HEMATID ATHITIS
A is a hni infammaty disease that affets jints and the gan systems. A affets 0.5% t 1% f the ppatin wdwide.
Pathphysigy and Etigy
* Immngi pesses est in infammatin f synvim, pding antigens and infammaty by-pdts that ead t desttin f atia atiage, edema, and pdtin f a gana tisse aed panns
* Ganatin tisse fms adhesins that ead t deeased jint mbiity.
* Simia adhesins an in sppting sttes, sh as igaments and tendns, and ase ntates and ptes that fthe affet jint stte and mbiity.
* The etigy is nknwn bt is pbaby a mbined effet f envinmenta, epidemigi, infetis, and geneti fats.
* An infetis agent has nt been identified, bt many infetis pesses an pde a pyathitis simia t A.
* Wmen ae affeted me feqenty than men.
inia Manifestatins
* Athitis
* Biatea, symmeti athitis affets any diathdia jint, bt mst mmny invves the hands, wists, knees, and feet
* Skin manifestatins
* hematid ndes : ebws, ipt, sam.
* Vasiti hanges : bwn, spinteike esins in finges nai fds.
* adia manifestatins
* Ate peiaditis.
* ndtin defets.
* Vava insffiieny.
* nay ateitis.
* adia tampnade : ae.
* Pmnay manifestatins
* Asymptmati pmnay disease.
* Pea effsin, peisy.
* Intestitia fibsis.
* ayngea bsttin ased by invvement f the iaytenid jint ae.
* Negi manifestatins
* Mnneitis mtipex : wist dp, ft dp.
* apa tnne syndme.
* mpessin f spina neve ts.
* Dista sensy nepathy
* the manifestatins
* Feve.
* Fatige.
* Weight ss.
* Episeitis
Diagnsti Evaatin
* mpete bd nt (B) : nmhmi, nmyti anemia f hni disease; may as have in defiieny anemia (hyphmi, miyti).
* F : psitive in 70% t 80% f patients with A.
* ES and -eative ptein : eevated de t ative infammatin.
* Synvia fid anaysis
* X-ays : hanges devep within 2 yeas.
* Handswists : magina esins f the pxima intephaangea (PIP), metaapphaangea, and apa jints; geneaized stepenia.
* evia spine : esins that pde atantaxia sbxatin.
* Magneti esnane imaging (MI) : t detet spina d mpessin that ests fm 1 t 2 sbxatin and mpessin f snding vasa sttes.
* Bne san : ineased ptake in the jints invved in A.
* Synvia bipsy.
* Infammaty es assiated with A.
* Exdes the ases f pyathitis by nting the ak f the pathgi findings.
Management
* NSAIDs t eieve pain and infammatin.
* DMADs t ede disease ativity.
* Mntheapy mbinatin f de agent, sh as methtexate hydxyhqine, with newe agent, sh as tm nesis fat (TNF) inhibit bigi agent.
* mbinatin f TNF inhibit and methtexate has shwn geate benefit in impving signs and symptms, pevent adigi deteiatin f the jint, and impve physia fntin in mpaisn with mntheapy.
* Ga is t have ng-tem impat n the jint.
* tisteids t ede infammaty pess.
* a mft meases:
* Appiatin f heat and d.
* se f spints.
* se f tanstanes eetia neve stimatin (TENS) nit.
* Intphesis deivey f mediatin thgh the skin sing diet eetia ent.
* Nnphamagi mdaities:
* Behavi mdifiatin.
* eaxatin tehniqes.
* Sgey:
* Synvetmy.
* Athdesis jint fsin.
* Tta jint epaement.
mpiatins
* ss f jint fntin bease f bny adhesins and damage f sppting sttes 7% f patients beme disabed within 5 yeas f nset; 32% annt wk afte 10 yeas.
* Anemia f hni disease.
* Fety's syndme : netpenia, spenmegay, and defmity; s in 1% f patients
Nsing Assessment
* Pefm jint examinatin if indiated, inding whih jints affeted; M f eah jint; pesene f heat, edness, sweing, and pssibe jint effsin.
* Nte pesene f defmities:
* Swan nek : PIP jints hypeextend.
* Btnniee : PIP jints fex.
* na deviatin : finges pint twad na.
* Assess pain sing a pain measement sae sh as the visa anag sae (10 m staight ine sed 0 t 100; patient makes a mak indiating intensity f pain).
* Assess fntina stats sing the Ameian ege f hematgy : evised iteia f assifiatin f gba fntina stats.
* ass I : mpetey abe t pefm sa ativities f daiy iving (ADs).
* ass II : abe t pefm sa sef-ae and vatina ativities, bt imited in avatina ativities.
* ass III : abe t pefm sa sef-ae ativities, bt imited in vatina and avatina ativities.
* ass IV : imited abiity t pefm sa sef-ae, vatina, and avatina ativities.
* Assess f adheene t teatment pan, any mpementay methds sed, and any advese eatins t mediatins.
Nsing Diagnses
* hni Pain eated t disease pess
* Impaied Physia Mbiity eated t pain and imited jint mtin
* Dessing Gming Sef-ae Defiit eated t imitatins senday t disease pess
* Ineffetive ping eated t pain, physia imitatins, and hniity f A