Osteoarthritis vs Rheumatoid Arthritis

Osteoarthritis vs Rheumatoid Arthritis

• These can be differentiated by cause, affected joints and symmetry
• Both are forms of arthritis affecting the musculoskeletal system

Osteoarthritis (OA)

• Caused by the deterioration of articular (hyaline) cartilage, which leads to rubbing of bones
• Over time, the cartilage wears away, causing pain
• Can cause cartilage to break off and bone to harden abnormally
• Body attempts to compensate with bone spurs, called osteophytes
• Results in stiffness, pain, and limited mobility
• Characterized by no inflammation of tissue in affected areas
• Affects weight-bearing joints like hips, knees, and spine
• Usually affects these weight bearing joints unsymmetrically
• Occurs due to general wear and tear, gradually over time
• Risk factors include repeated injuries, being overweight, genetics, and manual labor

Rheumatoid Arthritis (RA)

• Caused by an autoimmune response attacking the synovium (connective tissue within joints)
• Leads to white blood cells attacking the tissue within the joint, causing inflammation
• Over time, bones can fuse together (ankylosis)
• Marked by inflammation, presents with red, warm, soft/boggy joints
• Affects fingers, wrists, and can extend to neck, shoulders, elbows, feet, and ankles
• Affects these joints very symmetrically
• Accompanied by low-grade fever and anemia
• Exact cause unknown
• Affects women more than men
• May be related to hormonal issues or genetics
• Typically occurs between ages 20-60

Anatomy and Physiology of Bone

• Bones and the musculoskeletal system are essential for perception and coordinated movements
• Bone comprises extracellular matrix, protein matrix, cells, and mineral deposits of calcium and hydroxyapatite

Bone Cells:

• Osteoblasts responsible for forming cells secreting bone matrix
• Osteocytes are mature cells
• Osteoclasts destroy, resorb, and remodel bone. They are in the lacunae

Functions of Bones:

• Provides support
• Protects soft organs
• Enables movement
• Stores minerals
• Facilitates blood cell formation (hematopoiesis)

Perception and Coordination:

• Achieving awareness of the environment by organizing and interpreting sensory information
• Stimuli requiring movement send signals to the CNS for coordination

Coordination:

• Synchronization and integration of activities

Pathology affecting Perception and Coordination:

• Grouped into congenital anomalies, cerebral pathology, and structural defects

Congenital anomalies (birth defects) can affect:

• Perception and coordination
• There is adequate sensory-cortical function, but insufficient musculoskeletal coordination due to in-utero development problems

Cerebral pathology (abnormalities of the brain):

• Usually due to an organic brain problem
• Characterized by inadequate sensory cortex perception and uncoordinated musculoskeletal function
• Most neurotransmitter for movement is acetylcholine
• Problems with acetylcholine production/utilization or neurotransmitter binding receptor cause uncoordinated function
• Examples of Cerebral pathology: Amyotrophic lateral sclerosis and myasthenia gravis

Structural defects:

• Pathologic, traumatic, acquired, inflammatory, or genetic
• Adequate (though maybe inadequate) Sensory perception that leads to insufficient muscular coordination
• Spinal Assessment

Vertebral Column:

• Vertebrae is irregular bones
• Normal curvature: cervical (concave), thoracic (convex), lumbar (concave), sacral (Convex)
• Assess normal anatomical structures identify problems of the spine. Take note of these anatomical structures for further examination of the spine
• S-shape of the spine: Shock absorber, enhances strength and flexibility, and facilitates balance

Assessment findings

• Gluteal and shoulder-hip folds are symmetric
• Vertebral column is erect and bending forward allows for proper positioning
• Abnormalities suggest kyphosis, lordosis, or scoliosis

Assessment Procedures:

• Expose the back, buttocks, and legs
• Inspect spinal and trunk curves (posterior and lateral)
• Note differences in shoulder/iliac crest height

Kyphosis

• Increased thoracic spine curvature
• Occurs among elderly with osteoporosis/neuromuscular disorders due to bone porosity and ligament deterioration. Spinal ligaments no longer support spinal vertebrae.

Lordosis

• Sway-back posture
• Exaggerated lumbar spine curvature
• Common in pregnancy/abdominal obesity due to weight shifting the center of gravity downward

Scoliosis

• Lateral spine deviation
• Asymmetric waistline/prominent scapula
• Onset often adolescent, degree of activity can increase spinal curvature

Pathophysiology of Structural Spinal defects

• Lordosis: Continuous impact on lumbosacral vertebrae,
• Lumbosacral affectation due to pulling weight from center of gravity in pregnancy or obese clients
• Leads to disc misalignment and exaggerated lumbar concavity
• Ultimately causes a Waddled Gait(duck-like walking) upon ambulation
• Pressure and compression of lumbo-sacral nerve endings
• Nerves impulses are sent like “pain” causing client to experience Acute Pain
• Fluid leaks through vascular congestion

Pregnancy/Edema Consideration

• Some Pregnant women that present Edema in the lower extremity is caused by compression/congestion of the vascular structures within the lower extremities
• The above compression and congestion may also lead to injury to afferent and efferent neuronal pathways which can both lead to bowel and bladder affectation
• Bowel and bladder affectation in clients with Acute onset of pregnancy may cause an additional stress due to potential waistline increase.

Scoliosis specific factors

• Letter "S," spine deviates laterally with prominent scapula

Potential Causes

• Paraspinal injury
• Infectious agents
• Mechanical trauma
• Idiopathic

Kyphosis specific factors

• Kyphosis pathophysiology: excessive osteoclast activity (resorption) and decreased matrix formation
• Reduced structure in the spine, mineral storage in the body
• Osteoporosis is another key symptom. Usually happens in females
• Leads to forward spinal curvature, and therefore shortening

Management Interventions

• Exercise prevent muscle wasting & aid mobility, in either passive or active form
• Weight reduction
• Especially clients with lordosis because they are at risk of increased pressure to their spinal neural endings
• Orthosis prevent deformities from occurring
• Spinal bracing using Boston, Milwaukee, and Charleston braces

Surgical Interventions

• Spinal fusion to correct severe damage
• Insertion of instrumentation/rods to correct alignment
• Bone chips between vertebrae

(Spinal) Preoperative considerations

• Inform patient about potential post-operative numbness/tingling
• Emphasize postoperative importance of wearing prescribed braces

(Spinal) Postoperative considerations:

• Monitor for complications like clear leakage from dressing on affected area
• Cerebrospinal fluid Leakage - causes Spinal Headache
• Fat embolism
• Monitor for chest pain, dyspnea, and anxiety
• Lumbar radiculopathy: spinal nerve root problem, pain that shoots down the arm or leg
• Prevent Infection
• Maintain alignment with logroll maneuvers and prevent bending
• Elevate back to support the alignment
• Assess hypotension, V/S, movement and sensation, ability for patients to void

Knee Structures

• Genu Valgus: Knock-knees, knees angle in and touch
• Straightened legs
• Injury, bone infection, overweight/obesity, and rickets are the main etiologies for Genu Velgus
• Genu Varus: Bowlegs, archer's bow appearance
• Etiologies for Bow-legs are injury, bone infection, overweight/obesity, and rickets
• Genu Recurvatum: hyperextended knees bent backward

Genu Recurvatum Etiology:

• Ligament defect
• Malunion, trauma-related healing of fractured bones
• Gastrocnemius muscle weakness (calf muscle, major connector for both knee and ankle)
• Motor neuron defect
• Ligament defects, connecting to the femur, knees and the tibia and fibula
• Pathophysiology of Structural Knee defects

Three major parts of the knee that cause defects:

• Injury to the bone matrix
• Problems in the skeletal Growth and Development
• Problems with acetylcholine receptors and their function

Injured bone matrix will:

• Cause fracture, infect/ cause inflammation
• Inflammatory mediator migrate from affects site/ causes migration of osteoclasts and macrophages
• Osteoclasts break bone
• Cause the cartilage to be less dense which will cause joint injuries for younger patients of life
• Cause epiphyseal line to close, which leads to improper growth

Problems in Growth :

• Cause vitamin and calcium deficiency
• Demineralization of the epiphyseal cartilage
• Osteoid matrix lead to the different deformaties

Symptoms/Causes of Bone pathology

• Muscle atroghy and failure which causes muscle weakness
• Ach receptor cant reach motor neurons -Complications can cause various of the issues due to knee, Self esteme

Management:

• Physical therapy and brace attachments
• Osteonomy or bone shortening and alter the knees
• Total knee replacements

Structural Foot Defects

• Has 26 bones, has a spring function
• FEET
• Divided into three mainsections
• Flexible structures of bones, joints, muscles, and soft tissues

Main Sections

• Forefoot(5 toes and 5 metatasal)
• Midfoot with the arches _Hind foot (heel and ankle)

Foot drop

• Food is plantar flexed with toe dorsiflexion (ankle bends in direction the sole)
• Characterized in steppage gait
• Toes are dragged along the ground _ the patient will preform high steps or tip toe

Pathopphys:

Ineffective muscle function results the feet

Manifested

• Structural pulls and loss of functions (limited reach and stability )
• Affection from nerves and muscles

Congenital abnormalities

• Structural or motor

Management

• Help client to sit at 90 degrees
• Device installation of foot that supports
• Make frequent skin inspections by position

Nursing Care

• Help client to learn about procedures as well as equipment

Claw foot

• Disintictiy hollow

• Pes cavus

• Etiology Idiapathic or medical condituions

Manifestation

Bone contriction

Nursing Care

• Widen feet wear etc

Club Foot

• Rotate foot and compressed inside to out
• Is adiapathic
• Types of rotation inside / out

etiology

Malunion formation

Nursing Intervention

• Manage and reduce any pressure to site
• Use devices

Management of club foot

• Ponseti method

Hammer Toe:

• Flex
• May need surigcal allieviations

Etioology

• Overload and constricted

Corn and Callues

• Aredss of overgrowth of skin

Etioology or Cause

• Genetics or medical codition

Maintence and Prevautions

• Wear propery attire that will have the joints with space
• Surgery

Common Signs by Defect or disease states

• Pain
• Redness or Swelling
• Heat
• Loss of function

Management

• Maining of joints and muscles through stretching, strength training and more as recommended by physical therapeute.
• Help of balance with the addition of special braces during time of
• Prevent falls

Traumatic events

• Contusion
• Muscle Puling
• Sprain
• Fracture ( bone breaks)

Etiology

• blunt force/ contact that causes
• Puling or over strectging
• Injured by twisting
• Causes swelling, or breaks

Management

• Check area
• RICE- rest ice compres elevation
• Surgaical interveinal
• Heat and therapy for healing

Signs for Trauma (Bone injury)

• Pain swelling , bruising
• Bone or tissue damage that is shown through the bone fractures

Fracture Diagnostic

• Simple fracture
• Compound fracture
• Comminuted fracture(pieces scattered)
• Greenstick fracture (hair line fracture)

Pathophys

• Damaged tissued cause over sensativity that can be both helped and limited function

Key point in Traumatic Event Management

• Proper care following surgerical or non, should allow minimal contact and rest
• Elevation can allow best amount circulation

Key Point in Management and Prevention

• Maintain balance and exercise
• In some cases surgerical procedure
• Maintain hydration to prevent infection or complications.

Bone formation stages

• Damage/ break and hematnma
• Procallus formation
• callus formation
• Remodeled stage

Inflamatory Condition signs:

• Heat
• Redness
• Pain
• Swelling
• Loss function

Pathway of Inflammarory Condition

• Damage the Injured agents

• Stimute through immiune to bind and protect damage sites

• Migrate the cell will bind and make contrictuons to slow the damage

• With a lot of migration and bonding the vasulatiy is going to cause swelling and irratation in sites

Note of The Signs

• The signs are caused by various reactions to the sites and immune response

Pott Disease

It is Extra pulmarly damage with bacteria

Factor

• Infection or exposure

Pathophys

• Damaging of spine, causes disablility and or muscle function

Management

Testing procedure for for what best helps

Signeand Sypmtoms

Infection and abnormal function

Diagnostic

Test like skin , mTB

Interventions

Medications and or surgery

10F: Care of Clients with Neutral and Autoimmune Disturbances

• Seizure Episode or abnormal motor that the causes
• Nueron A working group of the brain, the causes that stimulate the actual seizures

Causes That

Can affect brian Medications and allergies Tumors

Phases

Phase of seizures and prodromal stage for when symtoms affect

Main Phases

Initial phases Postical - recover Actonic drugs Types of: Genteized

• Onset rapid Focal
• Orgginate on hemisphere

Diagnostic test:

• CT or MRI

Manage

Look for history of events Try precent damage Give care following procedures

Epilepsy

Can by caused by multiple syndromes

Causes of

• Traums
• Medical and health issues
• Tumor or health issue

Nursing

Precauntion for protecttion for the patient during

Headaches

• cephlalgia. Symptoms not disease based. Types and classificarion headache

Headche causes

• Tention
• Strain

How to clasify

• By sypmtoms and location

Diagnostic

• Evalation

Actions

• Dark / comfort
• Medication

Alters ( LOC)

• When orientatation is needed
• How you react

Results

• Brain issue
• Toxic

Diagnostic test

• Use cat to check for bleeding

Manifications

• Alter level changes

Nursing Care

• Check and help client