Arthritis
(ar-thrīt′ĭs )
pl. arthritides [arthro- + -itis]
Inflammation of the joints, often accompanied by pain, swelling, stiffness, and deformity. Arthritis is very common, affecting millions. The most prevalent type, osteoarthritis (degenerative arthritis), increases in incidence with age but is not considered a part of normal aging. Other forms of arthritis include rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. Arthritis differs from rheumatic disease: arthritis is a disease of joints; rheumatic disease may also affect other tissues and organs.
arthritic (ar-thrit′ik), adj.
CAUSES:
Arthritis may result from infections (such as rheumatic fever, staphylococcal infections, gonorrhea, tuberculosis), metabolic disturbances (such as gout, calcium pyrophosphate crystal disease), multisystem autoimmune diseases (such as psoriasis, rheumatoid arthritis, systemic lupus erythematosus), neuropathies (such as Charcot joint), joint trauma, or endocrine diseases (such as acromegaly).
SEE: bursitis; SEE: monoarthritis; SEE: osteoarthritis; SEE: polyarthritis; SEE: rheumatism
TREATMENT:
Anti-inflammatory drugs, corticosteroids, monoclonal antibodies, antibiotics, aspiration of joints, surgery, and occupational or physical therapies are used to treat arthritis, depending on the cause and severity of the illness.
BASAL JOINT ARTHRITIS: Severe osteoarthritic changes including joint space narrowing, sclerosis, and osteophyte formation, noted at the first carpometacarpal joint and adjacent joints. Degenerative changes involve the trapezium and its surrounding articula.
Acne-associated arthritis:
ABBR: AAA Arthritis accompanying acne fulminans, typically in adolescent boys. It is a rare type of spondyloarthropathy. The joint disease in AAA commonly involves the acromioclavicular and sacroiliac joints. Painful hyperostosis of the sternum and clavicles is a typical finding. Affected boys are HLA-B27 negative.
SYN: SEE: synovitis acne pustulosis hyperostosis and osteomyelitis syndrome.
Acute suppurative arthritis:
SEE: Septic arthritis.
Adjuvant arthritis:
ABBR: AA An experimental model of arthritis induced into rodents by injection of foreign substance, such as Freund adjuvant, into the tail vein or paw. This model can be used to study new agents for human arthritis treatment.
SEE: Rheumatoid arthritis...
Allergic arthritis:
Arthritis occurring in serum sickness or, occasionally, as a result of food allergies.
SEE: serum sickness..
Bacterial arthritis:
SEE: Septic arthritis..
Cricoarytenoid arthritis:
Arthritis caused by degenerative changes of the cricoarytenoid joints. It is a cause of dysphonia and vocal fold immobility but does not damage the laryngeal nerve.
Degenerative arthritis:
SEE: Osteoarthritis.
Enteropathic arthritis:
Arthritis associated with inflammatory bowel disease.
Epidemic arthritis:
An infectious arthritis, often accompanied by a rash, caused by the Ross River virus.
Experimental arthritis:
Arthritis induced in laboratory animals, used to study pathophysiology or to foster improvements in diagnosing or treating a disease.
TREATMENT:
It is treated with intravenous ceftriaxone. A tetracycline antibiotic is usually given at the same time to treat possible coinfection with Chlamydia species.
Gouty arthritis:
Arthritis caused by gout.
Hypertrophic arthritis:
SEE: Osteoarthritis.
Juvenile idiopathic arthritis:
ABBR: JIA SEE: Juvenile rheumatoid arthritis.
Juvenile rheumatoid arthritis:
ABBR: JRA Any of a group of related inflammatory joint diseases of childhood, the most severe of which is also the most common variety.
INCIDENCE:
Between 1 in 100,000 and 200,000 children and teenagers have JRS.
CAUSES:
The cause of the disease is unknown; it is likely to be both polygenic and multifactorial.
SYMPTOMS AND SIGNS:
Affected children with severe JRA have destructive and disabling joint inflammation; chronic pain; intermittently spiking fevers; maculopapular skin rashes; enlargement of the lymph nodes, liver and spleen; pleurisy or pericarditis; and elevated levels of inflammatory markers (such as erythrocyte sedimentation rate, C-reactive protein) in the blood. Long-term complications of the disease include anemia, growth retardation, and osteoporosis. The disease is occasionally lethal.
DIAGNOSIS:
JRA is only diagnosed if it begins before age 16. It must last at least 6 weeks, and involve four or more joints.
TREATMENT:
Anti-inflammatory agents are the mainstay of palliation but have little effect on the outcome of the disease. Corticosteroids may have adverse effects on bone growth; therefore most rheumatologists try to minimize their use. Disease-modifying drugs, such as methotrexate or leflunomide are current mainstays of treatment. Hematopoietic stem cell transplantation may be used in specialized treatment centers. Surgery is used to release ankylosed joints once the child reaches physical maturity and is able to carry out vigorous rehabilitation. Physical and occupational therapy is needed to maintain muscle strength and joint range of motion to prevent contractures, deformities, and disability. Gait training and joint protection also are helpful. Splinting joints in correct alignment reduces pain and prevents contractures. Regularly scheduled slit-lamp examinations help in the early diagnosis of iridocyclitis, which should be managed by an ophthalmologist, usually with corticosteroids and mydriatics. Other extra-articular manifestations should be referred to medical and surgical specialists.
PATIENT CARE:
The child and family are instructed about the disease, treatment, and coping strategies, and are encouraged to express concerns. A well-balanced diet, regular periods of exercise and rest, and avoidance of overexertion are encouraged. The child should be encouraged to be independent and involved in education and have an active social life. Moist heat helps relieve pain and stiffness. Placing the child in a warm bath, immersing painful hands and feet in pans of warm water for 10 min two or three times a day, or using daily whirlpool baths, a paraffin bath, or hot packs provide temporary relief of acute swelling and pain. Swimming and aerobic exercise in warm water are recommended to strengthen muscles and maintain mobility. Good posture and body mechanics are important; sleeping on a firm mattress without a pillow or with only a thin pillow is recommended to maintain proper body alignment. The patient should lie prone to straighten the hips and knees when resting or watching television. When braces or splints are required, their use is explained and demonstrated. Activities of daily living and playing provide opportunities to maintain mobility and incorporate therapeutic exercises using assistive and safety devices. The child with photophobia due to iridocyclitis should wear sunglasses. The child and family are referred to local and national support and information groups such as the Arthritis Foundation (404-872-7100) (www.arthritis.org). Desired outcomes include the child's ability to achieve and maintain optimal health with joints that are movable, flexible, and free of deformity; to move with minimal or no discomfort; to engage in activities suitable to his or her interests, capabilities, and developmental level; and to perform self-care activities to maximum capabilities.
SYN: SEE: juvenile idiopathic arthritis; SEE: Still disease.
SEE: Nursing Diagnoses Appendix.
Lyme arthritis:
Arthritis that develops in the large joints in approx. 35% to 80% of patients with Lyme disease, caused by the spirochete Borrelia burgdorferi. It appears 2 weeks to 2 years after infection and is marked by periodic episodes of pain that moves among different joints. The shoulders, knees, elbows, and ankles are usually involved. Approx. 10% of patients develop permanent deformities. The likelihood of chronic arthritic complaints is much diminished if patients are treated with amoxicillin or other appropriate antibiotics.
SEE: Lyme disease..
Migratory arthritis:
Arthritis that begins in one joint, e.g., the ankle, and moves after a few hours or days to another joint, e.g., the knee. It is a symptom of diseases such as viral infections, infectious endocarditis, rheumatic fever, or systemic lupus erythematosus.
Monoarticular arthritis:
Arthritis affecting a single joint.
Arthritis mutilans:
Severe joint destruction, a characteristic of several inflammatory joint diseases, including some instances of psoriatic arthritis.
Neuropathic arthritis:
Arthritis associated with diseases of the nervous system. It occurs most commonly as a result of diabetes but can occur in tabes dorsalis, syphilis, and syringomyelia.
Palindromic arthritis:
Transient recurrent arthritis, of unknown cause, usually affecting large joints, such as the knees and elbows.
Psoriatic arthritis:
Arthritis associated with psoriasis. The exacerbations and remissions of arthritic symptoms do not always parallel those of psoriasis. Sausage-shaped deformities of the fingers and toes are often present.
Reactive arthritis:
Arthritis that occurs shortly after an infection of the urinary or gastrointestinal tract. It often affects large joints in the lower extremities, usually in people under 50. Reiter syndrome may be a form of reactive arthritis.
Rheumatoid arthritis:
ABBR: RA A chronic systemic disease marked by inflammation and destruction of multiple synovial joints as well as negative effects on the health of numerous other organ systems. .
RHEUMATOID ARTHRITIS
Video for Gripping with Rheumatoid Arthritis....
INCIDENCE:
Approx. 1.3 million Americans have RA, according to the National Arthritis Data Workgroup. The disease is rare before age 35, and most prevalent in people over the age of 50. Women are affected three times more often than men. Members of some ethnic groups, such as certain Native Americans, have higher rates of this disease than the general population. The illness usually begins in mid-life, but any age group can be affected.
CAUSES:
The cause of RA is unknown; however, factors implicated in the development and the severity of this disease include genetics,, autoimmune phenomena, and environmental influences.
SYMPTOMS AND SIGNS:
The disease usually affects similar groups of joints on both sides of the body and can create bony erosions that can be seen radiographically. Subcutaneous nodule formation and elevated serum rheumatoid factor levels are common. Patients typically complain of joint stiffness in the morning rather than after activities. Joint pains, morning stiffness, gelling, malaise, and fatigue are often present. Systemic disease marked by pleural effusions, pericarditis, pulmonary fibrosis, neuropathies, and ocular disorders may occur. Symptoms usually develop gradually over the course of several months but may begin abruptly in some patients.
DIAGNOSIS:
Because of its multisystemic character, its gradual onset, variable presentation and many disease mimics, RA can be challenging to identify and diagnose. A combination of symptoms (morning stiffness, symmetrical joint pains in the hands or feet), signs (joint redness, heat, and swelling; palpable synovial thickening in the joints), laboratory tests (rheumatoid factor, anticyclic citrullinated antibody tests, sedimentation rate, C-reactive protein levels), and x-ray findings are used to diagnose the disease.
TREATMENT:
Medications for RA reduce inflammation, joint pain, and prevent joint destruction, but no currently prescribed drug or treatment cures the disease. Most rheumatologists recommend aggressive therapy with disease-modifying antirheumatic drugs (DMARDs) early in the course of the illness to prevent bony erosions and loss of joint function. Drugs in this class include agents like methotrexate. Nonsteroidal anti-inflammatory drugs (such as ibuprofen) or corticosteroids are often prescribed for palliation. Many patients may continue to take low-dose corticosteroids for years, but the benefits of long-term steroid use must be weighed against the risks (such as diabetes, osteoporosis, and adrenal suppression). Gold compounds can be used, but they are weaker than DMARDs and other, newer agents. Powerful immunosuppressive agents like cyclosporine, azathioprine, and mycophenolate may also be used. Combination therapies involving several agents from different classes can be used. Biologic agents include antibodies to tumor necrosis factor and other immunomodulatory drugs that influence B and T lymphocyte function. Side effects and contraindications to each current class of medical therapies are significant, require close monitoring, and may occasionally include life-threatening infections, exacerbations of diseases (such as hepatitis B or multiple sclerosis), or lymphoma. Joint replacement surgery can be helpful for some patients. Homeopathic substances such as black currant (gamma linolenic acid) and fish oil have also been recommended for rheumatoid arthritis.
IMPACT ON HEALTH:
Inflammatory arthritic conditions like RA are a primary cause of functional disability, early retirement, and loss of independence.
PATIENT CARE:
All joints are assessed for inflammation, deformities, and contractures. The patient's ability to perform activities of daily living (ADLs) is evaluated. The patient is assessed for fatigue. Vital signs are monitored, and weight changes, pain (location, quality, severity, inciting and relieving factors), and morning stiffness (esp. its duration) are documented. Use of moist heat is encouraged to relieve stiffness and pain. Prescribed anti-inflammatory and analgesic drugs are administered and evaluated; the patient is taught how to use these medications. The patient’s response to all medications is evaluated, esp. after a change in drug regimen, and the patient and family are taught to recognize the purpose, schedule, and side effects of each. Over-the-counter drugs and herbal remedies may interact with prescribed drugs and should not be taken unless approved by physicians or pharmacists. Inflamed joints are occasionally splinted in extension to prevent contractures. Pressure areas are noted, and range of motion is maintained with gentle, passive exercise if the patient cannot comfortably perform active movement. Once inflammation has subsided, the patient is instructed in active range-of-motion exercise for specific joints. Warm baths or soaks are encouraged before or during exercise. Cleansing lotions or oils should be used for dry skin. The patient is encouraged to perform ADLs, if possible, allowing extra time as needed. Assistive and safety devices may be recommended for some patients. The patient should pace activities, alternate sitting and standing, and take brief periods of rests. Referral to an occupational or physical therapist helps keep joints in optimal condition; referrals also teach the patient how to for simplify activities and protect his or her joints. The importance of keeping physical and occupational therapy appointments and following home-care instructions should be stressed to both the patient and the family. A well-balanced diet that controls weight is recommended (obesity further stresses joints). Both patient and family should be referred to local and national support and information groups. Desired outcomes include cooperation with prescribed medication and exercise regimens, ability to perform ADLs, slow progression of debilitating effects, control pain, and use of assistive devices properly. For more information and support, patient and family should contact the Arthritis Foundation (404-872-7100) (www.arthritis.org).
SEE: Nursing Diagnoses Appendix..
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RHEUMATOID ARTHRITIS: Joint deformities seen in the hand of a patient with rheumatoid arthritis. Note the hypertrophy of the IP joints, rheumatoid nodules, and volar subluxation of the triquetrum. This patient had fusion of the wrist joints.RHEUMATOID ARTHRITIS Rheumatoid arthritis of the foot. First metatarsophalangeal joint shows severe erosion of the joint surface with subluxation of the metatarsal (arrow).
Septic arthritis:
Arthritis of the synovial tissues in a joint as the result of a pyogenic bacterial infection. Once infection occurs, cartilage is destroyed, and the joint space narrows. Patients at greatest risk are those with pre-existing arthritis, joint trauma, or immune deficiencies and those who use intravenous drugs.
SYN: SEE: bacterial arthritis; SEE: acute suppurative arthritis....
CAUSES:
The primary site of infection is usually elsewhere; joint infection occurs as the result of bacteremia or spreads from osteomyelitis in an adjacent bone. The most common pathogen isolated from a septic joint is Staphylococcus aureus. Other common isolates include Neisseria gonorrheae (in young, sexually active patients) and group B streptococci, or gram-negative bacilli such as Escherichia coli and Salmonella spp.
SYMPTOMS AND SIGNS:
Suppurative arthritis is marked by an acutely painful, warm, swollen joint with limited range of motion and fever; the white blood cell count and erythrocyte sedimentation rates are increased. Except in gonococcal arthritis, only one joint is affected, usually the knee, hip, or shoulder.
DIAGNOSIS:
The disease is diagnosed by aspiration of fluid from the inflamed joint and laboratory culture and analysis. Typically, in septic arthritis, the white blood cell count of the aspirated fluid is greater than 50,000 cells/mL (often 100,000 cells/mL), and a gram stain of the aspirated fluid reveals the causative organism.
TREATMENT:
Prompt treatment is necessary: it includes drainage of the joint and antimicrobial drug therapy (intravenous penicillinase-resistant penicillins and third-generation cephalosporins). The affected joint is supported with a sling or pillows, and the patient's pain is treated with mild opioids and nonsteroidal anti-inflammatory agents. Without vigorous treatment, significant joint destruction can occur.
Syphilitic arthritis:
Arthritis occurring in the secondary and tertiary stages of syphilis and marked by tenderness, swelling, and limitation of motion.
Systemic juvenile idiopathic arthritis:
A form of juvenile rheumatoid arthritis that accounts for 20% of all cases; boys are affected 60% of the time. Fever and rash may be the presenting symptoms, either with or without joint involvement. Ultimately, 25% of these children develop severe arthritis.
Tuberculous arthritis:
Chronic, slowly progressing arthritis of the hips, knees, ankles, or intervertebral disks caused by Mycobacterium tuberculosis. The organism usually spreads via the blood or from osteomyelitis in an adjacent bone. The macrophage and lymphocyte response to the mycobacterium destroys the bone along the joint margins, resulting in progressive pain, fibrosis, and restricted movement.
SEE: granuloma....
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