Arthritis is inflammation of one or more joints that can be caused by infection, trauma, or other causes. The main types discussed are osteoarthritis, rheumatoid arthritis, septic arthritis, gout, and psoriatic arthritis. Common signs include pain, stiffness, and limited movement of the affected joints. Management focuses on relieving pain and modifying the immune system. Complications can include permanent joint deformity, fistula formation, and development of nodules.

1. ARTHRITIS
PRESENTER: M.DAKA
MSc PHN student, Bsc, DN, ZEN

2. INTRODUCTION
• A joint is where two or more bones come together, such as the
hip or knee. In case where there is infection or trauma,
inflammation sets in.
• The word "arthritis" means "joint inflammation." Inflammation
is one of the body's natural reactions to disease or injury, and
includes swelling, pain, and stiffness.

3. INTRODUCTION
• Inflammation that lasts for a very long time or recurs,
as in arthritis, can lead to tissue damage. Is the most
common and the second most common cause of
disability in the USA (Ignatavicius & Workman, 2016).

4. Objectives
• General objective
• At the end of the lesson students should be able display
and understanding and knowledge on Arthritis and its
management

5. Objectives
1.Define Arthritis
2.Mention the general etiological/predisposing factors to
arthritis
3.Describe the general pathophysiology of arthritis
4.Discuss the types of arthritis

6. Objectives
5. Outline the clinical features of arthritis
6. Discuss the management of arthritis
7. State complications of arthritis

7. DEFINATION
• This is the inflammation of one or more joints
characterized by pain and stiffness, resulting from
infection, trauma, degenerative changes, autoimmune
disease or other causes. (Ignatavicius & Workman, 2016).

8. DEFINATION
• Arthritis is an inflammation of one or more joints
characterized by joint pains swelling joint stiffness and
tenderness of inflamed joints.

9. ETIOLOGY
• Direct and indirect effect of infections (bacterial and viral)
PREDISPOSING FACTOR
• Age. The risk of developing arthritis, especially
osteoarthritis increases with age (30 to 50 years)
• Gender. In general, arthritis occurs more frequently in
women than in men.

10. PREDISPOSING FACTOR
 Obesity. Being overweight puts extra stress on weight-
bearing joints, increasing wear and tear, and increasing
the risk of arthritis, especially osteoarthritis

11. PREDISPOSING FACTOR
 Work factors. Some jobs that require repetitive movements
or heavy lifting can stress the joints and/or cause an injury,
which can lead to arthritis, particularly osteoarthritis.

12. PATHOPHYSIOLOGY
• The bones of a joint are covered with a smooth, spongy
material called cartilage. which cushions the bones and
allows the joint to move without pain.
• The joint is lined by a thin film of tissue called the
synovium.

13. PATHOPHYSIOLOGY
• The synovium's lining produces a slippery fluid called
synovial fluid that nourishes the joint and helps reduce
friction
• Strong bands of tissue, called ligaments, connect the
bones and help keep the joint stable.

14. PATHOPHYSIOLOGY
• Muscles and tendons also support the joints and enable the
person to move.
• With arthritis, an area in or around a joint becomes inflamed,
causing pain, stiffness and, sometimes, difficulty moving.
• Some types of arthritis also affect other parts of the body,
such as the skin and internal organs.

15. TYPES OF ARTHRITIS`

16. OSTEOARTHRITIS
• This is the degenerative condition attacking the
articular cartilage, usually of the large joints.
• It is also called osteo-arthrosis degenerative arthritis.

17. OSTEOARTHRITIS
•

18. OSTEOARTHRITIS
• Causes are unknown; however, the following
predispose
• Old age due to degeneration of the cartilage
• Obesity; cartilage degeneration.
• Systemic disease

19. OSTEOARTHRITIS
• Trauma; can cause ligament damage and meniscal tears.
• Impaired blood supply to the joint will cause necrosis.
• Excessive joint use due to damage to the cartilage
• Genetic influences; such as those with hands characterised
by the presence of nodes at the distal interphalangeal joint
in the hand

20. OSTEOARTHRITIS
• Clinical features
• Pain and swelling of the joints which may be symmetrical or
asymmetrical.
• Joint stiffness in the morning or after sitting.
• Limitation to joint movement due to pain.
• Primary joints; hips, knees, vertebrae, and fingers are involved.

21. OSTEOARTHRITIS
• Medical management
• Anti-inflammatory drugs that are non-steroidal such as
aspirin 300mg-600mg, tid daily or indomethacin 75-
150mg in divided doses daily.

22. OSTEOARTHRITIS
• Analgesics such as diclofenac 50mg to 100mg bid.
• Splints, cervical collar, or traction are used to rest the
joints. Avoid activities that precipitate pain.
• Local heat (hot compress) relieves pain, muscle spasms
and stiffness.

23. OSTEOARTHRITIS
• Surgical management
• Osteotomy; involves re-shaping of the bone by
cutting to correct deformity and promote normal joint
formation.
• Arthrodesis; surgical fusion of the joint resulting in
loss of joint movement, done to provide pain relief or
correct joint instability.

24. OSTEOARTHRITIS
• Arthroplasty; a reconstructive procedure which
entails replacement of part of a joint or the whole
joint.
• It is done to permit mobility and relieve pain.
• Partial hip replacement where the head of femur that is
degenerated is replaced by a prosthesis consisting of

25. OSTEOARTHRITIS
• a spherical head and a stem of stainless steel.
• Total hip replacement where head and neck of femur
are removed, cartilage from the acetabulum is removed
and fitted with a polythene cup.
• Prosthesis is fitted into a patient

26. RHEUMATOID ARTHRITIS
• This is the chronic inflammation and degeneration of
the collagen tissue characterised by recurrent
inflammation involving the synovium or lining of the
smaller joints which are mainly affected
• It is a chronic, progressive, systemic inflammatory
autoimmune disease process that

27. RHEUMATOID ARTHRITIS
• affect the synovial joints such as over knuckles, elbows, or
heels.
• Heart and renal system may eventually be involved
• Auto-antibodies (rhematoid factors) are formed that attack
healthy tissue, especially synovium, causing inflammation

28. RHEUMATOID ARTHRITIS
• Rheumatoid arthritis affects people of any age, but most
often begins in women with a ratio of 3:1 over men.
• It begins between the ages of 20 – 50 years
Signs and symptom
• Disease usually begins with unusual fatigue, generalized
weakness and anorexia

30. RHEUMATOID ARTHRITIS
• Signs of joint inflammation (redness, swelling, warmth, pain
etc) begin most commonly in the fingers; particularly
involving the
• Morning stiffness (lasting longer than 30 minutes after rising)
which subsides with activity
• Fixed deformities of the hands and feet are common in
rheumatoid arthritis.

31. RHEUMATOID ARTHRITIS
• proximal inter phalangeal joints (PIPs) and the
metacarpophalangeal joints (MCPs) bilaterally and
symmetrically.
• Additional joints such as the wrist, elbows, shoulders,
knees and hips are involved and mobility is impaired.

32. RHEUMATOID ARTHRITIS
• Other problems in the late or severe stages of rheumatoid
arthritis include:
• Severe weight loss
• Fever
• Signs of anaemia
• Muscle atrophy and Loss of bone density

33. RHEUMATOID ARTHRITIS
• Investigation
• Patient history taking will review predisposing factors
• General appearance through physical assessment will
review deformity of the joints
• X – ray will confirm the condition

34. RHEUMATOID ARTHRITIS
• Bone scan
• Serum Rheumatoid factor (abnormal antibodies)
• Raised ESR due to antigen antibody reaction
• Aspiration of synovial fluid for MCS to rule out any
infection

35. RHEUMATOID ARTHRITIS
• Medical management
• Drug therapy is used to relieve inflammation and pain and
arrest the progress of the disease:
• Salicylates
• Aspirin is the corner stone of treatment especially in early
phases of disease such as rheumatoid arthritis.

36. RHEUMATOID ARTHRITIS
• It has anti inflammatory, antipyretic and analgesic effects.
• Non Steroidal Anti inflammatory
• Ibuprofen, Indomethacin
• Butazolidin
• Corticosteroid medications, such as prednisone from 30mg tapering
to up to 5mg, reduce inflammation and pain and slow joint damage.

37. RHEUMATOID ARTHRITIS
• Immune suppressants to act and tame the immune system,
which is out of control in rheumatoid arthritis.
• Examples include azathioprine, methotrexate and
cyclosporine . These medications can increase
susceptibility to infection
• Warm compress

38. SEPTIC ARTHRITIS
• It is also known as pyogenic, infective or suppurative arthritis
• Common in children
• Males are more susceptible
• Caused by bacteria and virus
• Other predisposing factors include: low immunity, poor personal
hygiene, trauma, sickle cell disease and diabetes mellitus

39. SEPTIC ARTHRITIS
• Causes
• Blood borne infection from other parts of the body.
• Local spread from osteomyelitis.
• Penetrating wound at the joint or near it.
• Low immunity
• Sickle cell anaemia

40. SEPTIC ARTHRITIS
Causative organisms
• Staphylococci aures
• Gonococcus
• Streptococci
• Pneumococci

41. SEPTIC ARTHRITIS
• Pathophysiology
 When joint infection occurs as a result of bacteremia, the
initial growth of microorganisms is either in the synovial
membrane or in the adjacent bone.

42. SEPTIC ARTHRITIS
 In either case, an inflammation of the synovial membrane
is quickly established and results in a marked increase in
leukocytes in the synovial fluid, even though the fluid itself
is sterile.
 When the microorganisms have spread into the joint fluid,
culture of the fluid reveals the etiology of the infection

43. SEPTIC ARTHRITIS
•The pathologic findings are varied and depend on the
duration of the infection, the organism and the resistance of
the host.
•Early in the infection, only inflammatory changes in the
synovium are seen.

44. SEPTIC ARTHRITIS
•Late in the course of untreated septic arthritis, destruction of
joint structures is marked.
•Articular cartilage is particularly vulnerable because it is an
avascular tissue.

45. SEPTIC ARTHRITIS
Signs and symptoms
• Severe pain over the joint, aggravated by movement.
• Swollen tender and hot joint.
• Spasms of surrounding muscles
• Fever due to antigen and antibody reaction

46. SEPTIC ARTHRITIS
• Fever due to antigen and antibody reaction
• limited function of joints due to pain
• Inflammation of the joints from arthritis is characterized
by joint stiffness, swelling, redness, and warmth.
• Hearing or feeing a grating sensation when using the joint

47. SEPTIC ARTHRITIS
• Management-Investigation
• Joint aspiration culture it to determine microbe exudate
leukocytosis
• Full blood Increased leukocytes in infection
• Elevated sedimentation rate

48. SEPTIC ARTHRITIS
• Treatment
• consists of both drainage of the synovial fluid and a
prolonged administration of an antibiotic systemically.
• Antibiotic choices include cloxacillin, chloramphenicol,
ceftriaxone 1g od, cofotaxime 1g bid and ceftizoxime 1g
od.

49. PSORIATIC ARTHRITIS
• Psoriatic arthritis is a chronic disease characterized by
inflammation of the skin (psoriasis) and joints (arthritis).
• With psoriasis, there are patchy, raised, red, and white areas
of skin inflammation with scaling

50. PSORIATIC ARTHRITIS
• About 10% of people with psoriasis also develop an
associated inflammation of their joints called psoriatic
arthritis
• Psoriasis usually affects the tips of the elbows and knees,
the scalp

51. PSORIATIC ARTHRITIS
• Psoriatic arthritis can cause a sausage-like swelling of
fingers and toes and is often associated with fingernails
that are pitted or discolored.
• It may affect only one joint or a few joints. For example,
one knee or the spine, or just the fingers and toes.

52. PSORIATIC ARTHRITIS
• It is common in both male and women at the age of 30 to 50,
But it can also start in childhood.
• joint symptoms
• Pain or aching, tenderness, and/or swelling in one or more
joints
• Reduced range of motion in affected joints.

53. PSORIATIC ARTHRITIS
• Pain or stiffness in the lower back.
• Tenderness, pain, or swelling where tendons and
ligaments attach to the bone (enthesitis),
• Swelling of an entire finger or toe with a sausage-like
appearance (dactylitis).

54. PSORIATIC ARTHRITIS
Skin symptoms
• Silver or gray scaly spots on the scalp, elbows, knees,
and/or the lower spine.
• Papules that are raised and sometimes scaly on the arms,
legs and torso.
• Pitting of the nails.

55. PSORIATIC ARTHRITIS
• Medical management
• Treat like other type of arthritis with
• prednisolone and aspirin with the addition of
• cold or warm compress

56. Gout
• This is a type of arthritis due to the excessive amount of
uric acid, an end product of purine metabolism within the
tissues and fluids
• Characterized by inflammation due to formation of crystals.
• Sometimes they become enlarged (tophi) and cause
permanent joint deformation.

57. Gout
• Other signs and symptoms are the same as rheumatoid
arthritis

58. Gout
• Predisposing factors
• Conditions like Overweight or obesity, Congestive heart
failure, Diabetes, Hypertension, Kidney disease and Blood
cancer Foods like, red meat, organ meat, game meat and
some sea food

59. Gout
• Drinks e.g., alcohol and fructose syrup
• Medical management
• NSAIDS and corticosteroids plus Allopurinol to reduce the
uric acid.

60. NURSING DIAGNOSIS
• Acute pain related to inflammation of the synovium and
irritation of the nerve endings.
• Activity intolerance related to joint pain.
• Impaired physical mobility related to joint stiffness.
• Self-care deficit related to contractures, fatigue, or loss
of motion.

61. NURSING DIAGNOSIS
• Disturbed body image related to physical and
psychological changes and dependency imposed by
chronic illness.
• Ineffective coping related to actual or perceived
lifestyle or role changes.

62. COMPLICATIONS
• •Heart disorders especially for rheumatoid arthritis as the
causative organism also attacks the heart muscles
• •Anemia due immunosuppression drugs like
methotrexate
• •Disorders of the spinal cord due to chronic
inflammation

63. COMPLICATIONS
• •Formation of fistula near the joints due to repeated
inflammation
• •Defects of the joints that may lead to permanent deformity
• •Formation of small lumps of tissues known as rheumatoid
nodules
• •Inflammation of the blood vessels due to spread of
infection

64. SUMMARY
• We discussed that arthritis is the inflammation of the join
which can be caused by trauma of invasion of micro-
organisms. The types we discussed are osteoarthritis,
rheumatoid, septic, gout and psoriatic arthritis. The
common signs and symptoms include

65. SUMMARY
• pain, joint stiffness and limited joint movement.
Management mostly is to relieve pain and modify the
immune system.
• Finally we looked at the complications which include:
permanent deformity, fistula formation and formation of
nodules.

66. ASSIGNMENT
• Using the nursing diagnosis above, complete the Nursing
Care Plan for arthritis

67. REFERENCES
• Berkow, R, (2014), Merck Manual of Medical Information, New Jersey: Merck and Co,
Inc.
• Black J. M. et al (2005). Medical Surgical Nursing - Clinical Management for Positive
Outcome. 6th Edition. Vol.1. Saunders. London
• Lewis et al. (2011) Medical Surgical Nursing Assessment and Management of Clinical
Problems. 6th Edition.st. Louis
• https://order.store.mayoclinic.com/books/gnweb43?utm_source=MC-DotOrg-
PS&utm_medium=Link&utm_campaign=FamilyHealth-Book&utm_content=FHB
accessed at 8;00 hrs on 13/07/23
• The American Juvenile Arthritis Organization www.kidsgetarthritistoo.org Accessed at
10; 00hrs on 20/07/2023