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.

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  Osteophytes  Synovitis  Subluxation

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

6. 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

7. 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)

8. Chronic Pain

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

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

11. Total Hip Arthroplasty

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. Rheumatoid Arthritis

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

18. Rheumatoid Arthritis

19. 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)

20. Drug Therapy for RA (Continued) Moderate to severe disease  Methotrexate  Leflunomide  Biological response modifiers such as etanercept, infiximab, adalimumab, anakinra

21. 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

22. 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.

23. Lupus Erythematosus

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

25. 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

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

27. Progressive Systemic Sclerosis

28. 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.

29. 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

30. Collaborative Management  Acute gout  Chronic gout  Drug therapy  Diet therapy

31. 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

33. 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