Interventions for Clients with Connective Tissue Disease and

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

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.

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

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

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

Joint Space Narrowing OA typically asymmetrical Paget’s disease

Subchondral Sclerosis Increased bone density or thickening in the subchondral layer

Osteophytes Bone spurs

Subchondral Cysts Fluid-filled sacs in subchondral bone

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

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

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

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

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

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

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

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

Subcutaneous nodules (disappear and appear without warning)

Hammer toes

Joint Protection: Do’s and Don’t’s

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

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.

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

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

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

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

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

Typical “hidebound” face of person with scleroderma Tissue hardens; claw-like fingers; fibrosis

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