Chapter 65: Arthritis and Connective Tissue Diseases
Arthritis is inflammation of a joint.
The most prevalent types of arthritis are osteoarthritis, rheumatoid arthritis, and gout.
Osteoarthritis (OA), the most common form of joint (articular) disease in North
America, is a slowly progressive noninflammatory disorder of the diarthrodial (synovial)
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
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
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 (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 (AS) is a chronic inflammatory disease primarily affecting the
axial skeleton (sacroiliac joints, intervertebral disk spaces, and costovertebral
Most persons are positive for HLA-B27 antigen.
Extraarticular inflammation can affect eyes, lungs, heart, kidneys, and peripheral nervous
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 is a common benign, inflammatory skin disorder with a possible genetic
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 (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
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 (infectious or bacterial arthritis) is caused by invasion of joint cavity
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 consumption.
Affected joints may appear dusky or cyanotic and are extremely tender. Inflammation of
great toe (podagra)