Understand the pathophysiology of ra,OA, & sle. Understand the pathophysiology of ra,OA, & sle

Understand the pathophysiology of RA,OA, & SLE.

• Understand the pathophysiology of RA,OA, & SLE.

• Review signs and symptoms of RA, OA, & SLE.

• Understand how these conditions affects a persons everyday life.

• Understand the treatments available for RA, OA, & SLE.

Leading cause of disability in Canada

• Leading cause of disability in Canada

• Affects 1 in 6 individuals

• Costs Canadians 33 billion each year

• 2/3 individuals with arthritis are women

• One of the most prevalent chronic diseases of Aboriginal peoples

• Skeletal remains from humans living 4500BC show signs of arthritis

• By 2031 approximately 7 million people will be living with Arthritis

• Has caused more deaths than melanoma, asthma, or HIV/AIDS

• Only 1.3% of research is dedicated to arthritis.

# 1: Arthritis isn’t serious

• # 1: Arthritis isn’t serious

• #2: Arthritis is an old person’s disease

• #3:Arthritis is a normal part of aging

• #4: Not much can be done for those living with arthritis

• #5: People with arthritis can’t exercise

CBC

• CBC

• Radiographs of involved joints

• CT/MRI scans

• Direct arthroscopy

• Synovial/Fluid aspirate

• Synovial membrane biopsy

• Arthrocentesis

• There are four types of medications used to treat RA:

• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Disease-modifying anti-rheumatic drugs(DMARDS).
• Corticosteroids
• Biologic Response Modifiers (“Bioligics”)

Support injured joints and weak muscles

• Support injured joints and weak muscles

• Improve joint mobility and stability

• Help to alleviate pain, swelling and muscle spasm

• May prevent further damage and deformity

Osteoarthritis

• Osteoarthritis

• Most common form of arthritis

• Over 3 million Canadians affected (1/10)

• Osteoarthritis is defined as “a degenerative joint disease characterized by destruction of the articular cartilage and overgrowth of bone”

Normal Joint: Cartilage covers the end of bones to act as a shock absorber and to promote smooth movement of the joint.

• Normal Joint: Cartilage covers the end of bones to act as a shock absorber and to promote smooth movement of the joint.

• Osteoarthritis: Cartilage wears down over time. Patients may experience a painful bone-on-bone articulation.

Primary Osteoarthritis – no identifiable reason for arthritis development.

• Primary Osteoarthritis – no identifiable reason for arthritis development.

• Secondary Osteoarthritis – a likely cause for osteoarthritis exists (e.g. joint injury among professional athletes).

Age

• Age

• Family History

• Excess weight

• Joint injury

• Complications of other

• types of arthritis

• MYTH – Normal wear and tear

Joint pain

• Joint pain

• Feeling joints “locking”

• Joint “creaking”

• Stiff joints in the morning

• Joint swelling

• Loss of joint flexibility or strength

• Clinical history

• X-rays

• Physical Assessment

• MRIs

• Joint Aspirate

Exercise

• Exercise

• Weight loss

• Heat & Cold Therapy

• Activity pacing

• Maintaining proper joint alignment

• Use of assistive devices

• Relaxation Exercises

Acetaminophen

• Acetaminophen

• NSAIDs

• Opioids

• Corticosteroid injections

• Topical analgesics

• Glucosamine and chondroitin

Osteotomy

• Osteotomy

• Arthrodesis

• Arthroplasty

• Total knee replacement
• Total hip replacement

One of the most common surgeries for osteoarthritis

• One of the most common surgeries for osteoarthritis

• Displacement osteotomy: a bone is “redesigned surgically to alter the alignment or weight-bearing stress areas”

Hip replacements involve replacement of a damaged hip with an artificial acetabulum and femoral component.

• Hip replacements involve replacement of a damaged hip with an artificial acetabulum and femoral component.

• Often performed for patients with osteoarthritis or rheumatoid arthritis, femoral neck fractures, and problems related to congenital hip disease.

Hip precautions

• Hip precautions

• Monitor for dislodgement

• Abduct leg

• Keep HOB less than 60 degrees

• Use of fracture bedpan

• High-seat surfaces

• Sleep on unaffected side

• Avoid crossing legs

• No bending at the waist

Educating Patient

• Educating Patient

• Discharge planning

• Evaluating patient risks

Monitor VS

• Monitor VS

• Wound assessments

• Neurovascular assessments

• Monitor wound drainage

• Pain relief

• Infection/Osteomyelitis prevention

• Promote early ambulation

• Ensure physiotherapy is consulted

A chronic disease, affecting over 1/1000 Canadians

• A chronic disease, affecting over 1/1000 Canadians

• Affects 8x as many women

• Auto-immune

• Cause is unclear – potential hormonal or genetic link

• When properly treated, most individuals can survive for a normal lifespan

Systemic Lupus Erythematosus (SLE) : The most common type of lupus. Any tissue in the body may be affected including the kidneys, heart, lungs, and brain.

• Systemic Lupus Erythematosus (SLE) : The most common type of lupus. Any tissue in the body may be affected including the kidneys, heart, lungs, and brain.

Educate patient on lupus.

• Educate patient on lupus.

• Help patient identify factors that precipitate flare-ups.

• Assess patient’s medication knowledge.

• Provide adequate symptom management.

• MedicAlert bracelet

• Provide emotional and psychological support.. A big one!

Mrs. Sour Hip is a 66 year old female who has suffered from lupus for the past 30 years. Mrs. Sour Hip experiences many joint-related lupus symptoms, particularly in her right hip. She will be undergoing a right hip replacement surgery next week. Her medical history includes systemic lupus erythematosus, HTN, a. fib, pneumonia in winter 2010, and a history of pernicious anemia for which she receives Vitamin B12 s/c q2months. Her medications include long-term corticosteroid therapy to help manage her lupus.

• Mrs. Sour Hip is a 66 year old female who has suffered from lupus for the past 30 years. Mrs. Sour Hip experiences many joint-related lupus symptoms, particularly in her right hip. She will be undergoing a right hip replacement surgery next week. Her medical history includes systemic lupus erythematosus, HTN, a. fib, pneumonia in winter 2010, and a history of pernicious anemia for which she receives Vitamin B12 s/c q2months. Her medications include long-term corticosteroid therapy to help manage her lupus.

• American Academy of Orthopaedic Surgeons. (2012) . Arthritis. Retrieved from http://orthoinfo.aaos.org/menus/arthritis.cfm

• Arthritis Foundation. (2012). Common Myths. Retrieved from http://www.arthritis.org/aam-common-myths.php

• Arthritis Society. (2010). Lupus. Retrieved from http://http://www.arthritis.ca/document.doc?id=327

• Arthritis Society. (2011). Osteoarthritis: Know Your Options. Retrieved from

• http://www.arthritis.ca/document.doc?id=328

• Arthritis Society. (2012). About Arthritis. Retrieved from http://www.arthritis.ca/aboutarthritis

• Canadian Arthritis Network. (2007). Arthritis Facts and Figures. Retrieved from http://www.arthritisnetwork.ca/home/Facts_and_Figures_2010.pdf

• Cartilage Health. (2008). What is articular cartilage? Retrieved from http://www.cartilagehealth.com/acr.html

• Canadian Psychological Association. (2012). Arthritis. Retrieved From http://www.cpa.ca/psychologyfactsheets/arthritis/

• Day, R. A., Paul, P., Williams, B., Smeltzer, S. & Bare, B. (2007). Canadian textbook of medical surgical Nursing (1st Canadian Ed.). Philadelphia: Lippincott Williams & Watkins.

• Firth, J. (2011). Rheumatoid arthritis: diagnosis and multidisciplinary management.

• Nursing, 20(18), 1179-80.

Firth, J. (2011). Rheumatoid arthritis: diagnosis and multidisciplinary management.

• Firth, J. (2011). Rheumatoid arthritis: diagnosis and multidisciplinary management.

• Nursing, 20(18), 1179-80.

• Gulanick, M. & Myers, J. (2011). Nursing Care Plans: Diagnoses, Interventions, and Outcomes (7th ed.). St.Louis, MO: Elsevier Mosby.

• John Hopkins Arthritis Center. (2012). Nutrition and Rheumatoid Arthritis. Retrieved from http://www.hopkinsarthritis.org/patient-corner/disease-management/rheumatoid-arthrtis-nutrition/

• Lupus Society of Canada. (2007). Lupus Fact Sheet: Takling About Lupus. Retrieved from http://www.lupuscanada.org/pdfs/factsheets/Talk-Online.pdf

• Lupus Society of Canada. (2012). Living with Lupus: Lupus Overview. Retrieved from http://www.lupuscanada.org/english/living/lupus-overview.html

• Mosby. (2009). Mosby’s Dictionary of Medicine, Nursing, & Health Professions (8th ed.). St. Louis, MO: Author.

• Myers, J., Gulanick, M. (2011). Nursing Care Plans (7th ed.). Elsevier

• National Institute of Arthritis & Musculoskeletal & Skin Diseases. (2010). Handout on Health: Osteoarthritis. Retrieved from http://www.niams.nih.gov/Health_Info/Osteoarthritis/default.asp

• Oliver, S. (2011). The role of the clinical nurse specialist in the assessment and management of biologic therapies. Musculoskeletal Care Journal. 9, 54-62.

• Sung-Jae, K., Kwang-Am, J. (2007). Arthroscopic Synovectomy in Rheumatoid Arthritis of Wrist. Clinical Medical Research, 5(4), 244-250.

• Walker, J. (2012). Care of patients undergoing joint replacements, Nursing Older People, 24(1), 14-20.

• Walker, J. (2011). Management of osteoarthritis. Nursing Older People, 23(9), 14-19.