Joint effusions
 Atrophy of skeletal muscle
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Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Psychosocial
 Severe pain may cause depression/anxiety
 Laboratory
 ESR
 nsCRP
 Radiographic
 Other diagnostic:
 MRI
 CT studies
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Drug therapy
Rest, immobilization
Positioning
Thermal modalities
Weight control
Integrative therapies
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Glucosamine, chondroitin
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Total joint arthroplasty (TJA)
Total joint replacement (TJR)
Arthroscopy
Osteotomy
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 Collaborate with patient/family to become
safety partners to prevent complications
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Hip dislocation
VTE
Infection
Anemia
Neurovascular compromise
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Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Noninflammatory localized arthritis
(osteoarthritis) is not systemic, not an
autoimmune disease
 Inflammatory arthritis:
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Rheumatoid arthritis
Systemic lupus erythematosus
Autoimmune disease
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Connective tissue disease (CTD) major focus
 Noninflammatory or inflammatory
 Rheumatic disease = any disease/ condition
involving musculoskeletal system
 Arthritis = inflammation of one or more joints
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Common connective tissue disease, destructive
to joints
 Chronic, progressive, systemic inflammatory
autoimmune disease; affects primarily synovial
joints
 Transformed autoantibodies (rheumatoid
factors) form, attack healthy tissue causing
inflammation
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Assessment
 Physical assessment/clinical manifestations:
 Early—joint stiffness, swelling, pain, fatigue, generalized
weakness
 Late—joints become progressively inflamed and quite
painful
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Weight loss, fever, extreme fatigue
Exacerbations
Subcutaneous nodules
Respiratory, cardiac complications
Vasculitis
Periungual lesions
Paresthesias
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 Sjögren’s syndrome
 Felty’s syndrome
 Caplan’s syndrome
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 Psychosocial
 Laboratory—rheumatoid factor, antinuclear
antibody titer, ESR, serum complement (C3 &
C4), serum protein electrophoresis, serum
immunoglobulins
 Thrombocytosis can occur with late RA
 Other diagnostic—x-ray, CT, arthrocentesis,
bone scan
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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DMARDs
NSAIDs
BRMs
Other:
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Glucocorticoids
Immunosuppressive agents
E788 awaiting approval
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Adequate rest
Proper positioning
Ice and heat application
Plasmapheresis (not common)
Complementary and alternative therapies
Promotion of self-management
Management of fatigue
Enhance body image
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 Chronic, progressive, inflammatory connective
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tissue disorder
Can cause major body organs/systems to fail
Spontaneous remissions and exacerbations
Autoimmune process
Autoimmune complexes tend to be attracted to
glomeruli of the kidneys
Often some degree of kidney involvement
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Skin involvement
 Butterfly rash
 Polyarthritis
 Osteonecrosis
 Muscle atrophy
 Fever and fatigue
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Renal involvement
Pleural effusions
Pericarditis
Raynaud’s phenomenon
Neurologic manifestation
Serositis
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Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Psychosocial results can be devastating
 Laboratory:
 Skin biopsy (confirms diagnosis)
 Immunologic-based laboratory tests
 CBC (often shows pancytopenia)
 Body system function
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Topical cortisone drugs
Plaquenil
Tylenol or NSAIDs
Chronic steroid therapy
Immunosuppressive agents
New drugs in clinical trials
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Lupozor
Belimumab (Benlysta)
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Chronic, inflammatory, autoimmune connective
tissue disease
 Not always progressive
 Hardening of the skin
 Classifications:
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Diffuse cutaneous
Limited cutaneous
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Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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C—calcinosis
R—Raynaud’s phenomenon
E—esophageal dysmotility
S—sclerodactyly
T—telangiectasia
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Hands and forearm edema with bilateral carpal tunnel
syndrome usually first symptoms to occur
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Arthralgia
Renal and cardiac system involvement
Problems with GI tract
Lung involvement
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Drug therapy
Identify early organ involvement
Skin protective measures
Comfort
GI management
Mobility
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Also called gouty arthritis
 Urate crystals deposit in joints and other body
tissues, causing inflammation
 Primary gout
 Secondary gout—hyperuricemia
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Drug therapy
 Nutrition therapy
 Limit proteins
 Avoid trigger foods
 Plenty of fluids
 pH increased with alkaline foods
 Low purine diet
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Polymyositis (dermatomyositis)
Systemic necrotizing vasculitis
Polymyalgia rheumatica and temporal arteritis
Ankylosing spondylitis
Reiter’s syndrome
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Marfan syndrome
Infectious arthritis
Lymes Disease
Pseudogout
Psoriatic Arthritis
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Caused by spirochete Borrelia burgdorferi,
resulting from bite of infected deer tick
 Stages I and II
 Chronic complications—arthralgias, fatigue,
memory/thinking problems
 Sometimes first and only sign/symptom is
arthritis
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Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Skin condition characterized by scaly, itchy rash
of elbows, knees, scalp
 Joints stiff especially in morning
 Treatment focus = managing pain
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Chronic pain syndrome, not an inflammatory
disease
 Pain, stiffness, tenderness at certain areas of
neck, upper chest, trunk, low back, extremities
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Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Severe fatigue for 6 months or longer, usually
following flu-like symptoms
 Four or more criteria must be met for CFS
diagnosis
 Treatment is supportive
The patient is a 63-year-old woman admitted to
the acute medical care unit. She is 5’4” and
weighs 211 lb. Her medical history includes
hypertension and GERD. On admission, she
reports pain in her hands and joints that is
unrelieved by OTC medications.
What additional assessment data should you
collect from the patient at this time?
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While completing your admission assessment, you observe the
patient’s hands appear as shown.
1. How would you document this finding?
2. What do you suspect the patient may be suffering from?
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An hour later, the patient is crying because of
severe joint pain in her hands.
What are your priority actions at this time?
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While the patient is in pain, her
vital signs are taken and recorded.
Are any of these vital signs a
cause for concern?
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Two hours later, laboratory values are drawn to
investigate the patient’s symptoms. The results
are:
Sodium 136 mEq/L
HCT 41.6%
Potassium 4.6 mEq/L HGB 12.8 g/dL
Calcium 8.9 mg/dL
ESR 28 mm/hr
Are any of these results of concern?
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50
Which population group is most likely to be
diagnosed with fibromyalgia syndrome?
A. Men between 30 and 50 years of age
B. Women between 30 and 50 years of age
C. Men between 50 and 70 years of age
D. Women between 50 and 70 years of age
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
The assessment of a patient status post total knee
arthroplasty for which continuous femoral nerve
blockade was utilized reveals that the patient is nervous
and vital signs are BP 92/58, HR 62, RR 12, and SpO2
89%. What should the nurse do next?
A.
B.
C.
D.
Take vital signs every 10 minutes
Notify the physician of the vital signs
Anticipate administering IV fluids
Notify the Rapid Response Team
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During a health history assessment of a patient with RA,
chronic HTN, and a recent CVA, she states that she
takes 2 fish oil capsules (5 g) daily as a supplement for
her RA. What additional question should the nurse ask?
A. “Have you found the fish oil to help your RA?”
B. “Does your physician know you are taking the fish
oil capsules to treat your RA?”
C. “Are you taking any anticoagulant medications as
well?”
D. “How long have you been taking the fish oil
capsules?”
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