Arthritis and Connective Tissue Diseases

Chapter 65: Arthritis and Connective Tissue Diseases ARTHRITIS  Arthritis is inflammation of a joint.  The most prevalent types of arthritis are osteoarthritis, rheumatoid arthritis, and gout. OSTEOARTHRITIS  Osteoarthritis (OA), the most common form of joint (articular) disease in North America, is a slowly progressive noninflammatory disorder of the diarthrodial (synovial) joints.  Factors linked to OA include increasing age, genetics, obesity, occupations with frequent kneeling, and lack of exercise.  OA results from cartilage damage, leading to fissuring, fibrillation, and erosion of articular surfaces.  Systemic manifestations (fatigue, fever) are not present in OA, whereas they are present in inflammatory joint disorders such as rheumatoid arthritis.  Manifestations range from mild discomfort to significant disability, with joint pain being the major symptom.  As OA progresses, increasing pain contributes significantly to disability and loss of function.  Care focuses on managing pain and inflammation, preventing disability, and maintaining and improving joint function.  Symptoms are initially managed conservatively through medication, joint rest, heat and cold, nutrition, and exercise.  Arthroscopy to repair cartilage or remove bone bits or cartilage may be recommended with OA progression.  Teaching should include information about nature and treatment of OA, pain management, posture and body mechanics, use of assistive devices, principles of joint protection and energy conservation. RHEUMATOID ARTHRITIS  Rheumatoid arthritis (RA) is a chronic, systemic disease with inflammation in connective tissue of the diarthrodial (synovial) joints, often remission and exacerbations.  The etiology of RA is unknown; it is probably due to autoimmune and genetic factors.  Onset is typically insidious with fatigue, weight loss, and generalized stiffness.  Articular signs include pain, stiffness, limitation of motion, and inflammation (e.g., heat, swelling, tenderness). Joint stiffness after periods of inactivity is common.  As RA progresses, muscle atrophy and destruction of tendons around joint cause one articular surface to slip past the other (subluxation).  RA can affect nearly every body system. Most common extraarticular signs are rheumatoid nodules and Sjögren’s and Felty syndromes. o Treatment goals include reduction of inflammation, management of pain, maintenance of joint function, and prevention/correction of joint deformity o Initial care usually involves drug therapy and education. ANKYLOSING SPONDYLITIS  Ankylosing spondylitis (AS) is a chronic inflammatory disease primarily affecting the axial skeleton (sacroiliac joints, intervertebral disk spaces, and costovertebral articulations).  Most persons are positive for HLA-B27 antigen.  Extraarticular inflammation can affect eyes, lungs, heart, kidneys, and peripheral nervous system.  Signs of AS are low back pain, stiffness, and limitation of motion.  Care is aimed at maintaining maximal skeletal mobility while decreasing pain and inflammation. Heat applications, exercise, and medications are often recommended.  Surgery may be done for severe deformity and mobility impairment. PSORIASIS  Psoriasis is a common benign, inflammatory skin disorder with a possible genetic predisposition.  Approximately 10% of people with psoriasis for reasons unknown develop psoriatic arthritis, a progressive inflammatory disease.  Psoriasis can occur in different forms, all having a degree of arthritis.  Treatment includes splinting, joint protection, drugs, and physical therapy. REACTIVE ARTHRITIS  Reactive arthritis (Reiter’s syndrome) occurs more commonly in young men and is associated with a symptom complex that includes urethritis (cervicitis in women), conjunctivitis, and mucocutaneous lesions.  The etiology is unknown, but it appears to occur after genitourinary or gastrointestinal tract infection.  The prognosis is favorable; most patients have a complete recovery after 2 to 16 weeks.  Since reactive arthritis is associated with C. trachomatis infection, patients and their sexual partners are often treated with antibiotics. SEPTIC ARTHRITIS  Septic arthritis (infectious or bacterial arthritis) is caused by invasion of joint cavity with microorganisms.  Large joints (knee and hip) are frequently involved, causing severe pain, erythema, and swelling.  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  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  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 body.  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 consumption.  Affected joints may appear dusky or cyanotic and are extremely tender. Inflammation of great toe (podagra)