1. Interventions for Clients with Connective Tissue Disease and Other Types of Arthritis

2. Rheumatology Connective tissue disease (CTD) is a major focus of rheumatology. Rheumatic disease is any disease or condition involving the musculoskeletal system. Arthritis means inflammation of one or more joints. (Continued)

3. Rheumatology (Continued) Non-inflammatory arthritis is not systemic. Inflammatory arthritis –Rheumatoid arthritis –Systemic lupus erythematosus

4. Osteoarthritis Most common type of arthritis Joint pain and loss of function characterized by progressive deterioration and loss of cartilage in the joints OsteophytesSynovitisSubluxation

5. Collaborative Management History Physical assessment and clinical manifestations –Joint involvement –Heberden's nodes –Bouchard’s nodes –Joint effusions –Atrophy of skeletal muscle

8. Assessments Psychosocial Laboratory assessment of erythrocyte sedimentation rate and C-reactive protein (may be slightly elevated) Radiographic assessment Other diagnostic assessments –MR imaging –CT studies

9. Chronic Pain Interventions: Pain control may be accomplished at home with drug and nonpharmacologic measures. Surgery may be performed to reduce pain. Comprehensive pain assessment should be performed before and after implementing interventions. (Continued)

10. Chronic Pain (Continued) Rest, positioning, thermal modalities, weight control, TENS, complementary and alternative therapies, stem cell therapy Surgical management

11. Total Hip Arthroplasty Preoperative care Operative procedures Postoperative care –Prevention of dislocation, infection, and thromboembolic complications –Assessment of bleeding –Management of anemia

12. Care of Total Hip Arthroplasty Assessment for neurovascular compromise Management of pain Progression of activity Promotion of self-care

13. Impaired Physical Mobility Interventions: Goal: to achieve independent function Therapeutic exercise Promotion of activities of daily living and ambulation Teaching about health and how to use assistive devices

14. Rheumatoid Arthritis A most common connective tissue disease and the most destructive to the joints Chronic, progressive, systemic inflammatory autoimmune disease primarily affecting the synovial joints Autoantibodies (rheumatoid factors) formed that attack healthy tissue Affects synovial tissue of any organ or body system

15. Collaborative Management Assessment Physical assessment and clinical manifestations –Early disease manifestations –Late disease manifestations –Joint involvement –Systemic complications –Associated syndromes

16. Assessments Psychosocial assessment Laboratory assessment: rheumatoid factor, antinuclear antibody titer, erythrocyte sedimentation rate, serum complement, serum protein electrophoresis, serum immunoglobulins Other diagnostic assessments

17. Drug Therapy for RA Mild disease Nonsteroidal anti-inflammatory drugs (NSAIDs), for instance, celecoxib, rofecoxib, valdecoxib with cox-2 inhibiting properties Disease modifying antirheumatic drugs (DMARDs), such as hydroxychloroquine, sulfasalazine, and minocycline (Continued)

18. Drug Therapy for RA (Continued) Moderate to severe disease MethotrexateLeflunomide Biological response modifiers such as etanercept, infiximab, adalimumab, anakinra

19. Nonpharmacologic Modalities in the Treatment of RA Plasmapheresis Complementary and alternative therapies Promotion of self-care Management of fatigue Enhancement of body image Health teaching

20. Lupus Erythematosus Chronic, progressive, inflammatory connective tissue disorder can cause major body organs and systems to fail. Many clients with SLE have some degree of kidney involvement.

21. Collaborative Management Physical assessment and clinical manifestations –Skin involvement –Musculoskeletal changes –Systemic manifestations including pleural effusions or pneumonia and Raynaud’s phenomenon

23. Assessments for Lupus Psychosocial results can be devastating. Laboratory –Skin biopsy (only significant test to confirm diagnosis) –Anti-Ro (SSA) test –Complete blood count –Body system functions

24. Progressive Systemic Sclerosis Referred to as systemic scleroderma, meaning hardening of the skin Diffuse cutaneous scleroderma Limited cutaneous scleroderma (Continued)

25. Progressive Systemic Sclerosis (Continued) Clients have CREST syndrome: –Calcinosis –Raynaud’s phenomenon –Esophageal dysmotility –Sclerodactyly –Telangiectasia Drug therapy slows disease progression but is often unsuccessful.

26. Gout Also called gouty arthritis, a systemic disease in which urate crystals deposit in the joints and other body tissues, causing inflammation Primary gout Secondary gout

27. Collaborative Management Acute gout Chronic gout Drug therapy Diet therapy

28. Lyme Disease Reportable systemic infectious disease caused by the spirochete Borrelia burgdorferi, resulting from the bite of an infected deer tick Stages I and II If not treated in early stages, chronic complications such as arthralgias, fatigue, memory and thinking problems present in later stages

29. Fibromyalgia Syndrome Chronic pain syndrome, not an inflammatory disease Pain typically located at trigger points Physical therapy treatment Drug therapy with NSAIDs Muscle relaxants Home exercises, including walking, swimming, rowing, biking, and water exercise