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Ignatavicius: Medical-Surgical Nursing, 7th Edition

Chapter 20: Care of Patients with Arthritis and Other Connective Tissue Diseases
Key Points - Print
OVERVIEW

Connective tissue disease is the major focus of rheumatology, the study of rheumatic
disease.
A rheumatic disease is any disease or condition involving the musculoskeletal system.
Most connective tissues diseases are classified as autoimmune disorders.
In autoimmune disease, the immune system does not recognize body cells as self and
therefore triggers an immune response; antibodies attack healthy normal cells and tissues.
Most autoimmune diseases have remissions and exacerbations.
The usual protective nature of the immune system does not function properly in patients with
autoimmune connective tissue disorders.
Be aware that most of the connective tissue diseases and arthritic disorders have a genetic
basis as part of their etiology; most are also classified as autoimmune diseases and have
remissions and exacerbations.

OSTEOARTHRITIS AND RHEUMATOID ARTHRITIS

Osteoarthritis is primarily a degenerative joint problem, whereas rheumatoid arthritis is a


systemic disease.
Older patients have osteoarthritis more than younger patients.
Younger patients have rheumatoid arthritis more than older adults.
Differentiate OA as primarily a degenerative joint problem and RA as a systemic disease.
Assess for visual complaints, indicating possible giant cell arteritis, in patients with
polymyalgia rheumatica and report changes immediately to the health care provider.
Be aware that arthritis often accompanies other diseases, such as psoriasis, Crohns disease,
and hemophilia.
Assess patients with rheumatoid arthritis for early or late clinical manifestations.
Collaborate with the health care team to manage chronic pain and increase mobility for
patients with arthritis and other connective tissue disorders.
Teach patients who have osteoarthritis or are prone to the disease to lose weight if obese,
avoid trauma, and limit strenuous weight-bearing activities.
Teach arthritic patients about the benefits of exercise, joint protection techniques, and energy
conservation guidelines.
Instruct patients with arthritic pain to use multiple modalities for pain relief, including ice/heat,
rest, positioning, complementary and alternative therapies, and medications as prescribed.
Assess for therapeutic and adverse effects of drugs used for arthritis and connective tissue
diseases.
Teach patients to monitor and report side and adverse effects of drugs used to treat arthritis
and connective tissue diseases.
Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Key Points - Print

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Implement interventions to prevent venous thromboembolitic complications, for example,


anticoagulants, exercises, and sequential compression devices.
Observe the patient for bleeding when he or she is taking anticoagulants.
Teach patients who are taking hydroxychloroquine (Plaquenil) to have frequent (every 6
months) eye examinations to monitor for retinal changes.
Administer biological response modifiers and other disease-modifying agents with caution.
Be aware that disease-modifying antirheumatic drugs and biological response modifiers slow
the progression of connective tissue diseases.
Recognize that patients with rheumatoid arthritis may have body image disturbance as a
result of potentially deforming joint involvement and nodules.
Remind patients to avoid crowds and other possible sources of infection when they are taking
immunosuppressant drugs.
Implement interventions for patients having total joint arthroplasty (TJA) to prevent venous
thromboembolitic complications (e.g., anticoagulants, exercises, sequential compression
devices); observe the patient for bleeding when he or she is taking anticoagulants.
Be careful when positioning a patient after a total hip arthroplasty (THA) to prevent
dislocation; do not hyperflex the hips or adduct the legs.
Teach patients receiving biological response modifiers (BRMs) and other disease-modifying
agents to avoid crowds and people with infections.
Be aware that disease-modifying antirheumatic drugs (DMARDs) and BRMs slow the
progression of connective tissue diseases, especially rheumatoid arthritis and systemic lupus
erythematosus.
Encourage patients with arthritis and connective tissue diseases to discuss their chronic
illness and identify coping strategies that have previously been successful.
Provide information about community resources for patients, especially professional
organizations such as the Arthritis Foundation.
LUPUS ERYTHEMATOSUS
Prioritize care for patients with systemic lupus erythematosus by monitoring for lifethreatening complications, such as renal failure.
Differentiate clinical manifestations and prognosis for patients with systemic lupus
erythematosus versus systemic sclerosis.
Teach patients with lupus to avoid sunlight since exacerbations of the disease may be
triggered.
SYSTEMIC SCLEROSIS

Differentiate clinical manifestations and prognosis for patients with SLE versus systemic
sclerosis (SSc).
Prioritize care by assessing for swallowing ability in patients who have systemic sclerosis
and collaborate with the nutritionist for food modifications if needed.

GOUT
Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Key Points - Print

20-3

Monitor for acute joint inflammation in patients with a history of gout; the great toe and other
small joints are most typically affected.
Remind patients with gout to avoid factors that trigger an attack, such as aspirin, organ
meats, and alcohol.

OTHER CONNECTIVE TISSUE DISEASES

Recognize that patients with fibromyalgia syndrome and chronic fatigue syndrome are often
frustrated because they have not been diagnosed or have been misdiagnosed.
Teach patients with fibromyalgia and chronic fatigue syndrome that antidepressant drugs can
promote sleep and decrease pain as well as prevent or treat the depression that is common
with these illnesses.
Teach people ways to prevent or detect early Lyme disease.
Ankylosing spondylitis is also known as Marie-Strmpell disease or rheumatoid spondylitis.
The disease affects the vertebral column and causes spinal deformities. Other features include
iritis, arthritis or arthralgia, and nonspecific systemic manifestations such as malaise and
weight loss.
Remind patients to avoid crowds and other possible sources of infection when they are taking
immunosuppressant drugs.
Monitor and interpret laboratory test results for patients with autoimmune connective tissue
diseases.

In summary:
Collaborate with the health care team to manage chronic pain and increase mobility for
patients with arthritis and other CTDs.
Reinforce the importance of good health practices, such as adequate sleep, proper nutrition,
regular exercise, and stress-management techniques for patients with arthritis and other CTDs.
Encourage patients with arthritis and connective tissue diseases to discuss their chronic illness
and identify coping strategies that have previously been successful.
Be aware that chronic, painful diseases affect the patients quality of life and role
performance.
Provide information about community resources for patients, especially professional
organizations such as the Arthritis Foundation and Lupus Foundation.

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

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