This document discusses three types of arthritis: osteoarthritis, rheumatoid arthritis, and gout. It defines each type, describes their causes, risk factors, symptoms, diagnostic measures, and treatment options. Osteoarthritis is the most common type and involves the breakdown of cartilage in joints. Rheumatoid arthritis is an autoimmune disease causing inflammation of the lining of joints. Gout is caused by uric acid crystals depositing in joints due to high uric acid levels. Nursing interventions focus on managing symptoms, medication administration, education, and lifestyle changes.

1. Arthritis
Prepared by
Amaal Mohamed Ahmed El-zeftawy
Assistant .Professor of Community Health
Nursing
Faculty of Nursing
Tanta University
2018-2019

2. LEARNING OBJECTIVES
• By the end of this lecture , the student will
be able to:
– Define of osteoarthritis, rheumatoid arthritis and gout
– Underline risk factors of osteoarthritis, rheumatoid
arthritis and gout.
– Explain pathology of osteoarthritis.
– Enumerate the clinical manifestation of osteoarthritis,
rheumatoid arthritis and gout
– Differentiate between osteoarthritis, rheumatoid
arthritis and gout according to causes , S&S, diagnostic
measures and effective nursing intervention and
treatment.

3. Arthritis
meansinflammation of
ajoint actually refersto
morethan 100 different
diseases.

4. Osteoarthritis
Osteoarthritis (OA), the most common form of
arthritis, is a chronic, degenerative, joint
disease that affects mostly middle-aged and
older adults. The disease is also known as
degenerative arthritis or degenerative joint
disease.

5. Causes of osteoarthritis
Secondary
osteoarthritis
Primary
osteoarthritis

6. Pathology of Osteoarthritis

8. Risk factors associated with osteoarthritis:
Age
Female gender
Hereditary gene defect
Joint injury or overuse
Joint alignmentObesity

9. Symptoms of osteoarthritis.
1.Pain: - it occurs in the affected joint,
particularly after use, worse at the end of the
day.
2.Warmth.
3.Swelling.
4.Stiffness after prolonged inactivity.
5.Crepitus (i.e. crackling sound heard when a
joint is moved) of the affected joint.

10. • 6. Some patients may
complain of” heberden
nodes”. It is bony
enlargements of the small
joints at the end of the fingers.
Bouchard nodes also occur
and are seen as bony
enlargements of the middle
joint of the fingers. These
nodes are not painful but can
be helpful identifying the
disease.

11. • 7. When osteoarthritis affects the spine,
pain typically occurs in the neck or low
back. Osteoarthritis of the spine is
called “ spondylosis “.
• 8. Osteoarthritis of the knee is
associated with repeated trauma or
injury. Severe osteoarthritis of the knee
results in pain and joint dysfunction
and may require total knee replacement

12. Diagnosis of osteoarthritis
X-ray
Joint
aspiration
Arthroscopy

13. Factor to distinguish OA and other disease.
1-Osteoarthritis usually occurs in older people after
the age 45 years, but occur at any age.
2-It is usually located in only one or a few joints.
3-The joints are less inflamed than in other arthritic
conditions.
4-Progression of pain is almost always gradual.
5-It affects men and women in equal numbers but
after the 50 age the women is more.

14. Management of osteoarthritis:
1. Exercise.
2. Heat and cold therapies.
3. Physical and occupational therapy
4. Weight maintenance.
5.Medication.
6.Injections of thick liquids into the
joints.
7. Joint surgery.

15. Rheumatoid Arthritis
• Rheumatoid Arthritis is a chronic
diesease ,inflammatory disease
(inflammation of joint lining) ,
autoimmune disease (immune
reaction against joint tissues - synovial
membrane).
• Causes pain, swelling, stiffness, loss of
function in the joints.
• Generally occurs in a symmetrical
pattern.

17. • May also attack tissue in the
skin, lungs, eyes, and blood
vessels.
• Small joints of hands and feet
affected first, larger joints later.
• Begins during the most
productive years (30 – 60).

18. • Occurs much more frequently in
women than in men (w:m=3:1).
• Specific agent or agents are not
yet known.
• Infectious agents, such as viruses
and bacteria, may trigger RA in
people with an inherited tendency
to develop the disease.

19. Causes of rheumatoid arthritis
• The exact cause of rheumatoid arthritis is
not known.
• Rheumatoid arthritis is an autoimmune
disorder, which means the body's
immune system attacks its own healthy
cells and tissues.
• The response of the body causes
inflammation in and around the joints,
which then may lead to a destruction of
the skeletal system.

20. • Rheumatoid arthritis also may
have devastating effects to other
organs, such as the heart and
lungs.
• Researchers believe certain
factors, including heredity, may
contribute to the onset of the
disease.

21. Rheumatoid arthritis is characterized by:-
• Period of remission (i.e. periods with no
symptoms).
• Period of exacerbation (i.e. periods with
an increase in symptoms).

22. Symptoms of rheumatoid arthritis
• The affected joints are swollen, hot and
painful.
• Stiff joints. There is morning stiffness and
generally it lasts more than 30 minutes
after awakening.
• Enlarged and/or deformed joints (such as
fingers bent toward the little finger and/or
swollen wrists)
• Frozen joints (joints that freeze in one
position).

24. • Hard nodules (bumps) under the
skin near affected joints

25. • Cysts behind the knees that may
rupture, causing lower leg
swelling and pain.
• Inflamed blood vessels
(vasculitis) may occur
occasionally, leading to nerve
damage & leg sores.

26. • Inflamed membranes around the
lungs (pleurisy), the sac around the
heart (pericarditis), or inflammation
and scarring of the lungs themselves,
that may lead to chest pain, difficulty
breathing, and abnormal heart
function.
• Swollen lymph nodes
• Sjögren's syndrome (dry eyes and
mouth)

27. Diagnoses of rheumatoid arthritis
X-ray
Joint
aspiration
Biopsy
(of
nodules
tissue)
blood
tests

28. Treatment for rheumatoid arthritis:
• Resting affected joints regularly
• Nonsteroidal anti-inflammatory medications,
such as ibuprofen
• Disease-modifying medication, such as slow-
acting medications (to slow bone
deformation)
• Corticosteroids (to reduce inflammation)
• Immunosuppressive medications, such as
methotrexate (to suppress inflammation)

29. • Exercise (to keep the joints as flexible as
possible)
• Physical therapy (to keep the joints from
"freezing" and becoming immobile)
• Heat or cold application to the joints
• Surgery (to repair, replace, or fuse
together an affected joint)
• Special devices (to provide support for the
affected joint).

30. Nursing intervention:-
• 1. Provide emotional support, because
elderly can easily become depressed and
irritable.
• 2. Monitor the duration of morning
stiffness. Duration reflects the severity of
the disease.
• 3. Check for rheumatoid nodules,
pressure ulcers, and skin breakdown,
especially if the patient is in traction or
wearing splint.

31. • 4. Administer medication as prescribed.
Assess the effectiveness of the
administered drugs and watch for adverse
reactions.
• 5. Use pain relieving measures as heat
packs, soaks and rest.
• 6. Make sure the patient adhere to the
prescribed physical therapy program.

32. • Patient teaching:-
1.Explain the nature of the disease to the
patient.
2.Encourage a balanced diet.
3.Encourage the patient to take hot showers or
baths at bedtime or in the morning to reduce
the need for analgesics.
4.Make sure the patient knows how and when
to take prescribed drugs and how to
recognize possible adverse effects.

34. Gout
• Gout is a condition that causes sudden and severe
attacks of pain, redness and swelling of joints.
• Most often it affects a single joint in one episode,
often the big toe.
• About 9 out of 10 affected individuals affected by
gout are men over the age of 40.
• The peak age of attacks is 75 years, but it can
occur in young individuals on rare occasions.
• Also known as "the disease of kings and the king of
diseases,”.

36. Causes of gout
• Gout is caused by monosodium urate
crystal deposits in the joints, due to an
excess of uric acid in the body.
• The excess of uric acid may be caused
by an increase in production by the body,
under-elimination of the uric acid by the
kidneys, or increased intake of certain
foods that metabolize into uric acid in the
body.

37. • Normal Uric acid levels are 2.4-6.0
mg/dL (female) and 3.4-7.0 mg/dL
(male).
• Normal values will vary from
laboratory to laboratory.

38. • Foods that are high in purines (the
component of the food that
metabolizes into uric acid) include
certain meats, seafood, dried beans,
and dried peas.
• Alcoholic beverages may also
increase levels of uric acid in the
body.

39. Gout attacks may be triggered by any/all
of the following:
1. Some individuals have a hereditary condition making them
more susceptible to gout.
2. Obesity and sudden weight gain and abnormal kidney
function.
3. Consumption of large quantities of alcohol and certain types
of cancer.
4. Some medications, such as thiazide ( diuretics )to control
blood pressure.
5. Consumption of large quantities of protein-rich foods that
are rich in purines can lead to attacks. Purine-rich foods
include organ meats (e.g. liver, kidney), herring, anchovies,
and to an extent, all meat products.
6. emotional stress

40. Symptoms of gout
• Severe, sudden pain in one or more joints (most
often the joint in the big toe)
• Swollen joint(s)
• Red or purplish, tight, shiny skin over joint
• Warmth in joint area
• Fever
• Chills
• General feeling of illness
• Rapid heartbeat
• Hard lumps of urate crystal deposits under the
skin (called tophi)

42. Diagnosis
• A complete medical history and a physical
examination,
• Sampling the joint fluid by inserting a small needle
into the affected joint; this procedure is performed
under local anaesthetic.
• Under the microscope, joint fluid from an affected
joint will be full of tiny uric acid crystals that look like
small needles.
• Blood tests may also be performed to check for uric
acid levels ,and kidney tests may be done to check
kidney function.

43. • Treatment for gout:
• Nonsteroidal anti-inflammatory medications
(NSAIDs) (to relieve pain and inflammation)
• Colchicine, an oral or intravenous
medication (to relieve pain and inflammation
and is very effective in the immediate
treatment of a gouty attack, but often causes
nausea and stomach upset, so many
patients do not tolerate this drug).
• Corticosteroids (to reduce inflammation)

44. • Increasing fluid intake while avoiding
alcoholic beverages
• Reducing the intake of protein-rich foods
• Reducing weight (if obesity is a factor)
• Medication (to lower the uric acid level in
the blood)
• Medication (to block production of uric acid
in the body)
• Surgery (to remove extremely large tophi).

45. Prevention of gout.
• Certain foods with high concentrations of purines can be
avoided.
• Drinking alcohol should be avoided.
• Prescription and non-prescription medications should be
reviewed with the doctor (it is important that you not
discontinue a medication without consulting the doctor, as
an untreated condition such as high blood pressure may be
worse than a gouty attack).
• Other common causes of a gouty attacks include
dehydration, injury to a joint, surgery, and a febrile illness.
Prevention should focus on avoidance of these situations.
• If surgery is needed, discuss with the doctor whether
prophylactic medication to prevent a gouty attack is
appropriate.