Rheumatoid_arthritis_and_gout

IMMUNE SYSTEM DISORDERS

GOUT 

GENETIC DEFECT OF PURINE METABOLISM: • OVER SECRETION OF URIC ACID or • RENAL DEFECT = DECREASED EXCRETION OF URIC ACID or • BOTH

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ELEVATED URIC ACID

GOUT 

CAUSES: • SEVERE DIETING/STARVATION • EXCESSIVE INTAKE OF FOODS HIGH IN PURINES • HEALTH CONDITIONS WHICH CAUSE AN INCREASE IN CELL TURNOVER (LEUKEMIA, MULTIPLE MYELOMA, SOME ANEMIAS, etc.) • SIDE EFFECT OF CERTAIN MEDS

Precipitating Factors    

Trauma Alcohol ingestion Surgical stress Illness

HYPERURICEMIA (ELEVATED URIC ACID)  

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Greater than 7 mg/dl Symptoms related to sudden increase of uric acid levels Urate crystals precipitate within a joint – inflammatory response occurs Tophi – accumulations of urate crystals

Tophi 

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1 IN 5 will develop tophi Deposited in peripheral areas: • • •

Great toe Hands ear

ASSESSMENT     

ACUTE PAIN TOPHI RENAL IMPAIRMENT RISK OF URINARY CALCULI ELEVATED SERUM URIC ACID >8mg/dl

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Untreated: will lead to destruction of the synovium, bursa, bone and tendons. Tophi have also been found in walls of aorta, heart valves, eyelids, cornea and sclerae

TREATMENT  

Adequate Hydration Medication: • Chochicine – antiinflammatory • NSAID - analgesic

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Diet: • Restrict foods high or moderately high in purines (anchovies, scallops, organ meats, oysters) • Grodner, page 844

RHEUMATOID ARTHRITIS 

Allergic

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Cytotoxic

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Immune complex disorders

Inflammatory Rheumatic Disorders Rheumatoid Arthritis (RA)

Causes of RA 

Autoimmunity

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Genetic factors

Inflammation = synovitis + pannus 

Stages: • Early • Moderate • Severe • Terminal

CLINICAL SYMPTOMS 

Early vs. advanced disease • Early: fatigue, anorexia, weight loss, generalized stiffness • Moderate: joint stiffness, limitation in ROM, signs of inflammation • Severe: joint deformity (cartilage and bone destruction)

Swan Neck Deformity 

hyperextension of the proximal interphalangeal joint, while the distal interphalangeal joint is flexed

Diagnosis of RA     

History and physical assessment Positive RF Elevated Sed rate Elevated C-reactive protein Synovial fluid analysis

DRUG THERAPY   

NSAIDS CORTICOSTEROIDS DMARD’s

NURSING CARE OF THE CLIENT WITH RA 

NURSING DIAGNOSES: • PAIN • MOBILITY • BODY IMAGE • KNOWLEDGE DEFICIENT • SELF CARE DEFICIT

INTERVENTIONS   

NUTRITION MANAGE PAIN PREVENT/CORRECT JOINT DEFORMITY: • MEDS • JOINT PROTECTION • HEAT AND COLD APPLICATION • EXERCISE

INTERVENTIONS   

REST AND PACED ACTIVITY RESTORE FUNCTION and make LIFESTYLE ADJUSTMENTS: • PT • OT • Social Work