Disorders of Skeletal Function: Rheumatic Disorders

Arthritis
Primary arthritis
Those affecting body systems in addition to the musculoskeletal system
Resulting from an immune response
Secondary arthritis
Rheumatoid conditions limited to a single or few diarthrodial joints
Resulting from a degenerative process and the resulting joint irregularities that occur as the bone attempts to remodel itself
Characteristics of Rheumatoid Arthritis
Associated with extra-articular as well as articular manifestations
Usually has an insidious onset marked by systemic manifestations such as fatigue, anorexia, weight loss, and generalized aching and stiffness.
Characterized by exacerbations and remissions
May involve only a few joints for brief durations, or it may become relentlessly progressive and debilitating
Results of Progressive Joint Destruction
May lead to subluxation (dislocation of the joint resulting in misalignment of the bone ends)
Instability of the joint
Limitation of movement
Symptoms of RA
Fatigue
Weakness
Anorexia
Weight loss
Low-grade fever
Anemia
Systemic Autoimmune Rheumatic Diseases
A group of chronic disorders characterized by diffuse inflammatory lesions and degenerative changes in connective tissue
These disorders share similar clinical features and may affect many of the same organs
American Rheumatism Association Criteria for Rheumatoid Arthritis
Morning stiffness at least 1 hour present at least 6 weeks
Swelling of 3 or more joints for at least 6 weeks
Swelling of wrist, metacarpophalangeal or proximal interphalangeal joints for 6 or more weeks
Systemic joint swelling
Hand roentgenogram changes typical of RA
Rheumatoid nodules
Serum rheumatoid factor
Treatment Goals for a Person with RA
Reduce pain
Minimize stiffness and swelling
Maintain mobility
Become an informed health care consumer
Strategies to Aid in Symptom Control
Regulating activity by pacing
Establishing priorities
Setting realistic goals
Characteristics of Systemic Lupus Erythematosus (SLE)
Formation of autoantibodies and immune complexes
B-cell hyper-reactivity
Increased production of antibodies against self (autoantibodies) and non-self antigens
The autoantibodies can directly damage tissues or combine with corresponding antigens to form tissue-damaging immune complexes
Categories of Clinical Manifestations of SLE
Constitutional
Musculoskeletal
Dermatologic
Cardiovascular
Pulmonary
Renal
Neuropsychiatric
Types of Scleroderm
Diffuse or generalized form
Skin changes involve the trunk and proximal extremities
Limited or CREST variant
Hardening of the skin (scleroderma) is limited to the hands and face
Manifestations of the CREST Syndrome
Calcinosis (calcium deposits in the subcutaneous tissue that erupt through the skin)
Raynaud’s phenomenon
Esophageal dysmotility
Sclerodactyly (localized scleroderma of the fingers)
Telangiectasia

Types of Seronegative Spondyloarthropathies
Ankylosing spondylitis
Juvenile ankylosing spondylitis
Reactive arthritis, enteropathic arthritis (i.e., inflammatory bowel disease)
Psoriatic arthritis
Methods of Assessing Mobility and Detecting Sacroiliitis
Pressure on the sacroiliac joints with the person in a forward-bending position to elicit pain and muscle spasm
Measurement of the distance between the tips of fingers and the floor in a bent-over position with straight knees,
Modified Schöber’s test in which contralateral flexion of the back is measured
Measurement of chest expansion may be used as an indirect indicator of thoracic involvement

Reiter’s Syndrome
Clinical manifestation of reactive arthritis
Accompanied by extra-articular symptoms such as uveitis, bowel inflammation, carditis
Develops in a genetically susceptible host after
a bacterial infection due to Chlamydia trachomatis in the genitourinary tract
Salmonella, Shigella, Yersinia, or Campylobacter in the gastrointestinal tract

Subgroups of Psoriatic Arthritis
Oligoarticular or asymmetric (48%)
Spondyloarthropathy (24%)
Polyarticular, or symmetric (18%)
Distal interphalangeal (8%)
Mutilans (2%)
Causes of Osteoarthritis
Post-inflammatory diseases
Post-traumatic disorders
Anatomic or bony disorders
Metabolic disorders
Neuropathic arthritis
Hereditary disorders of collagen
Idiopathic or primary variants
Preventing Knee and Hip Osteoarthritis
Losing weight
Preventing injury
Strengthening the muscles bridging joints
Modifying job tasks
Metabolic and Endocrine Diseases Associated with Joint Symptoms
Amyloidosis
Osteogenesis imperfecta
Diabetes mellitus
Hyperparathyroidism
Thyroid disease
AIDS
Hypermobility syndromes
Gout Syndrome
Acute gouty arthritis with recurrent attacks of severe articular and periarticular inflammation
Tophi or the accumulation of crystalline deposits in articular surfaces, bones, soft tissue, and cartilage
Gouty nephropathy or renal impairment
Uric acid kidney stones
Types of Gout
Primary gout
Designate cases in which the cause of the disorder is unknown or an inborn error in metabolism
Characterized primarily by hyperuricemia and gout
Secondary gout
The cause of the hyperuricemia is known but the gout is not the main disorder
Objectives for Treatment of Gout
Termination and prevention of the acute attacks of gouty arthritis
Correction of hyperuricemia
Inhibition of further precipitation of sodium urate
Absorption of urate crystal deposits already in the tissues

Juvenile Rheumatoid Arthritis (JRA)
Definition
A chronic disease characterized by synovitis
Manifestations
Can influence epiphyseal growth by stimulating growth of the affected side
Generalized stunted growth also may occur

Manifestations of Children with SLE
Constitutional symptoms
Fever, malaise, anorexia, weight loss
Symptoms of the integumentary, musculoskeletal, central nervous, cardiac, pulmonary, and hematopoietic systems are similar to those of adults
Endocrine abnormalities include
Cushing’s syndrome from long-term corticosteroid use
Autoimmune thyroiditis
Signs and Symptoms of Giant Cell Arteritis
Constitutional symptoms
Malaise, fatigue, fever, weight loss, cough, sore throat
Polymyalgia rheumatica syndrome
Manifestations related to vascular involvement
Ischemic optic neuropathy
Claudication of jaw or arm