Treatment

Rheumatoid Arthritis

There is no knows method of preventing rheumatoid arthritis.

Medical Management

Common medical therapy for management of rheumatoid arthritis follows.

• Diagnostic Tests- Diagnosis is made by evaluating the results of history and physical examination, radiographic studies, and laboratory analysis. Diagnostic test results usually include the following:

• an elevated erythrocyte sedimentation rate

• mild leukocytosis

• positive rheumatoid factor

• increase turbidity and decreased viscosity of synovial fluid obtained by needle aspiration

• Medication – Inflammation is controlled with the use of salicylates. Medications are progressively added based on the patient’s response to basic therapy and about the toxicity of the medications. Adjunctive therapy may include the use of intraarticular steroids, therapy with analgesic agents that do not have anti-inflammatory effects (ex. Acetaminophen (Tylenol), propoxyphene (Darvon)), surgery, and/or antidepressant drugs.

• Treatment- consists of hot and cold packs to affected joints

• Diet- A nutritionally adequate diet is recommended. The patient is advised to maintain ideal body weight and to avoid weight gain, which will increase stress on the weight-bearing joints.

• Activity- The patient is advised to take frequent rest periods, avoid fatigue, and rest the affected joints. Instruct patient regarding energy conservation techniques. Assist patient in modifying daily routines to accommodate decreased abilities

• Goal of therapy

• Relief of pain

• Maintenance of joint function

• Prevention and correction of deformity by application of orthopaedic principles

• Correction of other health factor

Bacterial Arthritis

Medical Management includes the following:

1. Appropriate antibiotic therapy

2. Rest or immobilization of the joint

3. Surgical drainage or a system of irrigation and drainage if infection does not respond to antibiotic therapy or if osteomyletis is present.

4. Resumption of active range of motion when infection subsides and motion can be tolerated.

Osteoarthritis

Treatment includes the following:

• Weight reduction in instances of obesity

• Local heat to affected joints

• Medication to reduce symptoms, such as analgesics, anti-inflammatory agents, and steroids

• Exercise of affected extremities

• Surgical intervention

• Synovectomy- removal of the enlarged synovial membrane before bone and cartilage destruction occurs

• Arthrodesis – fusion of joint performed when joint surfaces severely damaged; this leaves patient with no range of motion of the affected joint.

• Reconstructive Surgery- replacement of badly damaged joint with a prosthetic device

• Activity – Emphasis is placed on the following:

• Unloading painful weight-bearing joints through the use of canes, walker, crutches

• Range of motion exercises to prevent deformities and contractures

Gouty Arthritis (gout)

Interventions and treatment includes the following:

• Administration of anti- inflammatory and uricosuric agents. ( ex. Probenecid, Colchicine, Allopurinol)

• Alkaline-ash diet to increase the pH of urine to discourage precipitation of uric acid and enhance the action of drugs such as Probenecid (Benemid)

• Elimination of foods high in purines (sweet breads, yeast, heart, sardines, and heavy alcohol intake)

• Explain to the patient that severe dietary purine restriction is not necessary as long as his or her hyperuricemia is well controlled by daily medication therapy.

• Weight loss is encouraged if indicated

• Promoting comfort

• Provide absolute rest until pain of acute attack subsides

• Avoid touching joint or moving affected extremity until acute pain subsides.