ARTHRITIS & CONNECTIVE TISSUE DX: A. ARTHRITIS- inflammation of joints, affects more women B.

OSTEOARTHRITIS- progressive, non-inflammatory, degenerative disorder affecting Dyarthroidal (synovial) joint due to event that damages cartilage or of unknown cause a. More prevalent women>50yrs- maybe due to lack of estrogen b. Damage sets off metabolic rx @ level chondrocytedull, yellow, soft, inelastic cartilagebody attempts repairirregular bony growths c. s/s: joint pain, stiffness during periods of rest & on waking (resolves 30min), crepetation, when affects phalanges HEBERDENs & BOUCHARDs NODEs, when affects kneesbowlegged, when affects hip-one leg shorter d. definitive dx=x-ray e. Tx: rest & immobilization(1wk), application heat/cold, nutrition therapyreduce weight, exercise, alternative therapy, drugs-acetaminophen, NSAIDS, antibiotics, intraarticular injections of corticosteroids & hyaloronic acid, oral supps glucosamine & chondroitin C. LOW BACK PAIN- caused by degenerative disk dx, herniated disk, lumbar-sacral strain, lumbar-sacral instability a. Acute pain <4wks, straight-leg test +ivedisk herniation when radicular pain occurs i. Tx: NSAIDS, muscle relaxants (cyclobenaprineflexerille), massage & back manipulation, heat/cold compress, back exercises @ home to strengthen b. Chronic pain>3mths, weight reduction same as above D. LUMBAR DISK DAMAGE- can be degenerative or herniated disk (slipped). Most common s/s low back pain, radicular pain down buttocks, & below knee, +ive straight leg test a. Tx= conservative therapy- limit movement (brace, corsette, belt), ice/heat, ultrasound massage, traction, TENS, NSAIDS & muscle relaxants. Once symptoms subside, back exercises 2xs dy for life i. *can lose bowel or bladder control if worsens ii. Tx2= laminectomy Assess neurologic fxn & VS q4hrs 1st 24 Check ability void Log roll pt if prescribed bed rest Ensure brace worn when out of bed E. RHEUMATOID ARTHRITIS- inflammation dx affecting connective tissues synovial joints. Periods exacerbation & remission. Cause=UNKNOWN

a. s/s-fatigue, weight loss, anorexia, generalized stiffness, limitation motion, joint stiffness on waking lasts >60min or hrs, joint pain that is warm to touch & increases with motion, tenosynovitis & joint capsule deformity b. Diagnostics i. +RF, increased ESR & C-reactive protein, increased WBC (up to 25,000/uL), fibrin flex in CSF, confirmed via tissue boipsy arthocentesis...bone scan helps confirm c. Tx: DMARDS- Sulfasalazine (alzulfidine, salazopyrin) &* Methotrexate (Rheumatrex)*, NSAIDS, biologic response modifiers, physical therapy, occupational therapy F. GOUT- systemic dx in which Urate crystals deposit into joints7 tissues causing inflammation a. Cause=excess production uric acid, decreased secretion, increased ingestion purines b. s/s: dusky, cyanotic joint, inflamed great toe, severe pain, trophy (visible uric acid deposits), kidney stones c. Diagnostics- increased uric acid, in serum & urine d. Tx: colchine (novocoline, colsalide), NSAIDS, allopurinol (zyloprim)for chronic gout i. Avoid aspirin, consume low-purine diet (avoid organ & red meats, shellfish, oily fish), diuretics, excessive physical & emotional stress, drink plenty of fluids esp. Milk, water & citrus juices G. SYSTEMIC LUPUS ERYTHEMATOSUS- chronic autoimmune inflammatory dx affects connective tissues by the formation of immune complexes which deposit into the tissues & blood vessels depriving tissue of O2. a. Cause=unknown b. s/s: butterfly rash face or upper bodyteach avoid sun, excessive fatigue, formation antibodies against blood cellsanemia, deceased WBC & decreased platelets c. diagnostics i. +iv blood presence ANA(antinuclear antibodies), RF, increased ESR, anti-SSA (R), anti-SS-B (La), anti-Smith (anti-SM0, anti-DNA & ENA (extractable nuclear antigens) ii. Chest x-ray, urinalysis, CBC, ECG iii. Tx: NSAIDS, Hydroxychloroquine (Plaquenil) to decrease inflammatory response, teach monitor for fever (1st sign exacerbation), joint protection, counsel against pregnancy.