7/30/2019 Arthritis and Connective Tissue Dx

1/2

RTHRITIS & CONNECTIVE TISSUE DX:

A. ARTHRITIS- inflammation of joints, affects more womenB. OSTEOARTHRITIS- progressive, non-inflammatory, degenerative disorder affecting Dyarthroidal

(synovial) joint due to event that damages cartilage or of unknown cause

a. More prevalent women>50yrs- maybe due to lack of estrogenb. Damage sets off metabolic rx @ level chondrocytedull, yellow, soft, inelastic

cartilagebody attempts repairirregular bony growths

c. s/s: joint pain, stiffness during periods of rest & on waking (resolves 30min),crepetation, when affects phalanges HEBERDENs & BOUCHARDs NODEs, when

affects kneesbowlegged, when affects hip-one leg shorter

d. definitive dx=x-raye. Tx: rest & immobilization(1wk), application heat/cold, nutrition therapyreduce weight,

exercise, alternative therapy, drugs-acetaminophen, NSAIDS, antibiotics, intraarticular

injections of corticosteroids & hyaloronic acid, oral supps glucosamine & chondroitin

C. LOW BACK PAIN- caused by degenerative disk dx, herniated disk, lumbar-sacral strain,lumbar-sacral instability

a. Acute pain 3mths, weight reduction same as aboveD. LUMBAR DISK DAMAGE- can be degenerative or herniated disk (slipped). Most common s/s

low back pain, radicular pain down buttocks, & below knee, +ive straight leg test

a. Tx= conservative therapy- limit movement (brace, corsette, belt), ice/heat, ultrasoundmassage, traction, TENS, NSAIDS & muscle relaxants. Once symptoms subside, back

exercises 2xs dy for life

i. *can lose bowel or bladder control if worsensii.

Tx2= laminectomy Assess neurologic fxn & VS q4hrs 1st 24 Check ability void Log roll pt if prescribed bed rest Ensure brace worn when out of bed

E. RHEUMATOID ARTHRITIS- inflammation dx affecting connective tissues synovial joints.Periods exacerbation & remission. Cause=UNKNOWN

7/30/2019 Arthritis and Connective Tissue Dx

2/2

a. s/s-fatigue, weight loss, anorexia, generalized stiffness, limitation motion, joint stiffnesson waking lasts >60min or hrs, joint pain that is warm to touch & increases with

motion, tenosynovitis & joint capsule deformity

b. Diagnosticsi. +RF, increased ESR & C-reactive protein, increased WBC (up to 25,000/uL),

fibrin flex in CSF, confirmed via tissue boipsy arthocentesis...bone scan helps

confirm

c. Tx: DMARDS- Sulfasalazine (alzulfidine, salazopyrin) &* Methotrexate (Rheumatrex)*,NSAIDS, biologic response modifiers, physical therapy, occupational therapy

F. GOUT- systemic dx in which Urate crystals deposit into joints7 tissues causing inflammationa. Cause=excess production uric acid, decreased secretion, increased ingestion purinesb. s/s: dusky, cyanotic joint, inflamed great toe, severe pain, trophy (visible uric acid

deposits), kidney stones

c. Diagnostics- increased uric acid, in serum & urined. Tx: colchine (novocoline, colsalide), NSAIDS, allopurinol (zyloprim)for chronic gout

i. Avoid aspirin, consume low-purine diet (avoid organ & red meats, shellfish, oilyfish), diuretics, excessive physical & emotional stress, drink plenty of fluids esp.

Milk, water & citrus juices

G. SYSTEMIC LUPUS ERYTHEMATOSUS- chronic autoimmune inflammatory dx affectsconnective tissues by the formation of immune complexes which deposit into the tissues &

blood vessels depriving tissue of O2.

a. Cause=unknownb. s/s: butterfly rash face or upper bodyteach avoid sun, excessive fatigue, formation

antibodies against blood cellsanemia, deceased WBC & decreased platelets

c. diagnosticsi. +iv blood presence ANA(antinuclear antibodies), RF, increased ESR, anti-SS-

A (R), anti-SS-B (La), anti-Smith (anti-SM0, anti-DNA & ENA (extractable

nuclear antigens)

ii. Chest x-ray, urinalysis, CBC, ECGiii. Tx: NSAIDS, Hydroxychloroquine (Plaquenil) to decrease inflammatory

response, teach monitor for fever (1st sign exacerbation), joint protection,

counsel against pregnancy.