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COH- Nursing Management of Patients withConnective Tissue and Collagen Disorders

Overview of Common Rheumatic Diseases

(Key Points for Competitive Exams)

1. Rheumatoid Arthritis (RA)

  • Diagnosis:
    • Rheumatoid Factor (RF): Positive in ~80% of cases.
    • Anti-CCP antibodies: More specific for RA.
    • Elevated ESR, CRP: Indicate inflammation.
    • X-rays: Show joint erosion, osteopenia, and narrowing joint spaces.
  • Signs/Symptoms:
    • Joint pain and swelling: Bilateral and symmetrical.
    • Morning stiffness: Lasts >1 hour.
    • Small joints first: Hands, wrists, feet.
    • Systemic symptoms: Fatigue, fever, weight loss.
    • Deformities: Swan-neck, boutonnière, ulnar deviation.
  • Treatment:
    • NSAIDs: Pain relief.
    • Corticosteroids: Control inflammation.
    • DMARDs (Methotrexate, Sulfasalazine): Slow disease progression.
    • Biologics (Infliximab, Adalimumab): Target immune pathways.
  • Nursing Care:
    • Pain management: Heat packs, rest, assistive devices.
    • Joint protection: Encourage use of splints and braces.
    • Exercise: Low-impact exercises, ROM activities.
    • Patient education: Medication adherence, monitoring side effects, lifestyle modifications.

2. Systemic Lupus Erythematosus (SLE)

  • Diagnosis:
    • ANA (Antinuclear Antibodies): Positive in most cases.
    • Anti-dsDNA, Anti-Smith antibodies: Specific for SLE.
    • Low complement levels (C3, C4): Reflect disease activity.
    • Urinalysis, Renal biopsy: Detect lupus nephritis.
  • Signs/Symptoms:
    • Butterfly rash: Across the cheeks and nose.
    • Photosensitivity: Skin reactions to sunlight.
    • Arthritis: Non-erosive, migratory joint pain.
    • Systemic involvement: Kidney (nephritis), brain (seizures, psychosis), heart (pericarditis), lungs (pleuritis).
  • Treatment:
    • Corticosteroids: Control acute flares.
    • Antimalarials (Hydroxychloroquine): Skin and joint symptoms.
    • Immunosuppressants (Azathioprine, Cyclophosphamide): Severe organ involvement.
    • NSAIDs: Mild joint pain.
    • Biologics (Belimumab): Target specific immune pathways.
  • Nursing Care:
    • Skin protection: Avoid sun exposure, use sunscreen.
    • Rest and activity balance: Prevent fatigue.
    • Monitor for organ damage: Regular blood tests, urinalysis.
    • Patient education: Recognizing flare signs, medication adherence.

3. Scleroderma (Systemic Sclerosis)

  • Diagnosis:
    • ANA: Positive in most cases.
    • Anti-Scl-70 antibodies (Diffuse type): Specific marker.
    • Anti-centromere antibodies (Limited type): Associated with CREST syndrome.
    • Imaging (CT, X-ray): Assess lung fibrosis, joint changes.
    • Pulmonary Function Tests (PFTs): Detect restrictive lung disease.
  • Signs/Symptoms:
    • Skin tightening: Thick, shiny, tight skin (starts on hands, face).
    • Raynaud’s phenomenon: Finger color changes (white, blue, red) with cold.
    • Esophageal dysmotility: Swallowing difficulty, reflux.
    • Systemic involvement: Pulmonary fibrosis, renal crisis, cardiac complications.
  • Treatment:
    • Vasodilators (Nifedipine): Manage Raynaud’s.
    • Proton pump inhibitors (PPIs): Control GERD.
    • Immunosuppressants (Methotrexate, Mycophenolate): Skin and lung involvement.
    • ACE inhibitors: Prevent or treat scleroderma renal crisis.
  • Nursing Care:
    • Protect extremities: Keep warm, avoid triggers for Raynaud’s.
    • Swallowing assistance: Small, frequent meals, elevate head after eating.
    • Skin care: Moisturizers to reduce dryness.
    • Emotional support: Coping strategies for visible skin changes.

4. Polymyositis

  • Diagnosis:
    • Elevated muscle enzymes (CK, aldolase): Muscle inflammation.
    • Muscle biopsy: Confirms inflammation.
    • EMG (Electromyography): Abnormal muscle electrical activity.
    • ANA, Anti-Jo-1 antibodies: Present in some cases.
  • Signs/Symptoms:
    • Symmetrical muscle weakness: Proximal muscles (hips, shoulders).
    • Difficulty climbing stairs, rising from a chair, lifting arms.
    • Systemic symptoms: Dysphagia, interstitial lung disease.
  • Treatment:
    • Corticosteroids: First-line treatment.
    • Immunosuppressants (Azathioprine, Methotrexate): Steroid-sparing agents.
    • Physical therapy: Maintain muscle strength and function.
  • Nursing Care:
    • Activity modification: Balance rest and exercise.
    • Nutritional support: Ensure adequate protein intake.
    • Swallowing precautions: Monitor for dysphagia.

5. Osteoarthritis (OA)

  • Diagnosis:
    • X-rays: Joint space narrowing, osteophytes, subchondral sclerosis.
    • No specific blood test: ESR and CRP are usually normal.
  • Signs/Symptoms:
    • Joint pain: Worsens with activity, improves with rest.
    • Stiffness: Morning stiffness <30 minutes.
    • Crepitus: Joint grinding.
    • Deformities: Heberden’s and Bouchard’s nodes.
  • Treatment:
    • NSAIDs (Topical or oral): Pain relief.
    • Acetaminophen: First-line for mild to moderate pain.
    • Intra-articular corticosteroids: For severe joint inflammation.
    • Physical therapy, exercise: Improve strength, flexibility.
    • Surgery (Joint replacement): For advanced disease.
  • Nursing Care:
    • Pain management: Heat packs, rest, assistive devices.
    • Weight control: Reduce stress on weight-bearing joints.
    • Encourage regular, gentle exercise.

6. Ankylosing Spondylitis (AS)

  • Diagnosis:
    • HLA-B27 antigen: Present in ~90% of cases.
    • X-ray: “Bamboo spine” appearance.
    • MRI: Early inflammation and fusion of sacroiliac joints.
  • Signs/Symptoms:
    • Lower back pain: Worsens at night, improves with activity.
    • Reduced spinal mobility: “Stiff spine.”
    • Postural changes: Kyphosis in advanced stages.
    • Systemic symptoms: Eye inflammation (uveitis).
  • Treatment:
    • NSAIDs: First-line treatment for pain and stiffness.
    • Biologics (TNF inhibitors like Etanercept): Severe cases.
    • Physical therapy: Posture correction, exercises to maintain flexibility.
  • Nursing Care:
    • Encourage exercise: Swimming, yoga for flexibility.
    • Posture training: Prevent spinal deformity.
    • Pain management: Heat application, rest.

7. Gout

  • Diagnosis:
    • Synovial fluid analysis: Presence of urate crystals.
    • Serum uric acid levels: Elevated during or after acute attacks.
    • X-rays: Chronic gout shows “punched-out” lesions.
  • Signs/Symptoms:
    • Acute joint pain: Often the big toe (podagra).
    • Swelling, redness, warmth: Affected joint.
    • Tophi: Hard urate deposits in chronic gout.
  • Treatment:
    • Acute attacks: NSAIDs, colchicine.
    • Prevention: Allopurinol (lowers uric acid), febuxostat.
    • Lifestyle modifications: Low-purine diet, avoid alcohol.
  • Nursing Care:
    • Pain management: Cold packs, rest.
    • Dietary education: Low purine foods (reduce red meat, shellfish).
    • Weight management: Prevent future attacks.

8. Fibromyalgia

  • Diagnosis:
    • Widespread pain index (WPI) and symptom severity (SS) scale: Assess widespread pain and related symptoms.
    • No specific lab test: Diagnosis based on symptoms and exclusion of other conditions.
  • Signs/Symptoms:
    • Chronic widespread pain: Both sides of the body, above and below the waist.
    • Fatigue: Extreme tiredness not relieved by rest.
    • Cognitive issues: “Fibro fog” (difficulty concentrating).
    • Sleep disturbances.
  • Treatment:
    • Medications: Duloxetine, pregabalin, low-dose antidepressants.
    • Exercise: Low-impact aerobic activities, yoga.
    • Cognitive-behavioral therapy (CBT): Helps manage stress.
  • Nursing Care:
    • Encourage regular sleep patterns.
    • Promote gentle exercise.
    • Support coping strategies: Stress reduction techniques, relaxation training.

🚨 Quick Highlights for Exams:

  • RA = Anti-CCP antibodies; morning stiffness >1 hour.
  • SLE = ANA positive, butterfly rash, multisystem involvement.
  • Scleroderma = Skin tightening, Raynaud’s phenomenon.
  • Polymyositis = Proximal muscle weakness, elevated CK.
  • OA = Joint pain worsens with use; Heberden’s nodes.
  • AS = Bamboo spine on X-ray, HLA-B27 positive.
  • Gout = Uric acid crystals, podagra.
  • Fibromyalgia = Chronic widespread pain, “fibro fog.”
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Categorized as COH-MSN, Uncategorised