Nursing

1. Connective Tissue Diseases
Medical Surgical Nursing

2. Connective Tissue Diseases
 Polymyositis
 Systemic Necrotizing Vasculitis
 Polymyalgia Rheumatica
 Giant Cell Arteritis
 Ankylosing Spondylitis
 Reiter’s Syndrome
 Marfan Syndrome

3. Polymyositis

4. Polymyositis
 Diffused inflammation
 Skeletal muscle

5. Polymyositis
 Weakness
 Atrophy
 Rash (dermatomyositis)
 Women > Men
 30-60 yrs of age

6. Polymyositis
 Polyarthritis
 Polyarthralgia
 Rynaud’s phenomenon

7. Polymyositis
 Drug Therapy:
 Steroids (high-doses)
 Immunosuppressive agents
 Supportive Care
 Nutrition !!!

8. Polymyositis
 Blood tests: elevated levels creatinine kinase (CK)
and aldolase
 Electromyography: pattern of electrical activity can
confirm a muscle disease.
 MRI: assess inflammation over a large area of
muscle.
 Muscle biopsy

9. Systemic Necrotizing Vasculitis

10. Systemic Necrotizing Vasculitis
 Arteritis
 Ischemia

11. Systemic Necrotizing Vasculitis
 Types:
 Polyarteritis
 Hypersensitivity Vasculitis (allergic)
 Drugs
 Infections
 Tumors
 Takayasu’s Arteritis (aortic arch syndrome)
 Pulseless disease
 Women in 20’s
 Japanese (most often)
 Cerebral ischemia (visual changes, syncope, vertigo)

12. Systemic Necrotizing Vasculitis
 Drug Therapy:
 Steroid (Prednisone)
 Immunosuppressive Agents

13. Polymyalgia Rheumatica

14. Polymyalgia Rheumatica
 Clinical syndrome
 Women > 50 yrs of age
 Joints:
 Neck
 Shoulder
 Hip

15. Polymyalgia Rheumatica (PMR)
 Stiffness (worse in morning)
 Weakness
 Aching proximal musculature (pelvic & shoulder
girdles)
 Low grade fever
 Arthralgia
 Fatigue
 Wt. loss
 Drug Therapy:
 Corticosteroids
 Calcium
 Vitamin D

16. Giant Cell Arteritis

17. Giant Cell Arteritis
 Temporal arteritis
 Genetic predisposition (HLA-DRBI)

18. Giant Cell Arteritis
 Fatigue
 Fever
 Wt. loss
 Night sweats
 Erthyema
 Pain
 Swelling
 Tenderness
 Diplopia
 Amaurosis fugax (temp. vision loss 1 eye)

19. Giant Cell Arteritis
 Drug Therapy:
 Corticosteroids (high doses)
 Calcium
 Vitamin D

20. Giant Cell Arteritis
 Complications:
 Blindness
 Aortic aneurysm
 Stroke

21. Giant Cell Arteritis
 Blood test
 Biopsy
 MRA
 Doppler Ultrasound
 PET Scan

22. Ankylosing Spondylitis

23. Ankylosing Spondylitis
 Marie-Strumpell Disease
 Rheumatoid Spondylitis

24. Ankylosing Spondylitis
 Vertebral column
 Spinal deformities
 At any age
 Men < 40 years

25. Ankylosing Spondylitis
 Iritis
 Arthritis
 Arthralgia
 Malaise
 Wt. loss
 Respiratory compromise

26. Ankylosing Spondylitis
 Drug Therapy:
 Anti-inflammatory agents
 Heat application
 DMARD’s (methotrexate)
 Biological Response Modifiers (BRM’s)
 TNF Inhibitors (infliximab Remicade)
 sulfasalazine (Azulfidine)

27. Reiter’s Syndrome

28. Reiter’s Syndrome
 Associated with HLA-B27 antigen
 Affect both male & female

29. Reiter’s Syndrome
 Triad:
 Arthritis
 Conjunctivitis
 Urethritis

30. Reiter’s Syndrome
 Balanitis circinata
 Skin lesions
 Both significant 4 confirmation of diagnosis

31. Reiter’s Syndrome
 Drug Therapy:
 Antibiotics (minocycline, Augmentin)
 NSAID’s
 Physical therapy

32. Marfan Syndrome

33. Marfan Syndrome
 Autosomal dominant
 Defect in extracellular microfibrils

34. Marfan Syndrome
 Abnormalities:
 Skeletal
 Ocular
 Cardiopulmonary
 Central nervous system

35. Marfan Syndrome
 Excessively tall
 Elongated hands
 Elongated feet
 Chest sinks in or sticks out
 Flexible joints
 Flat feet
 Crowded teeth
 Stretch marks
 Scoliosis
 Subluxation of lens (bilateral)
 Mitral valve prolapse w/regurgitation
 Aortic aneurysm w/regurgitation

36. Marfan Syndrome
 Management:
 Palliative & Preventive
 Cardiovascular meds
 Orthopedic surgery

37. Marfan Syndrome
 Chest Xray
 ECG
 Echocardiogram
 TEE
 MRI
 CT Scan
 Slit lamp eye exam

38. Thank You….
Sharon King, RN