Auto Immune Disease Chronic 2
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| Pathophysiology of Rheumatoid Arthirtis | From longterm exposure to unknown antigen, genetically. They target synovial membranes, Then leukocytes- go to area and degrade synovial tissues and cartilage. Immune response is↑,
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| Rheumatoid Factors | Antibodies that present in RA
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| Pannus | An abnormal tissue layer that includes new formed blood vessels, that may develop within the synovial membrane, leading to greater loss of bone and cartilage. This leads to scar tissue.
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| Risk Factors for RA | Family HX, smoking, obesity, physical, emotional trauma, air pollution, insecticides, and occupational exposure,
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| Manifastations | Elderly- hard to distinguish between osteoarthritis and RA. redness, warmth, pain welling and deformities, ↓appetite, fever, fatigue, anemia, sleep patterns, quality of life, emotional.
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| Swan Neck Deformity | Hyperextension of the PIP joints, Boutonniere Deformity
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| Respiratory | pleural disease, interstitial fibrosis, pneumonitis
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| Cardiovascular | Vasculitis, Pericarditis
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| Metabolic | Fatigue, weakness, anorexia, weight loss, ↓ fever
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| Integumentary | Rheumatoid Nodules
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| Exocrine | Dry eyes/mouth
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| Musculoskeletal | joint swelling, redness, warmth, pain, tenderness, morning stiffness, cervical pain, neuro. , limited ROM, Deformity, carpal tunnel syndrome, Ulnar deviation, swam-neck deform, joint effusion (Fluid in joint area) unstable, pain from moving
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| Concept of RA | Immunity
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| Interrelated Concepts | Confort, Pain, Clotting
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| Typical Age Ranges | 40-60 .
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| Epstein Barr Virus | Highest link between that and RA
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| Genetics | 50% RISK, 60% with the disease have Human Leukocyte Antigen (HLA)-DR4
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| Assessment: Noticing | Look for signs; joint swelling, pain, warmth, deformity . Also look for fever, anorexia, fatigue Psychosocial, Labs- RA factor, antinuclear-antibody titer, ESR, serum complement, serum protein, immunoglobulins, CT, Xray, arthrocentesis, bone scan
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| Most Commonly Effected | Hands and Feet
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| Not limited to Joints | Anemia, multisystem effects, Can have periods of remission
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| Complications | weight loss, fever, fatigue, periods of exacerbations, subQ nodules, Resp. & cardiac complications, Vasculitis (inflammation of the blood vessels), periungual (lesions on finger/toenails), paresthesia (burning hands/feet)
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| Associated Syndromes | Sjogren's Syndrome (dry eyes/mouth) Felty's Syndrome Caplan's Syndrome
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| Analysis: Interpreting | Chronic Inflammation,↓ mobility, potential for↓self-esteem
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| Planning and Implementation: Responding | Management of chronic inflammation and pain by meds, and supplements
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| Pharm Therapy | DMARDS- disease modifying anti-rheumatic drugs (methotrexate), NSAIDS, BRMS- biological response modifiers (Humara- helps with↓signals of inflammation.
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| Other Pharm Therapy | Glucocorticoids, immunosuppressive agents, Supplements- calcium, omega 3, linolenic acid,
WATCH for kidney stones from calcium, omega 3- can interfere with clotting
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| Non Pharm Interventions | Rest, proper positioning, ice/heat, plasmapheresis (helps with↑ levels of CRP, surgery, complementary and integrative therapies, promotion of self-care, management of fatigue,↑body image . Hydrotherapy
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| Promote Mobility | Independence- adaptive devices, splints/braces, walkers/canes wheelchair, Encourage movement . Combat Fatigue- physical therapy, conserving energy
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| Juvenile Idiopathic Arthritis | Unknown Cause in children, Inflammation lasting longer than 6 weeks, and one or more joints. Dx ↓ 16
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| Pathophysiology JIA | unknown but thought to have a autoimmune link joint inflammation that leads to scar tissue and limited ROM. Altered growth of the epiphyseal plates
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| Incidence of JIA | onset between 3-6 years of age & around puberty. occurs more often in males than females. 1-1000 kids in the US
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| Manifestations of JIA | Symptoms- fever, rash, lymphadenopathy (swollen lymph nodes), Splenomegaly/Hepatomegaly (enlarged spleen/liver),
Joints-↓ mobility, swelling, pain, gait differences
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| Tests for JIA | No definitive confirmation for it, ESR and CRP are beneficial for determining amount of inflammation; RA, ANA
X-rays, r/o other causes (fractures)
Monitor joint damage and bone development
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| Treatment:Planning | Control Inflammation (also pain), Pain, Preserve function, Prevention of deformities, Remission, ↓side effects of disease, splints for promoting bone growth
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| Pharm Therapy for JIA | NSIADS -(↓inflammation/pain), Ibuprofen, naproxen, Indomethacin, Meloxicam
DMARD- methotrexate
Steroids- Prednisone, methylprednisone
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| Nursing Care | Promote mobility, ROM with Stretching/hydrotherapy
Encourage adequate nutrition
Educate the PT
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