Septic arthritis (infectious or bacterial arthritis) is caused by invasion of joint cavity with
Large joints (knee and hip) are frequently involved, causing severe pain, erythema, and
This condition requires prompt treatment with antibiotics to prevent joint destruction.
Nursing care includes assessment and monitoring of joint inflammation, pain, and fever.
Lyme disease is a spirochetal infection transmitted by bite of an infected deer tick.
A characteristic symptom of the early localized disease is erythema migrans, a skin lesion
occurring at site of tick bite 2 to 30 days after exposure.
Viral-like symptoms, such as fever, chills, headache, swollen lymph nodes, and migratory
joint and muscle pain, also occur.
In late disease, arthritis pain and swelling may occur in large joints.
Antibiotics are used for active disease and to prevent late disease.
Reducing exposure to ticks is the best way to prevent Lyme disease.
Gout is caused by an increase in uric acid production, underexcretion of uric acid, or
increased intake of foods containing purines, which are metabolized to uric acid by the
Deposits of sodium urate crystals occur in articular, periarticular, and subcutaneous
tissues. This leads to recurrent attacks of acute arthritis.
Risk factors are obesity (in men), hypertension, diuretic use, and excessive alcohol
Affected joints may appear dusky or cyanotic and are extremely tender. Inflammation of
great toe (podagra) is a common initial problem.
Chronic gout is characterized by multiple joint involvement and visible deposits of
sodium urate crystals (tophi). Treatment includes drug therapy for pain management and to terminate an acute attack.
Future attacks are prevented by drugs, weight reduction as needed, and possible
avoidance of alcohol and food high in purine (red and organ meats).
Nursing interventions include supportive care of inflamed joints.
SYSTEMIC LUPUS ERYTHEMATOSUS
Systemic lupus erythematosus (SLE) is a chronic multisystem inflammatory disease with
immune system abnormalities.
The etiology of abnormal immune response is unknown; a genetic influence is suspected.
Extremely variable in its severity, ranging from a relatively mild disorder to rapidly
progressive and affecting many organ systems.
Commonly affected are the skin (butterfly rash over nose, cheeks), muscles
(polyarthralgia with morning stiffness), lungs (tachypnea), heart (dysrhythmias), nervous
tissue (seizures), and kidneys (nephritis).
Other signs include anemia, mild leukopenia, and thrombocytopenia. Infection is a major
cause of death.
A major treatment challenge is to manage active disease while preventing treatment
complications that cause long-term tissue damage.
Patients with mild polyarthralgias or polyarthritis are treated with NSAIDs.
Corticosteroids are given for severe cutaneous SLE. Antimalarial agents and
immunosuppressive drugs may also be used.
Nursing care emphasizes health teaching and importance of patient cooperation for
successful home management.
Systemic sclerosis (SS), or scleroderma, is a connective tissue disorder with fibrotic,
degenerative, and occasionally inflammatory changes in the skin, blood vessels,
synovium, skeletal muscle, and internal organs.
The cause of SS is unknown. Immunologic dysfunction and vascular abnormalities may
play a role in systemic disease.
In this disorder, collagen is overproduced. Disruption of cell is followed by platelet
aggregation and fibrosis. Proliferation of collagen