Rheumatic/Connective Tissue Disorders

CONNECTIVE TISSUE DISEASES

(Chapter 54)
• A group of diseases that are chronic in nature and characterized by diffuse inflammation
and degeneration in the connective tissues. (You have connective tissue about
everywhere)
• These disorders share similar clinical features and may affect some of the same organs.
• The characteristic clinical course is one of exacerbations and remissions.
• Some CTD can become systemic and affect organs
• May be a result of an autoimmune abnormality
o The body is attacking itself; thus beginning the autoimmune action
• May be acute or insidious on onset

Include: RA, Systemic Lupus Erythamatosus, Scleraderma, Polymyositis, and

Polymyalgia

Rheumatoid Arthritis
- A progressively deteriorating connective tissue disease. This process sets up in the
connective tissue. It is then characterized by an inflammation of the synovial membrane
(lining of the joints) of the diarthroidal joints (movable joints).
- Metabolic factors or aberrations occurring which cause an alteration in normal production
& function of collagen
- Primarily occurs in the synovial tissue
- Breakdown of collagen around the joints – Collagen is a protein that is found in
connective tissue (found in lung, heart, muscles, blood vessels, pleura & tendons). They
may ache all over and not feel well at all.
- Can effect the kidneys
- Destruction of cartilage and bone erosion
- Major effect is widespread inflammation
- Autoimmune
- Inflammation first in the synovial joint → degeneration
- Onset is early (20’s to 40’s)

Pannus Formation – is an inflammation of the synovium leading to vascular congestion with

increase in synovial thickness and granular tissue.

- Erodes bone and destroys cartilage

- Interference of normal nutrition of articular cartilage → necrosis of cartilage
- Tendons and ligaments weakened
- Joint dislocations and deformities

CLINICAL MANIFESTATIONS
• Local (lead to immobilization → contractures)
o Inflammation
o Swelling
o Pain
o Heat
o Erythema – Redness
o Decreased ROM
 Rheumatic/Connective Tissue Disorders

• Systemic
o Fever
o Weight loss
o Limited movement
o Weakness
o Fatigue
o Generalized aching
o Edema
o Lymph node enlargement
 You have a problem
o Joint tissue becomes spongy
o Presents bilaterally and symmetrically
o Onset may be acute (OA slowly)
o Hands, wrist, and feet are involved and can progress to shoulders, knees, elbows,
spine, and also temporal mandibular joint
o Joint stiffness in the a.m. lasting longer than 30 minutes (OA Feel stiff at first but
can work the pain out)
o Presents bilaterally and symmetrically

• Complications – Structural Deformities (specific to Rheumatoid Arthritis)

o Z-thumb deformity
 Overflex or hyperextension of the thumb
o Ulnar deviations
 Fingers deviate toward the ulnar side of hand (pinky)
 Metacarpal phalangeal joints are swollen – Spongy moveable nodules (OA
are hard)
o Genu Valgun
 Knock knees
 May tend to sublux (dislocate)
o Hallux melleus
 Hammertoes with lower arch (toes flexed up – cannot straighten them out)
 Some cannot walk – wide toed shoes
These people are on prednisone and things that mask infection and lot of times they can
get infection from attempting surgery.
o Swan-neck deformity
 Hyperextension of the PIP joint and flexion of the distal joint
o Boutonniere’s deformity - Hyperflexion of the PIP joint and extension of the distal
joint
- Assessment and diagnostic Evaluation (health history, physical --- hopefully with
Rheumatologist)
- What would you expect the result of these tests to be?
o ESR – increase in sedimentation rate (generalized test that will show that there is
some type of inflammatory process going on – does not tell the doctor much
because the inflammation process could be anything such as pneumonia)
o RBC – decrease (many times these patients are anemic)
o C4 complement component - proteins that are part of the inflammation response
will be decreased
 Rheumatic/Connective Tissue Disorders

o C-reactive Protein – abnormal protein will be positive (this will show inflammation –
it is more specific than the sedimentation rate ---- it will tell the doctor if
inflammation is getting ready to occur before the patient begins to complain of
increasing joint pain)
o Anti-nuclear antibody – measures antigens in body will be positive
o Arthrocentesis – normal fluid is clear, there will be color change in fluid
o X-rays – will see narrowing of the joint area and bone erosion
o Arthrography – detect connective tissue disease, radiopaque substance into the
cavity, outlines, then put through passive range of motion with x-ray – joint
swelling subsides
o RA (Rheumatoid Factor) – specific test for rheumatoid arthritis – if positive
considered positive for rheumatoid arthritis – have nodules rapidly destructive and
progressive

Difference between RA & Osteoarthritis

• Osteoarthritis presents itself in a little bit older population (around age 60)
• Rheumatoid happens earlier (like 20)
• Rheumatoid is inflammatory first and then the degeneration occurs. Osteoarthritis the
degeneration occurs first and it leads to inflammation
• With osteoarthritis people may wake up and feel sore in a particular part of the body, but
once they get up and kind of walk around a little bit, they get to feeling better. With
Rheumatoid, getting up and moving around does not make the pain feel any better.
• Rheumatoid arthritis presents bilaterally and symmetrically. Osteoarthritis they usually
come in with just one joint bothering them.

MEDICAL MANAGEMENT
Relief of Inflammation with Medications
• If you decrease inflammation you will decrease pain; then you would have possible
functioning of the joint for that individual.
• Every thing you do revolves around joint protection
• There are 3 stages of RA: Early, Moderate, Persistent or Erosive RA
o Now they begin with large doses of medications while they still have the
opportunity to combat the autoimmune process and prevent deformities
o Early Stage – education, rest/exercise, NSAID’s
• Window of control & improved disease management is within first 2 years of
onset, anti rheumatics, early avoid opioid analgesics
o Moderate Stage – OT/PT, ROM, exercises, pacing activities, add cyclosporines
o Persistent Stage – surgery, corticosteroids
o Advanced Stage – immunosuppressives

DRUG THERAPY PG 1613

• DMARD’s – Disease Modifying Anti Rheumatic Drug
o Plaquenil – Anti-malarial
 Reduces the inflammation -Have a lot of side effects; Have pretty bad
o Gold Salts side effects, so need to be monitored
-Can be toxic and need to be followed
 Myochrysine, Solganal, Radura -Will not be prescribed if appointments are
 Decrease breakdown kept up with.
-DMARD’s given with an NSAID or
Corticosteroids
 Rheumatic/Connective Tissue Disorders

o Penicillamine – Cuprimine, Depen

 Inhibits T-Cell function
 Decreases inflammation
• NSAID’s – Non Steroidal Anti Inflammatory Drug (avoid salicylates – take with food)
• Corticosteroids
o Prednisone
o Reduce inflammation and slow joint damage; given short term
o Carry side effects: Weight gain, retaining fluid, Cushing’s, elevated BP, elevated
blood glucose, causes sodium retention, can lead to Osteoporosis by reducing
bone mass, Masks S/S of infection, slows down healing. (Be careful when they
come into the hospital and you are assigning rooms, you do not want to put these
patients in with somebody else that has some type of infectious process) – if you
have a patient come in and they have been on prednisone for a while, the doctor
will go ahead and order accuchecks on them
• Immunosuppressive (CBC’s, liver, creatinine, every 2 to 4 weeks)
o Because it is an autoimmune process; they tame the immune system
o Methotrexate (Rheumatrex), Imuran, Sandimmune, Neoral, Cytoxan
(Cyclophosphamide), Arava
o Methotrexate can cause some blurred vision
• Antidepressant - Depressed, change in alteration of lifestyle (help with pain and sleep)

Pain, decreased ROM, Fatigue, and sleep disturbances are the most common problems
associated with RA.

Relief of Pain
• Traditional Methods of Pain Management
o Medications (acetaminophen)
o Splinting
 To decrease inflammation. Support optimal position of function
o Exercise, keep mobile
o Positioning
o Heat / Ice
o Emotional Support
o Rest body – “systemic disease”
o Massage
o Lose weight
o Position changes
o Foam mattress, supportive pillows
Fatigue - Make sure they rest, Don’t over do it
o Build endurance (walking, swimming, biking)
o Rest
o Conserve energy (pacing, delegating, prioritize)
o Identify factors that cause fatigue
o Activity/rest schedule
o Iron and food supplements
Sleep Disturbance
o Medication – sleep aids
 Rheumatic/Connective Tissue Disorders

Maintenance of Optimal Function

o Good body alignment
o Good posture
o Exercise – mild analgesic before, adjust according to stage of disease and activity
o Splinting
 Some will have splints made specifically for them.
 To rest and support the joint in its most optimal position
 Don’t let joint freeze in flexion, often remove splint and do ROM exercises
o Joint protection
o Energy conservation
o Assistive devices
 Canes, walkers, etc.
o Surgeries
 Synovectomy (replace synovial fluid), tenorraphy (repair tendon),
arthrodesis, arthroplasty (replacement)

Nursing Considerations for Rheumatoid Arthritis

• Decrease/relieve pain
• Increase ROM
• Decrease fatigue
• Decrease sleep disturbances
• Nutrition – Mediterranean diet (olive oil, fish, poultry, fruits, veggies)
• Promote optimal functioning

Education of Patient
o Sitting in firm chair with arm rest and help with getting up
o Good posture
o Isometric / Isotonic exercise
o Therapy for daily routine
o Balance activity with rest
o Plan ahead, Set priorities, Pace activity, Learn activity
o Assistive devices
 Increase independence
 Simplify task
 Utilize available function in pain free and atraumatic manner
o Shoe low heel with wide toe (may have shoes fitted)
o Develop realistic acceptance of disease
o Help client strive for independence
o Lie flat on firm mattress with feet against headboard
o One pillow under head, no pillow under knees
o While sitting, feet flat on floor, back straight

Elderly
- May have noncompliance to treatment regimen because of poor healing, decreased
vision, hearing loss, depression
- Possible over treatment or under treatment
- Meds accentuated
 Rheumatic/Connective Tissue Disorders

- Needs support

Synovial Fluid is Normally

- Viscous
- Scanty amount
- Clear/straw colored
- Few cells
Synovial Fluid with Joint Disease
- Cloudy, milky, dark yellow
- Has inflammatory cells (WBC)
- Copious amounts
- Decreased viscosity

Systemic Lupus Erythamatosus (SLE)

- Caused by immune system disturbance
- Leads to an over-production of autoantibodies
- Caused by combination of factors
o Genetic, hormonal, and environmental
- 3 types
1. Discoid
• Skin form
• Stay out of sun
2. Drug Induced
• Anti-convulsants
• Quit drug → remittance
3. Systemic
• Long term

Clinical Manifestations of Systemic Lupus

Onset insidious or acute
- MS: Arthralgias, arthritis, joint swelling
- Skin: Butterfly rash (bridge of nose and cheeks) oral ulcers
- CP: Pericarditis/Athersclerosis - abnormal lung sounds
- V/L: Inflammation terminal arteries, Lymphadanopathy, lesions on hands that necroses
- Renal: affects Glomeruli (Renal Failure), Bladder infections – Renal problems big issue
- N: Behavioral / personality changes
- GI: Ulcers in mouth, GI irritability
- Morning stiffness, joint swelling, tenderness, pain on movement

Assessment and diagnostic evaluation

- History, physical, blood work (no single test to confirm) – reveals anemia,
thrombocytopenia, leukocytosis, leukopenia
- What is the skin inspected for?
o Rashes, lesions, bruises
- What pigmentation changes may occur
- What should the scalp and throat be inspected for – lesions and rash, alopecia
- What would suggest vascular involvement – necrosis, unhealed wounds
- Joint involvement similar to RA
 Rheumatic/Connective Tissue Disorders

- Fever, fatigue, wt. Loss

- CNS involvement – gait, mood changes – ask family about any changes
- What risk factors does the client have as a result of anemia, thrombocytopenia r/f for
bleeding, leukocytosis increase in WBC, and leukopenia low WBC

Medical Management
- Acute and chronic disease treatment
- Drug therapy (refer to handout) – NSAID’s, Corticosteroids, Immunosuppressive, anti-
malarial meds (same as RA)
- Goals:
o Control disease activity
o Prevent loss of organ function
o Reduce likelihood of acute disease
o Minimize disability and prevent complications
o Health promotion screenings
- Avoid direct sunlight

Common Problems
- Fatigue
- Immobility
- Pain
- Impaired skin integrity
- Body image disturbance
- Knowledge deficit re: self care

Scleroderma (avoid extreme temperatures0

- Sclerosing of the systemic system, the inflammatory response that leads to edema
- Systemic sclerosis of fibrotic changes occur within the skin that leads to loss of elasticity
and movement. It is a chain of events from inflammation to degeneration occurring in the
blood vessels. It leads to major organ involvement.
- Begins with skin involvement
o Excessive collagen formation and accumulation in tissues
o This causes edema with resultant taut, smooth, and shiny skin
o Skin loses elasticity and movement
o Tissues degenerate and become non-functional
o This also occurs in the blood vessels and organs and can lead to death
- Clinical Manifestations
o How does it start? Color changes, severe pain in hands
o IS the skin moist or dry? Dry
o How are the extremities affected? Become stiff, unable to move
o Is progression rapid or slow? Slow progression

Considering the effects of this disorder on the organs, what problems do you think a
client might have?
- GI o Absorption of nutrients
o Swallowing o Nausea
o Constipation - Cardiovascular
 Rheumatic/Connective Tissue Disorders

o Decreased cardiac output - Skin assessment

o Afterload increases - Skin biopsy
dramatically - Pulmonary studies
- Respiratory - Echocardiogram
o Decreased O2 - Esophageal studies
o Decreased ventilation and - Blood tests (ANA)
inhalation
o Hypoxia Medical Management
o Hypercapnia - Goals:
o Decrease pain
o Decreased breath sounds
o Limit disability
Assessment and diagnostic evaluation o Prevention of contractures
- Review of systems o Minimize skin dryness

The worse thing is the esophageal hardening of the swallowing; this patient will end up with a
tube feeding of some sort. This is sclerosing of the body. This patient will have respiratory
problems. Sclerosing of all of the intestinal mucosa. At some point there will be progressive
renal failure.

Medical Management
- Anti-inflammatory drugs
- Calcium Channel Blockers
- Anti-hypertensive medications
- Immunosuppressants
- ACE Inhibitors

Scleroderma Care
- Skin care
- Avoid cold
- Warm socks
- Prevent ulcers
- Smoking cessation
- Protect fingers with mittens when buying frozen foods
- Properly fitting shoes

CREST Syndrome (synonymous with Scleroderma)

- C – Calcinosis – calcium deposits in the tissue
- R – Raynaud’s Phenomenon
- E – Esophageal hardening and dysfunction
- S – Sclerodactyly – Scleroderma of the digits
- T – Telangiectasis – capillary dilation that forms a vascular lesion

Common Problems
- Impaired skin integrity
- Self-care deficits
- Altered Nutrition
- Body image disturbance
- Advanced disease – such as: decrease CO, impaired gas exchange
 Rheumatic/Connective Tissue Disorders

Polymyositis
- Classified as autoimmune because autoantibodies are present
- Cause is thought to be related to several factors
o Genetic
o Drug-induced
o Viral

Clinical Manifestations
- Muscle weakness
o Symmetric
o Diffuse
- Dermatomyositis – get red lesions over bony surfaces

Assessment and Diagnostic Evaluation

- Electromyogram – stimulate muscle look for problems
- Muscle biopsy
- Serum studies – for muscle enzymes

Medical Management
- Physical Therapy (PT)
o ROM exercises
o Strengthening exercises

Common Problems
- Impaired physical mobility
- Fatigue
- Self-care deficit
- Insufficient knowledge of self-management

Polymyalgia Rheumatica (PMR)

- Autoimmune connective tissue disease
- Underlying causative factors are unknown
- Occurs predominately in whites
- Genetic marker suggests a familial predisposition
- More common in people over 50

Clinical Manifestations
- Muscle discomfort
- Joint swelling
- Systemic Symptoms
- Giant cell Arteritis (GSA) – inflammation that will cause a severe headache in the temple
area and in the jaw area – medications offers little relief, may also get into some visual
problems, associated with PMR. Need to get to doctor within a few hours. They will go
in and biopsy the area and look to see if it comes back as GSA and if it does the doctor
will increase their Prednisone or their Anti-inflammatory drugs and try to get the GSA
under control. This is important in you patient teaching that if there are visual
 Rheumatic/Connective Tissue Disorders

disturbances that they need to call their doctor especially if there is a headache and jaw
ache going on also.

Assessment and diagnostic Evaluation

- Head assessment – vision, jaw problems, HA
- Difficult to diagnose
- ESR, looking at ANA, H&H, RBC’s
- Musculoskeletal system
o Tenderness
o Decrease function

Nursing Plan of Care

- Teach patient about vision changes
- Teach pain management
- PT or therapy to learn exercises
- Make sure they keep visual appointments

Common Problems
- Pain
- Knowledge deficit regarding medication regimen
DIFFUSE CONNECTIVE TISSUE DISEASES

Clinical Diagnostic Nursing

Pathophysiology Management
Manifestations Evaluation Considerations
Systemic Disturbed immune Onset insidious or Complete history Treatment is to Fatigue
Lupus regulation that causes acute prevent progressive Impaired skin
Erythamatosu exaggerated production MS: Arthralgias, Physical loss of organ integrity
s (SLE) of autoantibodies arthritis, joint function, minimize Body image
swelling Blood Work disability and acute disturbance
3 TYPES Skin: Rash (bridge (+ANA) disease. Lack of knowledge
-Discoid, Skin, Drug of nose and Sed Rate -
induced cheeks) oral ulcers Elevated Prevent Nutrition problem
CP: Pericarditis complication by use Joint movement
Skin – take care of skin; V/L: Inflammation Fever, Fatigue, of: Renal assessment
avoid sun. terminal arteries Weight loss, NSAIDs, CNS assessment
R: affects Involvement of Corticosteroids, Care and sensitivity
p.1424 Glomeruli (Renal joints of Antimalarial, to pt
Failure) extremities Immunosuppressiv
Lymphadanopathy e
N: Behavioral /
personality
changes
GI: Ulcers in
mouth
Systemic -Skin involvement Raynaud’s - Changes in skin Hypertensive Meds Impaired Skin
Sclerosis / inflammation and Painful, cool, Penicillamine integrity
degeneration. An Edema in hands, Skin biopsy  skin thickness Self care deficit
Scleroderma inflammatory response Pale Pulmonary, Captopril Altered nutrition
that leads to edema and Red, white, and Esophageal Anti-inflammatory <body
C.R.E.S.T. the client has a taunt, blue studies Vasodilators Body image
smooth, shiny Blood test disturbance
appearance, look to LV of heart CHF Antinuclear Avoid Extreme
skin. Esophageal antibodies Temps Advanced may have
-Fibrotic changes to the hardening (ANA) problems with
skin lead to loss of Difficulty impaired gas
 elasticity and looseness swallowing exchange, Dec CO,
in the face. Trouble breathing Imp Swlg,
BV organs body R/F CREST (see Constipation
systems death next pg)
P.1426

Polymyositis Multifactoral with Onset varies from -No ONE test will - corticosteroid Impaired physical
(PM) genetic predisposition sudden with rapid confirm therapy with  with mobility
likely progression to a -Complete H & P  muscle enzymes Fatigue
very slow, -Electromyogram - Self care deficit
Possible Viral link insidious onset. R/O degenerative Immunosuppressiv Knowledge deficit of
muscle ds e agent self care techniques
st
1 Seen - Proximal -Muscle Biopsy -Plasmaquine –
muscle weakness, -Serum studies for Plasma poresis
can be  muscle -Hydroxychlorquine
symmetrical, enzymes (skin)
Reddened around -PT to maintain joint
joint surfaces. Or mobility and ROM
Scaly lesion over
joint surfaces
Polymyalgia Unknown -Proximal muscle Assess head Corticostroids Pain
Rheumatica discomfort with Increase dose
(PMR) Whites and often in 1st mild joint swelling Increase ESR prescribed – Knowledge deficit
degree relatives -C/O neck aching, eyesight
shoulder, pelvic, Diagnosis by
Immunoglobulin stiffness eliminating NSAIDs – mild
deposits in the walls of TEMPORAL
inflamed temporal ARTERY
arteries also suggest an -GSA (Giant Cell
autoimmune process. Arteritis)
Causes
MAY CAUSE Headache, Chg
BLINDNESS Vision, jaw clot
Alert MD of any visual -Low gd fever, wt
changes: Dimming, loss, malaise,
blurred vision, graying anorexia,
depression,
OSTEOARTHRITIS
• Also known as degenerative joint (rheumatic) disease DJD
• A commonly occurring arthritis which may affect any weight bearing joint
• It is not inflammatory disease, but inflammation may occur as a result of the disease
• Commonly called arthritis – Inflammation of joint
• Approximately 200 different disease entities
• Affects skeletal muscles, bones, ligaments, tendons, and joints
• Affects males and females of all ages
• Impact can be life threatening or just an inconvenience
• Acute or insidious onset with periods of exacerbations and remission
• There is no cure but treatments are advanced
PROBLEMS WITH OSTEOARTHRITIS
• Chronic pain
• Mobility limitations
• ADL’s alterations
• Self-image disturbances
• Systemic effects may lead to organ failure or death
RISK FACTORS
• Heredity
o 30% TBP (collagen) – aids is the elasticity and movability of a joint; Once the
cartilage is affected you have a decrease in the ROM because the cartilage is a
shock absorber in the joint
• Injuries
o Sports injuries; Once you have had an injury it is at a greater risk of developing OA
o If happens when you are young it is referred to as a traumatic arthritis
• 70% H2O with free movement
• Obesity
o Most people maintain idea that weight decreases progression; Usually the knees
• Wear and Tear of joints
• Overuse of knee and hips are the most involved with these processes.
o Repeated bending wears and tears
PATHOPHYSIOLOGY
• Articular cartilage absorbs shock. Every time walk, sit, stand, etc., putting stress on that
area. Cartilage is weeping out – there is a lot of fluid there, mainly water. That area is
about 70% water. All of that seeps out and invades the joint. This is what allows you to
be able to move your knees, hips, etc. Once you sit down, that water will reabsorb back
in. Synovial fluid helps nourish and bath the area. If you have thing like cartilage
breaking down or you inherited from your parents the fact that you are not building or
keeping enough collagen in there as you age. This helps contribute to it. Joint cartilage
and underlying bone will deteriorate. Once the cartilage frays away and becomes
impassive, the bone underneath is going to suffer because it does not have that
protection any more. You get boney spurs or overgrowth in areas. Because if the bone
becomes damaged it is going to try to heal itself and in doing so sometimes it overgrows
and you get spurs in the area. The doctor will first go in and do an arthroscopy. He will
go in look at that joint capsule and clean it out, shave off all of that overgrowth. This is
beneficial for a while. The sub___ bone which is the bone beneath the first layer of bone
will begin to absorb the weight very poorly and it will damage the cartilage farther and
 then the synovial cells which are typically in there to bathe the nerves are going to be
release enzymes. This release of enzymes further degrades the cartilage. The cartilage
then becomes rough and cracked. Your now have bone rubbing on other bone. This is
very painful.
CLINICAL MANIFESTATIONS
• Pain, stiffness, and functional impairment
o The pain is due to an inflamed synovium, stretching of the joint capsule or
ligaments, irritation of nerve endings in the periosteum over osteophytes.
• Deep aching pain in joint with soreness accentuated by use and weight bearing
o They will not have a lot of pain sitting and resting; it is when they try to get up is
when they have a lot of pain. (Getting up from a chair causes pain)
• Chair: Firm chair with arm support to use to get down and get back up. Hard back
o No sofa or recliner because they will have trouble
• Enlarged Joints - Swollen
• Mild tenderness
• Change alignment of joints, decreasing mobility and ROM ----- Contractures
• You want to keep them moving
• Heberden’s Nodes: bony proliferations over distal interphalangeal joints
• Bouchard’s Nodes: bony knobs over proximal interphalangeal joints (PIP)
• Metacarpalphalangeal Joint

DIAGNOSIS
• Physical assessment of MS System
o Do not force ROM
• Location and pattern of pain
o Ask what they do to relieve pain
• X-Rays
o See bone hypertrophy, bony spur formation, cartilage destruction with resulting
narrowing of joint spaces, and gross irregularities of joint structures
o Looking for narrowing of joint spaces
o Osteophytes (spurs) narrowing of joint spaces
o Presents Asymmetrically
• Athrocentesis
o Looking at the fluid in the joint capsules. May have enzymes in the fluid that are
the cause of the breakdown. They are looking at the color because cells with
inflammation will cause the fluid to take on a different color (yellow looking).
• No specific useful serum study. Serum studies are not useful in the diagnosis of this
disorder
• ESR  sed. Rate with most inflammatory conditions but not specific. Any time there is
inflammation in the body there will be an elevated ESR (sed) rate.
MEDICAL TREATMENT
• Salicylates
o Aspirin “Grandfather” (causes GI irritations) – Anti inflammatory – Take with food –
needs to be the coated variety. (very effective)
• Ibuprofen
o Advil, Motrin, Nuprin – OTC – Can cause GI distress – Take with food or milk
 • NSAIDs
• Anti Inflammatory – Bextra, Celebrex, “Super ASA” Decrease GI irritants with pain relief
o Older: Endocin, Naprocin. Very GI Disturbing NO ALCOHOL
• Glucosamine and Chondroitin
o Nutritional supplements – OTC – Vitamins
o Helps build cartilage – encourage growth
o Physician needs to know
• Tramadol (Ultram)
o Narcotic related pain reliever – decreased rate of addiction
o These people are in chronic pain, they are at high risk of becoming addicted so
they need to look into something more like the Ultram
• Interarticular Corticosteriods
o Administer MD office to relieve pain for 3-6 months some of the time
o Cannot do repeatedly
• RESEARCH
o Minecycline: Breaks down enzyme responsible for catabolism breakdown
Preventative measures
• Correct body mechanics
• Avoid grasping action that strain finger joint
• Spread weight of an object over several joints
• Maintain good posture – particularly lower back
• Use strongest muscle and favor large joints
• Don’t carry big heavy things with fingers
• Ex. Backpack; weigh over several joints – Both shoulders
• Overuse of joints can increase the risk of Osteoarthritis
• Surgery cannot return joints to precondition state
CONSERVATIVE MEASURES
• Heat or cold whichever relieves pain
o Hot paraffin wax
o Provides comfort
• Weight Control
o Decreases stress joints and decreases pain
• Rest joint, no overuse
o When it is flared (acutely inflamed) they need to rest it until they get past the acute
stage
o Promote rest
• Supportive devices
o Canes, crutches, walkers, splints, braces, stabilize ligaments, tendons – 
stress on joint
• Exercise
o Moderate exercise but rest with acute flare ups
o Swimming, stretching, etc.
• OT / PT
o PT - Assist with activity; OT – Helps with ADL’s
• Pain management / maintenance of joint function: essential in order to accomplish goals
of treatment
May have drug therapy

Nursing Management
• Chronic Pain R/T joint degeneration
• Impaired mobility R/T the restricted joint mobility
• Body image disturbances
• Self Care Deficit R/T immobility
• Knowledge Deficit
• R/F injury

Osteoarthritis – wear and tear leads to degeneration or the joint

Difference between Rheumatoid Arthritis & Osteoarthritis

• Osteoarthritis presents itself in a little bit older population (around age 60)
• Rheumatoid happens earlier (like 20)
• Rheumatoid is inflammatory first and then the degeneration occurs. Osteoarthritis the
degeneration occurs first and it leads to inflammation