connective tissue disorders

• patho of osteoarthritis: cartilage loss (becomes bone on bone and all cushion is gone), unprotected bone, deterioration of joint function, "wear and tear" (**)
• risk factors of osteoarthritis: age, females, obesity, occupation (ie farmers working hard with hands and knees)
• clinical manifestations of osteoarthritis: progressive pain over time and throughout the day (the more you use it the more wear and tear on it), decreased ROM (very stiff), tenderness to touch, swelling, crepitus
• medications for osteoarthritis: Tylenol, NSAIDs (works the best because it is an inflammatory problem), corticosteroid injections (temp relief of pain), and opioids (do not use long term)
• surgery for osteoarthritis: joint replacement
• complications of osteoarthritis: septic joint
• what are herberdens and bouchard nodes classic signs of?

  osteoarthritis
• physical assessment of osteoarthritis: progressive pain over time (increases with movement and use), stiffness in the morning for less than 30 minutes (**), decreased ROM, tenderness to touch, swelling, crepitus
• labs for osteoarthritis: X ray (shows narrowing of the joint space) and serum creatinine (NSAIDs cause kidney problems NOT due to osteoarthritis)
• interventions for osteoarthritis: vitals (temperature - monitoring for infection of bone), weight, skin integrity, analgesics/anti inflammatory medications, cold packs for JOINTS, heat pads for MUSCLES
• teaching for osteoarthritis: take medications as prescribed (NSAIDs - hurt kidneys so dont take too much; tylenol - dont take more than 3g/day; steroids - infection), report chest pain, abdominal pain, abnormal bleeding d/t the meds, participate in regular physical activity (need to move the joint), OT/PT, orthopedic surgery (joint replacement), and home health referral
• rheumatoid arthritis: antigen triggers immune response (autoimmune disease**), synovial tissue damaged, increase in thickening of synovial fluid leading to impaired movement and pain; body starts to attack its own joints
• risk factors for rheumatoid arthritis: cigarette smoke, bacteria, viruses, and can occur at ANY age
• what are swan neck and boutonniere deformities and ulnar deviation signs of?

  rheumatoid arthritis
• clinical manifestations of rheumatoid arthritis: joint pain, irreversible joint damage and disability
• medical treatment for rheumatoid arthritis: ROM exercises (keep the joints moving), aerobic exercise, PT/OT, medications (HYDROCHLOROQUINE)
• surgery for rheumatoid arthritis: joint replacement and bone fusion
• complications of rheumatoid arthritis: permanent joint deformity, infection, cancer, systemic problems with inflammation
• physical assessment of rheumatoid arthritis: unsteady gait, bony enlargement or swelling of affected joints, warmth and redness of joints, painful ROM of affected joints, constipation d/t decreased physical activity and/or narcotics, nausea and oral ulcers d/t methotrexate use, cough and/or SOB d/t interstitial lung disease caused by methotrexate use
• labs for rheumatoid arthritis: c reactive proteins, ESR (high = inflammation), ANA (high = inflammation), elevated serum creatinine d/t NSAID use, elevated liver enzymes d/t methotrexate or leflunomide
• interventions for rheumatoid arthritis: vitals (temperature - septic joint), joint pain and mobility, assess for other inflammatory changes in body, administer medications (ADALIMUMAB)
• teaching for rheumatoid arthritis: importance of adherence to treatment plan, report S&S of infection, immunosuppressive therapy, assist with referrals (infectious disease specialist, PT/OT), keep current with vaccinations
• laboratory testing for RA:

  • CRP and ESR: elevated = inflammation
  • hemoglobin: decreased = GI bleed (d/t NSAIDs)
  • serum albumin: decreased = increased disease severity
  • platelet count: elevated = very active disease d/t inflammation
  • liver and renal function: elevated = d/t medications
• osteoarthritis is characteristic by?

  pain that worsens with use and heberden nodes
• joints that are large, red, hot, and swollen and it appeared overnight?

  rheumatoid arthritis
• lupus erythematosus: chronic inflammatory disease; antibodies and the creation of immune complexes which are deposited into tissues
• triggers (risk factors) of lupus: pregnancy, exposure to sunlight, illness, major surgery, silica dust, medication allergies, genetic predisposition
• clinical manifestations of lupus: do not follow clinical pattern, varies from person to person, periods of remission and acute flare
• medical treatment of lupus: antimalarial medications (hydroxychloroquine), NSAIDs, glucocorticoids
• complications of lupus: renal failure, premature heart disease, lung disease, hyper coagulation, stroke, avascular necrosis of joints, increased risk for infection
• physical assessment of lupus: fatigue, difficulty concentrating (brain fog), joint pain, butterfly rash (***), photosensitivity, oral/nasal ulcers, dry eyes, dry mouth, hypertension (renal/cardiac complication)
• labs for lupus: WBC (leukopenia), platelets (thrombocytopenia), and BUN/Cr (elevated with renal involvement)
• interventions for lupus: administer medications as ordered (Hydroxychloroquine), provide a restful environment
• teaching for lupus: disease progress, avoid crowds and infections if on immunosuppressants (**), use sunscreen daily (trigger), energy conservation and activity prioritization, keep up to date on immunizations, avoid oral contraceptives (increased risk of hyper coagulability)
• fibromyalgia: chronic pain disorder (widespread pain + hypersensitivity to pressure), unclear etiology
• risk factors for fibromyalgia: rheumatoid arthritis, lupus, middle aged femaes
• fibromyalgia cycle: to help these patients need to break the cycle
• clinical manifestations of fibromyalgia: widespread pain, insomnia, fatigue, stiffness, cognitive dysfunction
• medical treatment for fibromyalgia: PT (BEST), strength training, aerobic exercise, CBT
• medications for fibromyalgia: SNRIs (antidepressants), GABA stimulant (pregabalin), sleep aids (short term only - less than 10 days). non opioid analgesics; OPIOIDS NOT RECOMMENDED