Transcript Inflammatory Disease - Jackson Orthopaedics Foundation

Inflammatory Diseases
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Objectives
Identify the S/S of inflammatory disease.
Classify the common disease modifying
drugs used to treat inflammatory disease.
Develop a nursing plan of care for individuals
with inflammatory disease.
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Inflammatory Arthritis
An inflammatory process with the
target organ being the synovial
membrane leading to pannus
formation (inflammatory exudate
in the lining of the synovial cells).
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Inflammatory Disorders
RA/JRA
SLE
Scleraderma
Sjogren’s Syndrome
Polymyositis/Giant Cell Arteritis
Psoriatric Arthritis
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Inflammatory Disorders con’t
Ankylosing Spondylitis
Reiter’s Syndrome
Fibromyalgia
Bursitis
Arthritic Infections
Gout
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Rheumatoid Arthritis
Osteopenia - demineralization of the
bone
Early on in the inflammatory
process,only the periarticular portion of
the bones are affected.
Over time, the inflammatory pain causes
disuse of affected joints leading to
generalized osteopenia of whole bones.
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Question #1
A common hand deformity in
rheumatoid arthritis is:
a.
b.
c.
d.
Radial deviation.
Supination deformity.
Ulnar deviation.
Flexion contracture.
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Answer #1
A common hand deformity in
rheumatoid arthritis is:
Ulnar deviation occurs when
the MCP joints are affected by
RA
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Rheumatoid Arthritis
Uniform joint space narrowing
Marginal erosions at bare areas
where synovium lies on bone
Subluxation
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RA of the Hands
RA of the Hands
RA of the Hips
RA-Epidemiology
Develops most often between ages
20 & 50
2 million Americans have RA
Roughly twice as many women as
men
Genetic predisposition
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RA-Etiology
Theories
Autoimmune
Infectious
Genetics
Family history of RA
Stress
Exacerbations
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RA-Pathophysiology
Rheumatoid Factor develops in
synovium
Antibody/antigen complexes
inflammation
Synovitis develops
Synovial lining thickens & invades
surrounding tissue
Granulation forms (Pannus)
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Answer #2
Which of the following symptoms
would you expect a patient with RA
to have?
Morning stiffness usually lasts
about 4 hours
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RA-Symptoms
Pain & swelling in hands & feet
Morning stiffness & stiffness after
rest
Loss of ROM
Fatigue (severe during a flare-up)
Rheumatoid Nodules
Flares & Remissions
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RA Complications
Flexion contractures
Joint Instability
Tendon Rupture
Septic Arthritis
Cord Compression
Sensory/motor loss
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RA Complications
TMJ
Cricoarytenoid joint involvement
Carpal Tunnel
Sjogren’s
Still’s
Depression
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Answer #3
Which of the following is a therapeutic
modality used for symptom
management in RA?
Exercise to promote ROM &
flexibility
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RA - Treatment Modalities
Drug therapy (pyramid)
NSAIDs, DMARDs, Steroid, Exp.
Avara, Remicaide (IV)
***See handouts for lists of drugs used
Exercise/ PT
ROM, strength, endurance, splints
Use of heat & cold
Joint Replacement
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RA Nursing Interventions
Pt & Family Education!!!!!
Joint protection/work simplification
Respect pain
Balance work/rest
Reduce effort on joint/avoid positions
Use larger/stronger/stable joints
Avoid remaining in one position
Avoid activities that don’t allow
stopping/break
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Amyotrophic Lateral Sclerosis
ALS (Lou Gehrig Disease) - chronic
progressive degeneration of motor
neurons - muscle weakness and
atrophy
M 3x>F, age 35-65
50% die in 3 years
Rx: symptomatic
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Gout
Monosodium urate crystals
Deposited into soft tissue
Activate inflammatory process and
inflammatory cytokines (IgG, IL-1, IL-2,
free radicals)
Etiology/Demographics
Seen mostly in males 40-60 years / women
after Menopause
Renal dysfunction
Alcohol use
Defect in purine metabolism
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Gout
Clinical Presentation
Sudden onset
Generally involves one joint – Lower
extremity
Physical examination
Red swollen joint, usually first MTP
Extremely painful point
Fever 103°F / tachycardia / headaches
Urate acid crystal nodules (tophi) noted on
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helix of ears
Gout
Diagnostics
Serum uric acid levels – ↑
WBC –↑ during acute episode
SED rate – ↑
Joint Aspiration – Synovial fluid
 Crystals of sodium urate noted under
special light → glow red under light
X-Rays
 Non-specific soft tissue swelling
 Erosive changes occur with disease
progression
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Gout
Clinical Management
Weight bearing activity restriction until after
acute episode subsides
NSAIDs – indomethacin preferable
Colchicine- narrow window of toxicity
Uricosurics
Allopurinol-never use for acute episodeFor chronic Rx
 Interferes with uric acid production
Diet
 Protein Restriction ???-controversial
 Alcohol / Purine Restriction
 Weight Loss if Obese
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Gout
Complications
Major concern is renal disease from
recurrent renal calculi
Often form large calculi called staghorn
calculi that fill renal calyx and causes renal
dysfunction
Stones cause interstitial inflammation and
can result in chronic renal failure
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Reiter’s Syndrome
Classic presentation is a young
male with a triad of :
Urethritis,
Conjunctivitis
Oligoarticular arthritis.
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SLE
Is an autoimmune disease that can
involve the skin, kidneys, blood
vessels, joints, nervous system,
heart, and other internal organs
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SLE - Symptoms
Skin rash
Arthritis
Fever
Anemia
Hair loss
Ulcers in the
mouth
Kidney
damage
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SLE - Epidemiology
Inherited tendency
Affects women about 9 to 10
times as often as men
3x more common in AfricanAmerican women
All ages, average age 30
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Lyme Disease
Spirochete B. Burgdorferi transmitted
from a tick bite
Erythema Migrans-”target lesion”
Unexplained fever, sweats, chills,
flushing, swollen glands, sore throat,
fever, HA, stiff neck, body aches &
fatigue.
Treated with Doxycycline, Amoxicillin or
Cephalosporins
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Giant Cell Arteritis
Early symptoms of giant cell
arteritis also may resemble the flu.
People are likely to experience
headaches, pain in the temples,
and blurred or double vision. Pain
may also affect the jaw and tongue.
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Polymyalgia Rheumatica
Primary symptoms of polymyalgia
rheumatica are moderate to severe
stiffness and muscle pain near the neck,
shoulders, or hips. The stiffness is more
severe upon waking or after a period of
inactivity, and typically lasts longer than
30 minutes. People with this condition
also may have flu-like symptoms,
including fever, weakness, and weight
loss.
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Sjogren's Syndrome
Affects an estimated 2 million to 4
million people in the United States
•Dry eyes Dry mouth
•Dental cavities
•Fatigue
•Low-grade fever
•Enlarged parotid glands
•Difficulty swallowing or
chewing
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Sjogren's Syndrome con’t
Oral yeast infections
Nosebleeds
Bruising
Skin rashes or dry skin
Vaginal dryness
Shortness of breath
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Sjogren's Syndrome-risk factors
Having a rheumatic disease. Approximately
half of the people who have Sjogren's
syndrome also have a rheumatic disease
Being female. Women are nine times more
likely than men to have Sjogren's syndrome.
Being a certain age. Sjogren's syndrome is
usually diagnosed in people between the
ages of 45 and 55. It rarely occurs in children
or teenagers.
Having a family history. Sjogren's syndrome
sometimes runs in families.
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Psoriatic Arthropathy
Affects about 7% of patients with
psoriasis
Enteropathic Arthritis
About 10-20% of Crohn’s disease and
ulcerative colitis patients can develop
peripheral joint arthritis.
Tuberculous Arthritis
Seen in undiagnosed TB and affects
spine (Potts dz) and lower extremities
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Fibromyalgia
A condition with generalized
muscular pain, fatigue, and poor
sleep
Affects nearly 4 million people
Fibromyalgia means pain in the
muscles, ligaments and tendons
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Scleroderma
Causes thickening and
hardening of the skin
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Multiple Sclerosis MS
Chronically progressive degenerative
disease caused by sporadic plaques,
demyelination slowly stops impulse
conduction of a nerve
Etiol: unknown - illness, trauma F>M
75% prolonged remissions
4 stages
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Multiple Sclerosis
Dx: MRI
Rx: Low fat diet, Linoleic acid
Plasmapheresis during exacerbations
Drugs to  autoimmunity
Nursing - Safety  sensation
Support: Physical 2˚ weakness
Emotional - Financial
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Myasthenia Gravis
Chronic autoimmune deficit in neurotransmission to motor end plates of
voluntary muscles
F 2x > M, age 20-30 F, > 40yrs M
 Thymus 80%, weak shoulder girdle
Dx & Rx: Anti-cholinesterase (tensilon)
with improve symptoms.
Thymectomy
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Question #1
A common hand deformity in
rheumatoid arthritis is:
a.
b.
c.
d.
Radial deviation.
Supination deformity.
Ulnar deviation.
Flexion contracture.
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Question #2
Which of the following symptoms
would you expect a patient with RA
to have?
a.
b.
c.
d.
Morning stiffness.
High energy level.
Bouchard’s nodes.
Increased flexibility.
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Question #3
Which of the following is a therapeutic
modality used for symptom
management in RA?
a. Avoid periods of rest throughout the
day.
b. Exercise to promote ROM &
flexibility.
c. Acetaminophen as 1st line drug.
d. Raisins soaked in apple cider
vinegar.
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Question #4
Which of the following inflammatory disorders
classically presents in young men along with
urethritis, conjunctivitis, and oligoarticular arthritis?
A) Amyotrophic Lateral Sclerosis
B) Gout
C) Reiter’s Syndrome
D) SLE
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Question #5
Which of the following does NOT
usually present with flu-like symptoms?
Lyme Disease
Giant Cell Arteritis
Polymyalgia Rheumatica
Sjorgen’s Syndrome
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Queston #6
Patients with which of the following
conditions sometimes develop arthritis:
Psoriasis
Chrohn’s Disease
Tuberculosis
All of the above
None of the above
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Question #7
Which pair of conditions BOTH affect
nerves
A) Fibromyalgia and Scleroderma
B) Multiple Sclerosis and Fibromyalgia
C) Myesthenia Gravis and Multiple
Sclerosis
D) Scleroderma and Myesthenia Gravis
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