MINI MED SCHOOL: ARTHRITIS
3 INSERVICE HOURS
OBJECTIVES:
At the end of this class, you will be able to:
1. List the types of arthritis.
2. Describe rheumatoid arthritis, osteoarthritis and gout.
Arthritis is an inflammatory disease of the joints that limits movement and leads to pain. It is the number one chronic disorder in our country. It also leads to disability. About 66 million people, that is, one out of every 3 adults in our nation, are affected by arthritis. About 300,000 children in our country have it. It costs the United States more than $86 billion every year. (Arthritis Foundation, 2004)
CAUSES
It can be caused by an infection in the joint, genes, a buildup of uric acid or simply with the breakdown of a joint as the person grows older.
There are more than 100 different types of arthritis like those below.
This type is the most disabling form or type. Mostly women get this. It happens when the lining of the joint becomes inflamed because the person has a problem with their immune system. Younger people from 30 to 50 years of age get this form more than other age groups. It can also occur in a young child. This form is called Still's disease or childhood arthritis.
This form leads to very painful swelling of the joints, mostly with the smaller, non-weight bearing joints of the body. It is most often seen in the hands and fingers. Permanent joint deformity can occur.
This is the most common form of arthritis. It is a degenerative joint disease. The ends of the bones break down and they become very rough. They are no longer smooth. Bones rub against rough bones as a result of this break down. This movement is no longer smooth. The person has pain and a loss of movement in the area. This form mostly affects large and weight-bearing joints like the hip, knee and back but it is also seen in the hands.
Older people get this form more than others. Women after menopause are at risk because the hormones of the body (estrogen) change. There is no cure for this form but there are medicines that can help stop the pain and to help the person to able to move about. Exercise also helps.
Some people may become so crippled that they only are able to stay in bed.
A defect in body’s function causes this type. The body has a buildup of uric acid. This leads to the buildup of crystals in the joints. It is called the “rich man’s disease” because many used to think that a rich diet and alcohol caused it. Now we know that this is not true. This form affects small joints, like the great toe. Men get it more than women. Gout is very different from the other forms.
There are many other forms but the three above are the most common.
Some other forms are lupus, septic arthritis that occurs after an infection like pneumonia, and arthritis that happens after a person has a fungal infection.
RHEUMATOID ARTHRITIS
About 6.5 million people in the United States are affected with this form of arthritis. Women are up to three times more likely than men to have it. It can start at any age, but it most often starts between 25 and 50 years of age. The cause is really not known but many think that it results from the person’s genes. It gets worse and worse but it does have periods of time when the symptoms go away and then return.
Some of the early signs are:
Some of the middle stage signs are:
The late signs are:
The American Rheumatoid Association (ARA) has established these criteria:
The doctor does a complete physical exam and medical history of the person. Some blood tests are taken. The person will show signs of anemia, high white blood cell counts and "rheumatoid factors" among other things that are not normal.
The goals of treatment are to control the inflammatory process and to stop some of the painful signs. There is no treatment available to fix any existing damage to the joints. The damage is permanent.
Some of the treatments are.
Passive range of motion should be done during the times that acute inflammation is over. All exercise should be done to the point of pain. Exercises keep and restore normal, or near normal, range of motion, muscle mass and strength.
Walking aids such as a walker and/or splints, and special shoe inserts may help the person to walk and to lower the pain.
Some of the side effects are GI upset, heart complications, blood changes, kidney problems, stomach pain, hepatitis, anorexia, dizziness and sleepiness.
Gold is given with a shot every week. Long term treatment for several years can be done but when it is stopped, the person will again get the pain. Some of the side effects are changes in theblood, therefore, the person will need lab tests very often.
Gold is not given to patients who have kidney disease, liver disease or problems with their blood.
Osteoporosis is a general, progressive breakdown of the bones.
There are three types of osteoporosis:
Type 1 is six times more prevalent in women than in men. This type appears between the ages of 51 and 75 years of age. Many women have it after menopause. Bone fractures happen very often. The cause of primary osteoporosis is not known.
Type 2 is two times more common in women than men and its onset is usually after 60 years of age. This type is a part of the normal aging process because there are fewer bone building cells. Neck fractures, fractures of the pelvis, the spine, the hip and the leg often happen. Some people, like women, can have both type 1 and type 2 at the same time.
Secondary osteoporosis can be caused by a number of diseases, like diabetes and hyperactive thyroid, some medicines, and things like long periods of time when the person is not bearing weight or they are in space without gravity. Calcium leaves the bones when a person is not bearing weight. This is the least common type of arthritis.
Some of the risk factors of type 1 and type 2 primary osteoporosis are:
Bone is destroyed at a greater rate than it is being formed.
People may have no signs at all in the early stage. The first symptom is usually a dull, aching, constant pain in the bones, mostly in the back. The pain may also go down the leg, and muscle spasm may be present. Later, the back pain may become chronic and never ending. The lower neck and below is the most common area for this disease. Bone fractures may also happen.
Other early signs and symptoms are:
Some of the middle stage signs and symptoms include lessening joint motion as
well as joint:
The late signs and symptoms are:
Complications
Some of the complications are:
Osteoporosis is diagnosed with a clinical assessment, the presence of bone and/or joint pain, lab findings, x-ray, and CT scans.
Prevention
Some of the things that can be done to prevent it are:
The cause of gout is not known but a number of things, including the over production of uric acid, can cause gout. Some of the other things are:
The more developed nations of the world have a greater incidence of gout than the undeveloped nations. Men are affected with gout more than women. It is rare in women prior to menopause. More severe symptoms are found among those that have had a bout of gout before the age of 30.
The first sign is usually pain in one or more joints at night time. The big toe is affected most often, however, it can also be found in the knee, ankle, instep, wrist, and elbow.
Other signs are:
Chronic arthritis, chronic joint pain, permanent joint damage, and limitations of joint mobility and function can occur if it goes untreated.
The joints that are most often affected are those of the feet and hands, however, the shoulder, cervical spine, and hip can also be affected with gout.
The diagnosis of gout is made after a physical exam, lab work, and the signs of the disease.
The goals of treatment include:
Some of the treatments are surgery, medicines including NSAIDs, exercise, rest, splints, a good diet and the avoidance of alcohol.
Copyright © 2009 Alene Burke
American College of Rheumatology (2004). "About the American College of Rheumatology." http://www.rheumatology.org/about/index.asp?aud=mem
Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS, et al.(1988). "The American Rheumatism Association 1987 Revised Criteria for the Classification of Rheumatoid Arthritis". Arthritis Rheum. 1988 Mar;31(3):315-24 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve &db=PubMed&list_uids=3358796&dopt=Abstract
Arthritis Foundation (2004). "The Facts About Arthritis". http://www.arthritis.org/resources/gettingstarted/default.asp
Arthritis Foundation (2005). "Straight Talk About Selective COX-2 Inhibitors and NSAIDs". http://www.arthritis.org/conditions/NSAIDS/Straight_Talk_FAQ.asp
Langford, Rae W. and June D. Thompson (2000). Mosby's Handbook of Diseases, 2nd Edition. Mosby Inc.
MDchoice, Inc. (2005)."Fungal Arthritis." http://www.drkoop.com/ency/93/000444.html
MDchoice, Inc. (2005). "Non-gonococcal (septic) Bacterial Arthritis" http://www.drkoop.com/ency/93/000430.html
MDchoice, Inc. (2005). "Psoritic Arthrits" http://www.drkoop.com/ency/93/000413.html
Merck & Co., Inc. (2005) Beers, Mark H. and Robert Berkow. Merck Manual of Diagnosis and Therapy: Seventeenth Edition. "Gout" Section 5Chapter 55. 2005. http://www.merck.com/mrkshared/mmanual/section5/chapter55/55a.jsp
Merck & Co. Inc. (2005) Beers, Mark H. and Robert Berkow. Merck Manual of Diagnosis and Therapy: Seventeenth Edition. "Osteoporosis" Section 5 Chapter 57. http://www.merck.com/mrkshared/CVMHighLight?file=/mrkshared/mmanual/section5/chapter57/57a.jsp%3Fregion%3 Dmerckcom&word=osteoporosis&domain=www.merck.com#hl_anchor
Merck & Co., Inc. (2005) Beers, Mark H. and Robert Berkow. Merck Manual of Diagnosis and Therapy: Seventeenth Edition. "Rheumatoid Arthritis" Section 5, Chapter 50. http://www.merck.com/mrkshared/mmanual/section5/chapter50/50a.jsp
Skidmore-Roth, Linda (2004). Mosby's Rapid Reference Library: Nursing Drug Reference. CD-ROM
3 INSERVICE HOURS
OBJECTIVES:
At the end of this class, you will be able to:
1. List the types of arthritis.
2. Describe rheumatoid arthritis, osteoarthritis and gout.
INTRODUCTION
Arthritis is an inflammatory disease of the joints that limits movement and leads to pain. It is the number one chronic disorder in our country. It also leads to disability. About 66 million people, that is, one out of every 3 adults in our nation, are affected by arthritis. About 300,000 children in our country have it. It costs the United States more than $86 billion every year. (Arthritis Foundation, 2004)
CAUSES
It can be caused by an infection in the joint, genes, a buildup of uric acid or simply with the breakdown of a joint as the person grows older.
TYPES OF ARTHRITIS
There are more than 100 different types of arthritis like those below.
- Rheumatoid Arthritis
This type is the most disabling form or type. Mostly women get this. It happens when the lining of the joint becomes inflamed because the person has a problem with their immune system. Younger people from 30 to 50 years of age get this form more than other age groups. It can also occur in a young child. This form is called Still's disease or childhood arthritis.
This form leads to very painful swelling of the joints, mostly with the smaller, non-weight bearing joints of the body. It is most often seen in the hands and fingers. Permanent joint deformity can occur.
- Osteoarthritis
This is the most common form of arthritis. It is a degenerative joint disease. The ends of the bones break down and they become very rough. They are no longer smooth. Bones rub against rough bones as a result of this break down. This movement is no longer smooth. The person has pain and a loss of movement in the area. This form mostly affects large and weight-bearing joints like the hip, knee and back but it is also seen in the hands.
Older people get this form more than others. Women after menopause are at risk because the hormones of the body (estrogen) change. There is no cure for this form but there are medicines that can help stop the pain and to help the person to able to move about. Exercise also helps.
Some people may become so crippled that they only are able to stay in bed.
- Gout
A defect in body’s function causes this type. The body has a buildup of uric acid. This leads to the buildup of crystals in the joints. It is called the “rich man’s disease” because many used to think that a rich diet and alcohol caused it. Now we know that this is not true. This form affects small joints, like the great toe. Men get it more than women. Gout is very different from the other forms.
- Other Forms
There are many other forms but the three above are the most common.
Some other forms are lupus, septic arthritis that occurs after an infection like pneumonia, and arthritis that happens after a person has a fungal infection.
RHEUMATOID ARTHRITIS
About 6.5 million people in the United States are affected with this form of arthritis. Women are up to three times more likely than men to have it. It can start at any age, but it most often starts between 25 and 50 years of age. The cause is really not known but many think that it results from the person’s genes. It gets worse and worse but it does have periods of time when the symptoms go away and then return.
The Signs
Some of the early signs are:
- a low grade fever,
- the feeling of being sick (malaise),
- fatigue,
- weight loss and
- a loss of appetite.
Some of the middle stage signs are:
- tenderness of the joints,
- joint pain and stiffness of 30 minutes or more after waking up and/or after the person is not moving about,
- small joints of the hands and/or foot, the elbows, wrists and/or the ankles are affected on both sides,
- afternoon fatigue,
- decrease of joint function and movement,
- the joints stay closed and not open (flexion contractures), and
- deformities.
The late signs are:
- severe tenderness in affected joints,
- severe joint pain,
- nodes or lumps under the skin and in the organs of the body,
- subcutaneous and visceral nodules,
- fever,
- poor leg circulation and leg ulcers,
- dry mouth,
- inflammation around the heart (pericarditis),
- a large spleen, and
- large lymph nodes
Diagnosis
The American Rheumatoid Association (ARA) has established these criteria:
- morning stiffness in and around joints lasting at least 1 hour before it gets better;
- soft tissue swelling of 3 or more joint areas;
- swelling of the hand, finger or wrist joints;
- swelling on both sides of the body;
- nodules;
- rheumatoid factor in the blood; and
- damaged joints in hand and/or wrist joints that are seen with an x-ray.
The doctor does a complete physical exam and medical history of the person. Some blood tests are taken. The person will show signs of anemia, high white blood cell counts and "rheumatoid factors" among other things that are not normal.
Treatment
The goals of treatment are to control the inflammatory process and to stop some of the painful signs. There is no treatment available to fix any existing damage to the joints. The damage is permanent.
Some of the treatments are.
- Rest. Complete bed rest may be needed when pain is severe. Otherwise, regular rest and sleep is all that is needed.
- Nutrition. A regular, good diet is necessary. Plant oil and/or fish oil supplements may help some people.
A good diet must have all four food groups. The four food groups are:
- Dairy. Cheese, milk and yogurt are dairy foods
- Meat. Chicken, steak, fish, beans, pork and veal products are members of the meat group.
- Fruits and vegetables. Apples, pears, lettuce, tomatoes, orange juice and potatoes are some of the foods that people can eat to get their daily fruits and vegetables.
- Grains. Bread and cereal belong to the grains food group.
- Exercise. Active range of motion and active exercise like walking and hand exercises should be done to prevent permanent damage. Splints are often also used.
Passive range of motion should be done during the times that acute inflammation is over. All exercise should be done to the point of pain. Exercises keep and restore normal, or near normal, range of motion, muscle mass and strength.
- Physical therapy is often used if the doctor orders it. They may use:
- cool, wet compresses;
- wax treatments and wax gloves to bring down the swelling and pain;
- range of motion exercise, and
- strength exercises.
Walking aids such as a walker and/or splints, and special shoe inserts may help the person to walk and to lower the pain.
- Occupational therapy may also be used in the plan of care to help the patient to better do their activities of daily living like their bath, eating and dressing. Self help devices, like grasping tools and special eating things, may also be used.
- NSAID Medicines These lower the inflammation and also help the pain. Many, like aspirin, can be bought over the counter without an order by the doctor.
Some of the side effects are GI upset, heart complications, blood changes, kidney problems, stomach pain, hepatitis, anorexia, dizziness and sleepiness.
- Gold. When the NSAIDs have not helped the pain and swelling after 2 to 4 months, gold is used to lower the pain, reduce the inflammation, and to decrease the chance of bone erosion.
Gold is given with a shot every week. Long term treatment for several years can be done but when it is stopped, the person will again get the pain. Some of the side effects are changes in theblood, therefore, the person will need lab tests very often.
Gold is not given to patients who have kidney disease, liver disease or problems with their blood.
- Other medicines There are other medications, such as steroids and shots into the joints, that can by used if the doctor orders them. All have side effects.
- Surgery. This may be done to maintain joint function and to relieve some of the pain.
OSTEOPOROSIS or OSTEOARTHITIS
Osteoporosis is a general, progressive breakdown of the bones.
There are three types of osteoporosis:
- Primary osteoporosis Type 1
- Primary osteoporosis Type 2
- Secondary osteoporosis
Type 1 is six times more prevalent in women than in men. This type appears between the ages of 51 and 75 years of age. Many women have it after menopause. Bone fractures happen very often. The cause of primary osteoporosis is not known.
Type 2 is two times more common in women than men and its onset is usually after 60 years of age. This type is a part of the normal aging process because there are fewer bone building cells. Neck fractures, fractures of the pelvis, the spine, the hip and the leg often happen. Some people, like women, can have both type 1 and type 2 at the same time.
Secondary osteoporosis can be caused by a number of diseases, like diabetes and hyperactive thyroid, some medicines, and things like long periods of time when the person is not bearing weight or they are in space without gravity. Calcium leaves the bones when a person is not bearing weight. This is the least common type of arthritis.
Some of the risk factors of type 1 and type 2 primary osteoporosis are:
- Lack of exercise
- Long periods of immobility
- Menopause (surgical or natural)
- Late onset of the woman’s “period”
- Early menopause
- A loss of ovary function
- Sex (women are at greater risk then men)
- Race (the white and Asian race are at greatest risk)
- A family history of it
- Malnutrition
- Lack of calcium
- Lack of vitamin D
- High sugar intake
- Eating large amounts of red meat
- Eating disorders
- Intense exercisers, particularly when the person is also underweight
- Cigarette smoking
- Coffee and alcohol use and abuse
Signs and Symptoms
Bone is destroyed at a greater rate than it is being formed.
People may have no signs at all in the early stage. The first symptom is usually a dull, aching, constant pain in the bones, mostly in the back. The pain may also go down the leg, and muscle spasm may be present. Later, the back pain may become chronic and never ending. The lower neck and below is the most common area for this disease. Bone fractures may also happen.
Other early signs and symptoms are:
- joint pain that can get worse with exercise or as the day, and its normal activities, goes on, and
- stiffness after a period of immobility
Some of the middle stage signs and symptoms include lessening joint motion as
well as joint:
- crackling sounds and feelings,
- tenderness,
- bone grating,
- flexion contractures, and
- enlarged joints.
The late signs and symptoms are:
- an increase in the duration and degree of pain,
- joint tenderness,
- pain with passive range of motion, and
- joint deformity.
Complications
Some of the complications are:
- deformities,
- immobility,
- spinal damage, and
- fractures.
Diagnosis
Osteoporosis is diagnosed with a clinical assessment, the presence of bone and/or joint pain, lab findings, x-ray, and CT scans.
Prevention
Some of the things that can be done to prevent it are:
- exercise,
- calcium and vitamin D and
- bone density tests every 1 to 3 years after age 49 especially for women.
- Exercise. A regular exercise routine can strengthen the muscles, maintain joint mobility, and to decrease the rate of calcium loss.
- Physical therapy. These treatments aim to prevent deformity, increase joint mobility, decrease pain, restore lost function, in some cases, and to help the person to perform their activities of daily living. Heat, massage, walking assistance with a walker or cane and other treatments may be done.
- A regular, nutritious diet. This diet should be high in protein. Women should take or consume 1500 mg of calcium a day and men should take or consume 1,000 to 3,500 mg of calcium a day if they are not taking in calcium in a normal manner. Vitamin D should be taken with calcium.
- Medicines. Hormones, like estrogen, other similar drugs, NSAIDS, aspirin, salmon cacitonin, fluoride, and newer bone building drugs are used.
GOUT
The cause of gout is not known but a number of things, including the over production of uric acid, can cause gout. Some of the other things are:
- Genes
- Drugs like “water pills” and alcohol
- Diseases like sickle cell anemia and diabetes
The more developed nations of the world have a greater incidence of gout than the undeveloped nations. Men are affected with gout more than women. It is rare in women prior to menopause. More severe symptoms are found among those that have had a bout of gout before the age of 30.
Signs
An acute attack of gout can occur at any time without any warning but it sometimes follows stress (physical or emotional), surgery, alcohol, an infection and fatigue.
The first sign is usually pain in one or more joints at night time. The big toe is affected most often, however, it can also be found in the knee, ankle, instep, wrist, and elbow.
Other signs are:
- pain that can be very severe,
- red joints,
- swelling,
- tender joints,
- warm, shiny, tense purple or red skin color over the joint(s),
- fast pulse,
- chills,
- fever, and
- limited joint movement.
Complications
Chronic arthritis, chronic joint pain, permanent joint damage, and limitations of joint mobility and function can occur if it goes untreated.
The joints that are most often affected are those of the feet and hands, however, the shoulder, cervical spine, and hip can also be affected with gout.
Diagnosis
The diagnosis of gout is made after a physical exam, lab work, and the signs of the disease.
Treatment
The goals of treatment include:
- the prevention of acute attacks,
- ending an acute attack when it does occur,
- the prevention of further crystal deposits and
- eliminating existing tophi.
Some of the treatments are surgery, medicines including NSAIDs, exercise, rest, splints, a good diet and the avoidance of alcohol.
Copyright © 2009 Alene Burke
REFERENCES
American College of Rheumatology (2004). "About the American College of Rheumatology." http://www.rheumatology.org/about/index.asp?aud=mem
Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS, et al.(1988). "The American Rheumatism Association 1987 Revised Criteria for the Classification of Rheumatoid Arthritis". Arthritis Rheum. 1988 Mar;31(3):315-24 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve &db=PubMed&list_uids=3358796&dopt=Abstract
Arthritis Foundation (2004). "The Facts About Arthritis". http://www.arthritis.org/resources/gettingstarted/default.asp
Arthritis Foundation (2005). "Straight Talk About Selective COX-2 Inhibitors and NSAIDs". http://www.arthritis.org/conditions/NSAIDS/Straight_Talk_FAQ.asp
Langford, Rae W. and June D. Thompson (2000). Mosby's Handbook of Diseases, 2nd Edition. Mosby Inc.
MDchoice, Inc. (2005)."Fungal Arthritis." http://www.drkoop.com/ency/93/000444.html
MDchoice, Inc. (2005). "Non-gonococcal (septic) Bacterial Arthritis" http://www.drkoop.com/ency/93/000430.html
MDchoice, Inc. (2005). "Psoritic Arthrits" http://www.drkoop.com/ency/93/000413.html
Merck & Co., Inc. (2005) Beers, Mark H. and Robert Berkow. Merck Manual of Diagnosis and Therapy: Seventeenth Edition. "Gout" Section 5Chapter 55. 2005. http://www.merck.com/mrkshared/mmanual/section5/chapter55/55a.jsp
Merck & Co. Inc. (2005) Beers, Mark H. and Robert Berkow. Merck Manual of Diagnosis and Therapy: Seventeenth Edition. "Osteoporosis" Section 5 Chapter 57. http://www.merck.com/mrkshared/CVMHighLight?file=/mrkshared/mmanual/section5/chapter57/57a.jsp%3Fregion%3 Dmerckcom&word=osteoporosis&domain=www.merck.com#hl_anchor
Merck & Co., Inc. (2005) Beers, Mark H. and Robert Berkow. Merck Manual of Diagnosis and Therapy: Seventeenth Edition. "Rheumatoid Arthritis" Section 5, Chapter 50. http://www.merck.com/mrkshared/mmanual/section5/chapter50/50a.jsp
Skidmore-Roth, Linda (2004). Mosby's Rapid Reference Library: Nursing Drug Reference. CD-ROM