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. 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

4. Clinical Features Age of Onset > 40 years Commonly Affected Joints
Cervical and lumbar spine
First carpometacarpal joint
Proximal interphalangeal joint
Distal interphalangeal joint
Hip
Knee
Subtalar joint
First metarsophalangeal joint 4

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

7. Joint Space Narrowing
OA typically asymmetrical
Paget’s disease

8. Subchondral Sclerosis
Increased bone density or thickening in the subchondral layer

11. Osteophytes
Bone spurs

12. Subchondral Cysts
Fluid-filled sacs in subchondral bone

13. 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

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

15. 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
S&P

16. Joints changes with RA Early Pannus
Granulation, inflammation at synovial membrane, invades joint, softens and destroys cartilage

17. RA
Mod advanced Pannus
joint cartilage disappears, underlying bone destroyed, joint surfaces collapse
Fibrous Ankylosis
Fibrous connective tissue replaces pannus; loss of joint otion
Bony Ankylosis
Eventual tissue and joint calcification

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

21. Assessment RA Deformities that may occur with RA Synotenovitis
Ulnar drift
Swan neck deformity
Boutonniere deformity

22. Mutlans deformity (rapidly progressing RA)
Hitch-hiker thumb
Genu valgus

23. Subcutaneous nodules (disappear and appear without warning)

24. Hammer toes

25. Joint Protection: Do’s and Don’t’s

26. 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

27. 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.
Sentences and phrases

28. Characteristic butterfly rash associated with SLE, especially discoid lupus erythematous
Barry’s lupus

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

31. 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
Sentences and phrases

32. 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

34. 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
S&P

37. Typical “hide-bound” face of person with scleroderma
Tissue hardens; claw-like fingers; fibrosis

38. Ankylosing Spondylitis
Insidious onset
Morning backache
Inflammation of spine; later spine ossification
Oh my back hurts!