Nursing Management: Arthritis and Connective Tissue Diseases Chapter 65 Overview Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Arthritis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 2

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Osteoarthritis Etiology and Pathophysiology Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 3

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Osteoarthritis Fig. 65-1. Pathologic changes in osteoarthritis. A, Normal synovial joint. B, Early change in osteoarthritis is destruction of articular cartilage and narrowing of the joint space. There is inflammation and thickening of the joint capsule and synovium. C, With time, there is thickening of subarticular bone caused by constant friction of the two bone surfaces. Osteophytes form around the periphery of the joint by irregular overgrowths of bone. D, In osteoarthritis of the hands, osteophytes on the distal interphalangeal joints of the fingers are termed Heberden’s nodes and appear as small nodules. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 4

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Osteoarthritis Clinical Manifestations Systemic Joints Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 5

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Osteoarthritis Fig. 65-2. Joints most frequently involved in osteoarthritis. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 6

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Osteoarthritis Clinical Manifestations, continued Deformity Diagnostic Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 7

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Osteoarthritis Collaborative Care Rest and joint protection Heat and cold applications Nutritional therapy and exercise Complementary and alternative therapies Drug therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 8

Nursing Management: Osteoarthritis Nursing Assessment Nursing Diagnoses Planning Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 9

Nursing Management: Osteoarthritis Fig. 65-4. Typical deformities of rheumatoid arthritis. A, Ulnar drift. B, Boutonnière deformity. C, Hallux valgus. D, Swan neck deformity. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 10

Nursing Management: Osteoarthritis Nursing Implementation Health promotion Acute intervention Ambulatory and home care Evaluation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 11

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Rheumatoid Arthritis Etiology and Pathophysiology Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 12

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Rheumatoid Arthritis Fig. 65-3. Rheumatoid arthritis. A, Early pathologic change in rheumatoid arthritis is rheumatoid synovitis. The synovium is inflamed. There is a great increase in lymphocytes and plasma cells. B, With time, there is articular cartilage destruction; vascular granulation tissue grows across the surface of the cartilage (pannus) from the edges of the joint, and the articular surface shows loss of cartilage beneath the extending pannus, most marked at the joint margins. C, Inflammatory pannus causes focal destruction of bone. At the edges of the joint there is osteolytic destruction of bone, responsible for erosions seen on x-rays. This phase is associated with joint deformity. D, Characteristic deformity and soft tissue swelling associated with severe advanced rheumatoid disease of the hands. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 13

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Rheumatoid Arthritis Clinical Manifestations Joints Extraarticular manifestations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 14

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Rheumatoid Arthritis Fig. 65-5. Extraarticular manifestations of rheumatoid arthritis. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 15

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Rheumatoid Arthritis Complications Diagnostic Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 16

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Rheumatoid Arthritis Table 65-7. American Rheumatism Association classification Criteria for Rheumatoid Arthritis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 17

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Rheumatoid Arthritis Collaborative Care Drug therapy Nutritional therapy 18 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing Management: Rheumatoid Arthritis Nursing Assessment Nursing Diagnoses Planning Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 19

Nursing Management: Rheumatoid Arthritis Nursing Implementation Health promotion Acute intervention Ambulatory and home care Rest Joint protection Heat and cold therapy and exercise Psychologic support Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 20

Gerontologic Considerations: Arthritis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 21

Spondyloarthropathies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 22

Ankylosing Spondylitis Etiology and Pathophysiology Clinical Manifestations and Complications Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 23

Ankylosing Spondylitis Fig. 65-6. Advanced ankylosing spondylitis. Kyphotic posture causes many patients to have a protuberant abdomen secondary to pulmonary restriction. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 24

Ankylosing Spondylitis Diagnostic Studies Collaborative Care Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 25

Nursing Management: Ankylosing Spondylitis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 26

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Psoriatic Arthritis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 27

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Septic Arthritis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 28

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Lyme Disease Fig. 65-7. Erythema migrans of Lyme disease. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 29

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Gout Etiology and Pathophysiology Clinical Manifestations and Complications Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 30

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Gout Fig. 65-8. Tophaceous gout. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 31

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Gout Diagnostic Studies Collaborative Care Drug therapy Nutritional therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 32

Nursing Management: Gout Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 33

Systemic Lupus Erythematosus Etiology and Pathophysiology Clinical Manifestations and Complications Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 34

Systemic Lupus Erythematosus Fig. 65-9. Multisystem involvement in systemic lupus erythematosus. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 35

Systemic Lupus Erythematosus Clinical Manifestations and Complications, continued Dermatologic manifestations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 36

Systemic Lupus Erythematosus Fig. 65-10. Butterfly rash of systemic lupus erythematosus. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 37

Systemic Lupus Erythematosus Clinical Manifestations and Complications, continued Musculoskeletal problems Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 38

Systemic Lupus Erythematosus Fig. 65-4. Typical deformities of rheumatoid arthritis. A, Ulnar drift. B, Boutonnière deformity. C, Hallux valgus. D, Swan neck deformity. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 39

Systemic Lupus Erythematosus Clinical Manifestations and Complications, continued Cardiopulmonary problems Renal problems Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 40

Systemic Lupus Erythematosus Clinical Manifestations and Complications, continued Nervous system problems Hematologic problems Infection Diagnostic Studies Collaborative Care Drug therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 41

Nursing Management: Systemic Lupus Erythematosus Nursing Assessment Nursing Diagnoses Planning Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 42

Nursing Management: Systemic Lupus Erythematosus Nursing Implementation Health promotion Acute intervention Ambulatory and home care Lupus and pregnancy Psychosocial issues Evaluation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 43

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Systemic Sclerosis Etiology and Pathophysiology Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 44

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Systemic Sclerosis Fig. 65-11. Skin changes in systemic sclerosis. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 45

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Systemic Sclerosis Clinical Manifestations Raynaud’s phenomenon Skin and joint changes Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 46

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Systemic Sclerosis Fig. 65-12. Hand of a patient with systemic sclerosis showing sclerodactyly. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 47

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Systemic Sclerosis Clinical Manifestations, continued Internal organ involvement Diagnostic Studies Collaborative Care Drug therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 48

Nursing Management: Systemic Sclerosis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 49

Polymyositis and Dermatomyositis Etiology and Pathophysiology Clinical Manifestations and Complications Muscular Dermal Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 50

Polymyositis and Dermatomyositis Fig. 65-13. Dermatomyositis skin changes. Gottron’s papules. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 51

Polymyositis and Dermatomyositis Clinical Manifestations and Complications, continued Other manifestations Diagnostic Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 52

Nursing and Collaborative Management: Polymyositis and Dermatomyositis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 53

Mixed (Overlapping) Connective Tissue Disease Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 54

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sjögren's Syndrome Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 55

Soft Tissue Rheumatic Syndromes Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 56

Myofascial Pain Syndrome Table 65-19. Comparison of Fibromyalgia and Myofascial Pain Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 57

Fibromyalgia Syndrome Etiology and Pathophysiology Clinical Manifestations and Complications Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 58

Fibromyalgia Syndrome Fig. 65-14. Tender points in fibromyalgia syndrome. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 59

Fibromyalgia Syndrome Diagnostic Studies Collaborative Care Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 60

Nursing Management: Fibromyalgia Syndrome Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 61

Chronic Fatigue Syndrome Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 62

Nursing and Collaborative Management: Chronic Fatigue Syndrome Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 63