Interventions for Interventions for Clients with Clients with

Connective Tissue Connective Tissue Disease and Other Disease and Other Types of ArthritisTypes of Arthritis

Rheumatology Rheumatology

Connective tissue disease (CTD) Connective tissue disease (CTD) is a major focus of rheumatology.is a major focus of rheumatology.

Rheumatic disease is any disease Rheumatic disease is any disease or condition involving the or condition involving the musculoskeletal system.musculoskeletal system.

Arthritis means inflammation of Arthritis means inflammation of one or more joints.one or more joints.

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RheumatologyRheumatology (Continued)(Continued)

Non-inflammatory arthritis is not Non-inflammatory arthritis is not systemic.systemic.

Inflammatory arthritisInflammatory arthritis– Rheumatoid arthritisRheumatoid arthritis– Systemic lupus erythematosusSystemic lupus erythematosus

Osteoarthritis Osteoarthritis

Most common type of arthritisMost common type of arthritis

Joint pain and loss of function Joint pain and loss of function characterized by progressive characterized by progressive deterioration and loss of deterioration and loss of cartilage in the jointscartilage in the joints

OsteophytesOsteophytes

SynovitisSynovitis

SubluxationSubluxation

Collaborative ManagementCollaborative Management

HistoryHistory

Physical assessment and clinical Physical assessment and clinical manifestationsmanifestations– Joint involvementJoint involvement– Heberden's nodesHeberden's nodes– Bouchard’s nodesBouchard’s nodes– Joint effusionsJoint effusions– Atrophy of skeletal muscleAtrophy of skeletal muscle

AssessmentsAssessments

PsychosocialPsychosocial

Laboratory assessment of Laboratory assessment of erythrocyte sedimentation rate erythrocyte sedimentation rate and C-reactive protein (may be and C-reactive protein (may be slightly elevated)slightly elevated)

Radiographic assessmentRadiographic assessment

Other diagnostic assessmentsOther diagnostic assessments– MR imagingMR imaging– CT studiesCT studies

Chronic PainChronic PainInterventions:Interventions:

Pain control may be accomplished Pain control may be accomplished at home with drug and at home with drug and nonpharmacologic measures.nonpharmacologic measures.

Surgery may be performed to Surgery may be performed to reduce pain.reduce pain.

Comprehensive pain assessment Comprehensive pain assessment should be performed before and should be performed before and after implementing interventions.after implementing interventions.

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Chronic PainChronic Pain (Continued)(Continued)

Rest, positioning, thermal Rest, positioning, thermal modalities, weight control, TENS, modalities, weight control, TENS, complementary and alternative complementary and alternative therapies, stem cell therapytherapies, stem cell therapy

Surgical managementSurgical management

Total Hip ArthroplastyTotal Hip Arthroplasty

Preoperative carePreoperative care

Operative proceduresOperative procedures

Postoperative carePostoperative care– Prevention of dislocation, infection, Prevention of dislocation, infection,

and thromboembolic complicationsand thromboembolic complications– Assessment of bleedingAssessment of bleeding– Management of anemiaManagement of anemia

Care of Total Hip ArthroplastyCare of Total Hip Arthroplasty

Assessment for neurovascular Assessment for neurovascular compromisecompromise

Management of painManagement of pain

Progression of activityProgression of activity

Promotion of self-carePromotion of self-care

Impaired Physical MobilityImpaired Physical Mobility

Interventions:Interventions:

Goal: to achieve independent Goal: to achieve independent functionfunction

Therapeutic exerciseTherapeutic exercise

Promotion of activities of daily Promotion of activities of daily living and ambulationliving and ambulation

Teaching about health and how Teaching about health and how to use assistive devicesto use assistive devices

Rheumatoid ArthritisRheumatoid ArthritisA most common connective tissue A most common connective tissue disease and the most destructive to disease and the most destructive to the jointsthe joints

Chronic, progressive, systemic Chronic, progressive, systemic inflammatory autoimmune disease inflammatory autoimmune disease primarily affecting the synovial jointsprimarily affecting the synovial joints

Autoantibodies (rheumatoid factors) Autoantibodies (rheumatoid factors) formed that attack healthy tissueformed that attack healthy tissue

Affects synovial tissue of any organ Affects synovial tissue of any organ or body systemor body system

Collaborative ManagementCollaborative Management

AssessmentAssessment

Physical assessment and clinical Physical assessment and clinical manifestationsmanifestations– Early disease manifestationsEarly disease manifestations– Late disease manifestationsLate disease manifestations– Joint involvementJoint involvement– Systemic complicationsSystemic complications– Associated syndromesAssociated syndromes

AssessmentsAssessments

Psychosocial assessmentPsychosocial assessment

Laboratory assessment: Laboratory assessment: rheumatoid factor, antinuclear rheumatoid factor, antinuclear antibody titer, erythrocyte antibody titer, erythrocyte sedimentation rate, serum sedimentation rate, serum complement, serum protein complement, serum protein electrophoresis, serum electrophoresis, serum immunoglobulinsimmunoglobulins

Other diagnostic assessmentsOther diagnostic assessments

Drug Therapy for RADrug Therapy for RAMild diseaseMild disease

Nonsteroidal anti-inflammatory Nonsteroidal anti-inflammatory drugs (NSAIDs), for instance, drugs (NSAIDs), for instance, celecoxib, rofecoxib, valdecoxib with celecoxib, rofecoxib, valdecoxib with cox-2 inhibiting propertiescox-2 inhibiting properties

Disease modifying antirheumatic Disease modifying antirheumatic drugs (DMARDs), such as drugs (DMARDs), such as hydroxychloroquine, sulfasalazine, hydroxychloroquine, sulfasalazine, and minocyclineand minocycline

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Drug Therapy for RA Drug Therapy for RA (Continued)(Continued)

Moderate to severe diseaseModerate to severe disease

MethotrexateMethotrexate

LeflunomideLeflunomide

Biological response modifiers Biological response modifiers such as etanercept, infiximab, such as etanercept, infiximab, adalimumab, anakinraadalimumab, anakinra

Nonpharmacologic Modalities Nonpharmacologic Modalities in the Treatment of RAin the Treatment of RA

PlasmapheresisPlasmapheresis

Complementary and alternative Complementary and alternative therapiestherapies

Promotion of self-carePromotion of self-care

Management of fatigueManagement of fatigue

Enhancement of body imageEnhancement of body image

Health teachingHealth teaching

Lupus Erythematosus Lupus Erythematosus

Chronic, progressive, Chronic, progressive, inflammatory connective tissue inflammatory connective tissue disorder can cause major body disorder can cause major body organs and systems to fail.organs and systems to fail.

Many clients with SLE have some Many clients with SLE have some degree of kidney involvement.degree of kidney involvement.

Collaborative ManagementCollaborative Management

Physical assessment and clinical Physical assessment and clinical manifestationsmanifestations– Skin involvementSkin involvement– Musculoskeletal changesMusculoskeletal changes– Systemic manifestations including Systemic manifestations including

pleural effusions or pneumonia and pleural effusions or pneumonia and Raynaud’s phenomenonRaynaud’s phenomenon

Assessments for Lupus Assessments for Lupus

Psychosocial results can be Psychosocial results can be devastating.devastating.

Laboratory Laboratory – Skin biopsy (only significant test to Skin biopsy (only significant test to

confirm diagnosis)confirm diagnosis)– Anti-Ro (SSA) testAnti-Ro (SSA) test– Complete blood countComplete blood count– Body system functionsBody system functions

Progressive Systemic Progressive Systemic SclerosisSclerosis

Referred to as systemic Referred to as systemic scleroderma, meaning hardening scleroderma, meaning hardening of the skinof the skin

Diffuse cutaneous sclerodermaDiffuse cutaneous scleroderma

Limited cutaneous sclerodermaLimited cutaneous scleroderma

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Progressive Systemic Progressive Systemic Sclerosis Sclerosis (Continued)(Continued)

Clients have CREST syndrome:Clients have CREST syndrome:– CalcinosisCalcinosis– Raynaud’s phenomenonRaynaud’s phenomenon– Esophageal dysmotilityEsophageal dysmotility– SclerodactylySclerodactyly– TelangiectasiaTelangiectasia

Drug therapy slows disease Drug therapy slows disease progression but is often progression but is often unsuccessful.unsuccessful.

GoutGout

Also called gouty arthritis, a Also called gouty arthritis, a systemic disease in which urate systemic disease in which urate crystals deposit in the joints and crystals deposit in the joints and other body tissues, causing other body tissues, causing inflammationinflammation

Primary goutPrimary gout

Secondary goutSecondary gout

Collaborative ManagementCollaborative Management

Acute goutAcute gout

Chronic goutChronic gout

Drug therapyDrug therapy

Diet therapyDiet therapy

Lyme DiseaseLyme DiseaseReportable systemic infectious Reportable systemic infectious disease caused by the spirochete disease caused by the spirochete Borrelia burgdorferi,Borrelia burgdorferi, resulting from resulting from the bite of an infected deer tickthe bite of an infected deer tick

Stages I and IIStages I and II

If not treated in early stages, If not treated in early stages, chronic complications such as chronic complications such as arthralgias, fatigue, memory and arthralgias, fatigue, memory and thinking problems present in later thinking problems present in later stagesstages

Fibromyalgia SyndromeFibromyalgia SyndromeChronic pain syndrome, not an Chronic pain syndrome, not an inflammatory diseaseinflammatory disease

Pain typically located at trigger Pain typically located at trigger pointspoints

Physical therapy treatmentPhysical therapy treatment

Drug therapy with NSAIDsDrug therapy with NSAIDs

Muscle relaxantsMuscle relaxants

Home exercises, including walking, Home exercises, including walking, swimming, rowing, biking, and swimming, rowing, biking, and water exercisewater exercise