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



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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.




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