Rheumatic diseases

Management gout

-Management of acute gouty inflammation --NSIADS (#1) --Colchicine (lowers uric crystals in gout) --Corticosteroids -Long-term management of hyperuricemia --Allopurinol --Probenecid

Pharmacological management RA

-NSAIDs (dont stop progression) -DMARDs (do stop progression) --methotrexate (most common) --> therapetic effect in 2-6wks, teratogenic, bone marrow suppression, gi ulcers, inc risk for infection --> should monitor liver, kidney function, and CBC for anemia --Hydroxychloroquine (Plaquenil) --> Eye exams yearly --Biologic agents --> Etanercept (Enbrel) --> Be on lookout for serious infections, NO VACCINES

Management OA

-Non pharmacologic: Ice, heat, weight reduction, exercise -Pharmacologic --Acetaminophen --NSAIDS (Celecoxib --> GI complications) --Opioids (rare) and topical analgesics -Local injections -Surgery -Exercise --> low impact, PT

General management RA

-PT and OT -reconstructive joint therapy for severe cases -dietition consult --wt loss is a problem --high protein, 5 major food groups --small, freq meals -education on med regimen

Clinical manifestations gout

-Pain and inflammation in 1 or more small joint --> usually in big toe (podagra) -Abrupt onset -Tenderness on palpation, warmth, redness -Tend to subside spontaneously 3-10 days -Elevated serum uric acid level

Clinical maifestations OA

-Pain, stiffness, loss movement & function -Tenderness over joint line or around joint -Joint swelling -Joint deformities & instability -Crepitus -Unsteady gait -Brief***** morning stiffness

RA lab findings

-RF 70-80% of pts -Anticyclic citrullinated peptide -Elevated ESR -Elevated CRP

Nursing management gout

-Rest joint -Ice* -Importance of medication compliance -Diet --Limit ETOH intake --Encourage hydration --Normal body weight --Restriction of sodium, fat, cholesterol --Avoid foods high in purines

Rheumatoid arthritis

-Women -Smoking -Autoimmune reaction --Commonly in synovial fluid** --Inflammation Results in pain, swelling, and pannus formation --Loss of articular surfaces & joint motion --Occurs bilaterally** --is systemic

Risk factors OA

-aging -obesity -women -trauma to a joint in past ** (one of the highest RF) -malignant of joints -genetic predisposition

Osteoarthritis (OA)

-also called degenerative joint disease (DJD) -most common joint disorder in society -cartilage deterioration -weight bearing joints (usually starting in knees or hips) -impacts quality of life, can become very painful -primary (idiopathic) vs secondary (to a previous joint injury) -no systemic sx, limited to affective joint, not bilateral -primary patho is not autoimmune in nature **

Risk factors gout

-eating high amount of purines --> found in alcohol, meats, and seafood -high fructose beverages -obesity -htn -thiazide diuretics

Gout

-effects men more -most common inflammatory arthritis -is a metabolic disorder -Urate crystals (tophi) accumulate in joints & soft tissues -occurs from hyperuricemia in body

Clinical manifestations systemic

-fatigue -weight loss -fever -rheumatoid nodules -heart, lungs, and blood vessels can be effected bc of inflammatory effect -cardiovascular risk of having RA is similar to ppl who have diabetes

Pharmacological cont'd

-glucocorticoids --high anti inflammatory effect --often used for flare ups and bridging --prednisone, prednisolone --serious toxicity w long term therapy --limit use -antidepressants

Patho OA

-gradual loss of articular cartilage --> bony outgrowths at joint margins --> narrowed joint space --> dec'd movement and potential for more damage

Clinical manifestations RA

-joint stiffness, swelling, warmth, erythema, lack of function -morning stiffness >1 hr -1st small joints of hands, wrists, and feet -2nd knees, shoulders, hips, elbows, ankles -Symptoms usually bilateral and symmetric -Deformities in hand and feet are common --> difficult to perform ADLs

A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process? A. "It will get better and worse again." B. "When it clears up, it will never come back." C. "I'll definitely need surgery for this." D. "It will never get any better than it is right now."

A -there are excaberations and remissions

A patient with newly diagnosed OA would be initially encouraged to use which of the following medications in the management of the disease? Oxycodone Acetaminophen ASA Topical hydrocortisone

Acetaminophen

A client is complaining of severe pain in the left great toe. What lab studies that the nurse reviews indicate that the client may have gout? A. Elevated white blood count B. Elevated uric acid levels C. Decreased hemoglobin and hematocrit D. Increased AST and ALT

B.