FINAL ARTHRITIS (1).pptx

SEMINAR ON :
WORLD ARTHRITIS DAY’
Under the Theme
“JOINT HEALTH FOR ALL”
By:
Prof (Dr) Sonam Dubey
Smt. Rukmaniben Deepchandbhai Gardi
Nurses Training Centre

LEARN TO FIND BEAUTY IN
EVERYTHING

INTRODUCTION
 Arthritis is derivedfrom the Greek term “ Diseaseof the Joints ”.
 More than 100 different types of arthritis have been described, the most
common being osteoarthritis or degenerative arthritis which is non-
inflammatory arthritis.
 Although the medical and economic consequences of arthritis are of great
concern , this disease also affects an individual’s capacity to live a full and
active life.
 Thus, it has increasingly become clear that the problems associated with
arthritis are not simply medical ones; it also appears to have a substantial
impact on a person’s functional capacity and quality of life. (Scott DL,2019)

PREVALENCE
 WHO (July 2023), with a prevalence of 365 million, the
knee is the most frequently affected joint, followed by
the hip and the hand .
 With ageing populations and increasing rates of obesity
and injury, the prevalence of osteoarthritis is expected
to continue to increase globally.

 Findings from the Global Burden of Disease
Study 2019 concluded that around 23.46 million
individuals in India had arthritis in 1990; this
increased to 62.35 million in 2019.
 The burden and impact of arthritis in India are
substantial and is increasing. Adopting suitable
control and preventive community measures to
reduce modifiable risk factors (obesity, injuries,
occupational stress) are needed to reduce the
current and future burden of arthritis in India.

DEFINITION
 Arthritis means redness and swelling
(inflammation) of a joint.

TYPES OF ARTHRITIS
1. Osteoarthritis , or “wear and tear”
arthritis, which develops when joint
cartilage breaks down from repeated
stress. It’s the most common form .
TYPES Etiology C / M
Primary O.A.
[Increasing
age]
1. Sports
injuries
2. Falls
3. Car
accidents
4. Ehlers-
Danlos
syndrome or
Joint
hypermobility
syndrome
1. Arthralgia
(especially on
movement).
2. Stiffness
3. Swelling near a
joint
4. A decreased
ROM.
5. Feeling like a
joint isn’t as
strong or stable
as it usually is
6. Joint deformity
Secondary
O.A.
[Injury, trauma,
other types of
arthritis]

cont…
2. Ankylosing spondylitis, or
arthritis of the spine (usually at lower back).
Vertebrae in the spinal column may fuse and
become rigid (ankylosis)
ETIOLOGY C / M
Variation of the
Human
Leukocyte
Antigen-B gene
(HLA-B). This
changed, or
mutated gene
produces a
protein called
HLA-B27 that
increases
disease risk.
1. AS inflames the
sacroiliac joints located
between the base of
the spine and pelvis,
called sacroiliitis
2. Lower back pain and
stiffness
2. Hip pain
3. Joint pain
4. Pain in a joint
(especially on
movement).

cont…
3. Juvenile arthritis (JA), a disorder where the
immune system attacks the tissue around joints. JA
typically affects children age 16 or younger.
ETIOLOGY C / M
 Juvenile Idiopathic
Arthritis (JIA) is the
most common type of
JA.
 It is an autoimmune
disease in which the
body’s immune system
mistakenly targets the
synovium.
 This causes the
synovium to make
extra synovial fluid.
1. Pain, swelling and
tenderness in the joints
2. The joints may also
feel warm
3. Morning joint stiffness
4. Limping gait
5. Younger children may
not be able to perform
motor activities that they
recently learned
6. Fever
7. Fatigue or irritability

cont…
4. Gout is a form of inflammatory arthritis that
causes pain and swelling in joints due to buildup
of uric acid in body.
ETIOLOGY C / M
 Hyperuricemia
 Eating or drinking
foods high in
purines:
 Sugary drinks and
sweets
 High fructose corn
syrup
 Alcohol
 Organ meats
 Seafood
 Red meat
 Gravy & meat
1. Intense pain
2. Discoloration or
redness on joint
3. Stiffness
4. Swelling
5. Tenderness, even to
a light touch
6. Warmth, or a feeling
like the joint is “on fire.”

cont…
5. Psoriatic arthritis is a form of arthritis that’s
linked to psoriasis — a chronic skin condition.
Psoriatic skin lesions /
silver grey scaly patches)
ETIOLOGY C / M
 Both arthritis
and psoriasis
areautoimmune
diseases
 Psoriatic arthritis
occurs when
patient develop
psoriasis
symptoms on
skin and
inflammation in
joints
1. Arthralgia & stiffness
2. Discoloration or redness
near affected joints
3. Pain or tenderness where
tendons and ligaments attach
to bones (like near Achilles
tendon)
4. Swelling in fingers and toes
(dactylitis or “sausage fingers”)
Pitted or flaky nails

cont…
6. Rheumatoid Arthritis (RA) is an
autoimmune disease that is chronic in nature. It
occurs in the joints on both sides of the body.
ETIOLOGY C / M
1. Uncontrolled
inflammation damages
cartilage, which normally
acts as a “shock
absorber” in the joints.
2. Specific cells in
immune system aid this
process.
3. These substances are
produced in joints but
also circulate and cause
symptoms throughout
body (heart, lungs, skin,
mouth, eyes)
1. Many people have
time with flares, then
time with remission
2. Pain, swelling,
stiffness & tenderness
in more than one joint
3. Stiffness, especially
in the morning or after
sitting for long periods
4. Pain and stiffness in
the same joints on
both sides of the body
5. Fatigue, weakness
6. Fever

DIAGNOSTIC EVALUATION
 Antinuclear antibody (ANA) test:
This checks antibody levels in the blood.
 Complete blood count (CBC): This
checks if white blood cell, red blood cell,
and platelet levels are normal.
 Creatinine: This test checks for kidney disease.
 Sedimentation rate: This test can find
inflammation.

cont…
 RF (rheumatoid factor) and CCP (cyclic
citrullinated peptide) antibody tests: These
can help diagnose rheumatoid arthritis. It can
also assess disease severity.
 White blood cell count: This checks
the level of white blood cells in blood.
 Uric acid: This helps diagnose gout.

Other tests may be done, such as:
 Joint aspiration (arthrocentesis):
A small sample of synovial fluid is
taken from a joint. It's tested to see
presence of crystals, bacteria,
or viruses.
 X-rays or other imaging tests:
These can tell how damaged a joint
is.
 Urine test: This checks for protein
and different kinds of blood cells.
 HLA tissue typing: This looks for
genetic markers of ankylosing
spondylitis.
Joint aspiration (arthrocentesis)

cont…
 Skin biopsy:
Tiny tissue samples are
removed and checked
under a microscope.
This test helps to
diagnose a type of
arthritis that involves the
skin, such as lupus or
psoriatic arthritis.

cont…
 Muscle biopsy:
Tiny tissue samples
are removed and
checked under a
microscope. This
test helps to
diagnose conditions
that affect muscles.

COMPLICATIONS
Joint destruction
Contractures & deformity
Scleral nodules
Nodules on the vocal cords

MANAGEMENT
 Management depends upon:
 Symptoms
 Age
 General health
 Type of arthritis
 Severity of symptoms
 There is no cure for arthritis.
 Goal of treatment is often to limit pain and
inflammation, and help ensure joint
function.

Short-term treatments include:
Medications:
Short-term relief for pain and
inflammation may include
analgesics such as
acetaminophen, aspirin,
ibuprofen, or other NSAIDs
medications.

cont…
Heat and cold:
Pain may be eased by using moist heat (warm
bath or shower) or dry heat (heating pad) on
the joint. Pain and swelling may be eased with
cold (ice pack wrapped in a towel) on the joint.

cont…
Joint immobilization:
The use of a splint or
brace can help a joint
rest and protect it from
further injury.

cont…
Massage:
The light massage of
painful muscles may
increase blood flow
and bring warmth to
the muscle.

cont…
TENS: Pain may be reduced with the use of a
TENS device. The device sends mild, electrical
pulses to nerve endings in the painful area.
This blocks pain signals to the brain and
changes pain perception.

cont…
Acupuncture:
This is the use of thin needles that are
inserted at specific points in the body. It may
stimulate the release of natural, pain-relieving
chemicals made by the nervous system. The
procedure is done by a licensed health care
provider.

cont…
 Physical Therapy:
It can help people regain mobility and reduce pain,
and it may help a person delay or avoid surgery in
other cases.

Long-term treatments include:
 Disease-Modifying Anti Rheumatic Drugs
(DMARDs):
These prescription medications may slow
down the disease and treat any immune
system problems linked to the disease.
Examples of these medications include
methotrexate, hydroxychloroquine,
sulfasalazine, and chlorambucil.

cont…
 Corticosteroids:
Corticosteroids reduce inflammation
and swelling. These medications,
such as prednisone, can be taken
orally or as an injection.

cont…
Hyaluronic acid therapy:
This is a joint fluid that
appears to break down in
people with osteoarthritis.
It can be injected into a
joint, such as the knee, to
help relieve symptoms.

Lifestyle modification :
Weight loss

cont…
Heat and Cold application

Dietary Management:
 Anti inflammatory foods to ease arthritis pain:
 Food high in Omega 3 Fatty Acid:
Wall nut Chia seeds Flax seeds

cont…
 Antioxidant rich fruits & vegetables:
 Lutein & vit A in Broccoli
 Papain in Papaya
 Vit C in Capsicum
 Vit A & E in Spinatch
 Fruits: Orange,Strawberry,
Grapefruit
(The deeper the color of fruits and vegetables,
the higher amount of Antioxidant it carries)

cont…
 Sulphur rich food:
 Cabbage
 Brussels Sprouts
 Broccoli
 Cauliflower
(These items contain sulfurophane compounds
which helps to reduce inflammation of joints.)

SURGICAL MANAGEMENT
Joint repair
(Arthroplasty):
In some instances, joint
surfaces can be smoothed
or realigned to reduce pain
and improve function.
These types of procedures
can often be performed
arthroscopically— through
small incisions over the
joint.

cont…
Joint replacement:
This procedure removes
the damaged joint and
replaces it with an
artificial one. Joints
most commonly
replaced are hips and
knees.

Arthrodesis
Joint fusion:
This procedure is more often
used for smaller joints, such as
those in the wrist, ankle and
fingers.
It removes the ends of the two
bones in the joint and then
locks those ends together until
they heal into one rigid unit.

REHABILITATION
 Imperative to decrease the potential long-term
disabilities
 Under proper counseling, individuals with
rheumatoid arthritis can safely exercise,
improving overall physical fitness, greater
ease for activities of daily living and an
improved sense of well being.

Rehabilitative Techniques
 Relative Rest:
 In studies by Mueller,2014, patients on strict bed rest
lost 1.0% to 1.5% of their initial strength per day over
a two-week period. In contrast, Gerber et al
2020, studied the importance of energy conservation
and interruption of daily activities lasting greater than
30 minutes.
 Patients appeared to be benefitted from the
modification of activity and were taught to recognize
those activities that caused pain and fatigue.

cont…
 Exercise:
 Greatly beneficial to the overall well-being and
functioning of the individual.
 Focus on stretching, strengthening and
aerobic conditioning while conserving energy.

MODALITIES [Conductive methods]:
 Superficial Heat:
 Useful in circumstances where the goal is to
heat joints that are covered by little soft tissue
such as those in the hands and feet.
Hydrocollator packs Paraffin wax Heating pads

[Convective methods]
Whirlpool baths Hubbard tanks Contrast baths
Hydrotherapy:
 Involves the use of water, either hot or cold, to treat
conditions like RA & also neurogenic pain, sprains and
strains, and mild peripheral vascular disease.

cont…
Fluidotherapy : produces a warm, air-fluid mixture, referred to
as fluidization. Presumed benefits include a massaging action
and ability to perform range-of-motion exercises.

[Conversion methods]
Radiant heat: such as Infrared Radiation.
 Mostly used for patients who cannot tolerate the weight of
hot packs.
 The energy is absorbed by the skin and converted into
superficial heat.

DEEP HEAT METHODS
 Deep heating increases the tissue temperature at
a deeper level without overheating skin and
subcutaneous fat. Eg: Ultrasound and Diathermy
Phonophoresis SVD

cont…
 Cold therapy: several physiologic effects like
slowing of nerve conduction velocity, and
decreased firing of the muscle spindles.
 Furthermore, it synovial collagenase activity,
making it effective in inflammatory arthropathies.
Cold pack & Ice massage

Electrical Stimulation
 Electrical Nerve Stimulation: The primary
delivery mechanism is via transcutaneous
electrical nerve stimulation (TENS).

cont…
 Lontophoresis: is believed to work through
the transcutaneous delivery of charged
medications (i.e. lidocaine, corticosteroids,
salicylate, antibiotics).
 Used for delivery of substances
that need local penetration in
order to avoid systemic effects,
and in cases where oral absorption
is variable or contraindicated

cont…
 Interferential current (IFC):
It uses alternating current signals of different
frequency in order to penetrate tissue without
discomfort.

Orthoses
 Joint preservation techniques are vital for prolonging
patient independence.
 Deformities resulting from RA or OA can limit a patient’s
functioning, an often overlooked consequence of the disease.
 Orthoses / Orthotic devices are essential because:
 Immobilization provide pain relief by eliminating the rubbing
of bone on bone
 Stability to a weakened joint, maintains normal alignment.
 Comfortable resting position for the entire hand and wrist at
nighttime, allowing for restful sleep.
 Greater degree of independence for the patient.

Adaptive Equipment
Any equipment used to progress or preserve function in persons
with disabilities. Self care focuses on dressing, feeding, hygiene,
and grooming.
Built-up handles and plate guards

Helper Dressing Aid
Zipper pulls Button hook
helper

NURSING MANAGEMENT
The major goals for a patient with arthritis are:
1. Improvement in comfort level.
2. Incorporation of pain management techniques
into daily life.
3. Incorporation of strategies necessary to modify
fatigue as part of the daily activities.
4. Attain and maintain optimal functional mobility.
5. Adapt to physical and psychological changes
imposed by the rheumatic disease.
6. Use of effective coping behaviors for dealing with
actual or perceived limitations and role changes.

Relieving Pain and Discomfort
 Assess the duration, intensity, severity, site,
side, and location of pain.
 Assessment of pain level by pain scale.
 Provide a variety of comfort measures (eg,
application of heat or cold; massage, position
changes, rest; foam mattress, supportive pillow,
splints; relaxation techniques, diversional
activities).
 Encourage verbalization of feelings about pain
and chronicity of disease

cont…
 Teach pathophysiology of pain and
rheumatic disease
 Assess for subjective changes /
improvement in pain.
 Administer anti-inflammatory, analgesic,
and slow - acting antirheumatic
medications as prescribed.
 Individualize medication schedule to
meet patient’s need for pain
management.

Reducing Fatigue
 Assess fatigue level / fatigability of the patient.
 Provide instruction about fatigue:
o Describe relationship of disease activity to fatigue
o Describe comfort measures while providing them
o Develop and encourage a sleep routine (warm bath and
relaxation techniques that promote sleep)
o Explain importance of rest for relieving systematic, articular,
and emotional stress.
 Explain how to use energy conservation techniques
(pacing, delegating, setting priorities).
 Identify physical and emotional factors that can cause fatigue.
 Facilitate development of appropriate activity/rest schedule.
 Encourage adherence to the treatment program.
 Encourage adequate nutrition, including source of iron
from food and supplements.

Increasing Mobility
 Assess the mobility level of the patient.
 Asses and encourage verbalization regarding limitations in
mobility.
 Assess need for occupational or physical therapy consultation.
 Emphasize range of motion of affected joints, under supervision.
 Promote use of assistive ambulatory devices.
 Explain use of safe footwear.
 Encourage individual appropriate positioning / posture.
 Encourage independence in mobility and assist as needed
 Allow ample time for activity
 Provide rest period after activity.
 Plan nursing care beforehand , so that pt will not get disturbed
during rest periods.
 Initiate referral to community health agency.

Facilitating Self Care
 Assist patient to identify self-care deficits and factors that
interfere with ability to perform self-care activities.
 Develop a plan based on the patient’s perceptions and priorities
on how to establish and achieve goals to meet self-care needs.
 Provide appropriate assistive devices;
 Encourage correct and safe use of assistive device.
 Allow patient to control timing of self-care activities
 Explore with the patient different ways to perform difficult tasks
or ways to enlist the help of someone else.
 Consult with community health care agencies when individuals
have attained a maximum level of self-care yet still have some
deficits, especially regarding safety.

Improving Body Image and
Coping Skills
 Assess patient’s ability to cope with stress due to
bodily changes, dependability & deformity
 Help patient identify elements of control over disease
symptoms and treatment.
 Encourage patient’s verbalization of feelings,
perceptions, and fears.
 Identify areas of daily life affected by disease. Answer
questions and dispel possible myths.
 Develop plan for managing symptoms and enlisting
support of family and friends to promote daily function.
 Encourage to accept the bodily changes in positive
way.

Monitoring and Managing
Potential Complications
 Assess the level of understanding of the patient.
 Help patient recognize and deal with side effects from
medications.
 Monitor for medication side effects like:
 GI tract bleeding or irritation,
 Bone marrow suppression,
 Kidney or liver toxicity,
 Increased incidence of infection,
 Mouth sores,
 Skin rashes,
 Changes in vision

cont…
 Other signs and symptoms include bruising,
breathing problems, dizziness, jaundice, dark
urine, black or bloody
stools, diarrhea, nausea and vomiting, and
headaches should be explained.
 Monitor closely for systemic and local
infections, which often can be masked by high
doses of corticosteroids.

Nursing Diagnosis
 Chronic pain & discomfort related to
inflammatory process / articular changes as
evidenced by findings on pain scale (7/10) and
patients subjective data
 Impaired physical mobility related to pain in
joints (arthralgia) and stiffness as evidenced by
limited or less ROM by the patient
 Disturbed body image related to deformity
development and dependability on others as
evidenced by social withdrawal & altered self
concept

cont…
 Self care deficit related to limited joint mobility
and contractures as evidenced by inability to
perform activity of daily living
 Anxiety related to onset of symptoms,
hospitalization and prognosis of disease as
evidenced by patient looks fearful & anxious
 Knowledge deficit related to disease
progression, treatment regimen and home
care as evidenced by patient frequently asks
questions regarding his/her disease condition

PREVENTIVE MEASURES
Stay active Take diet rich in calcium
& vit D
Take proper rest
Control body weight Drink plenty of water Yoga & light exercises

CONCLUSION
 Arthritis is defined as an acute or chronic joint
inflammation that often co-exists with pain and
structural damage.
 Anyone can get arthritis, including children and
young people, from all backgrounds, ages and
lifestyles.
 Nurses can educate the patient about the disease
and explain about lifestyle modifications which are
necessary to manage the disease.
 Rehabilitation modalities along with regular exercise
regimen helps to reduce pain and improve the
functioning of the joint.

References
 Scott DL, Garrood T. Quality of life measures: use
and abuse. Bailliere’s Best Practice and
Research in Clinical Rheumatology 14, 663-
687, 2019.
 Mueller EA. Influence of training and of inactivity
on muscle strength. Arch Phys Med
Rehabil 51:449-462, 2014.
 Gerber L, Furst G, Shulman B, Smith C, Thornton
B, Liang M, Cullen K, Stevens MB, Gilbert N.
Patient education program to teach energy
conservation behaviors to patients with
rheumatoid arthritis: A pilot study. Arch Phys Med
Rehabil 68(7):442-5,2020

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