-autoimmune (genetic basis)
-emotional stress (triggers exacerbation)
(disease pattern): bilateral, symmetric, multiple joints, usually affects UEs 1st, distal interphalangeal joints of hands spared, SYSTEMIC
-elevated rheumatoid factor, antinuclear antibody, ESR
(common drug therapy):
-NSAIDs (short-term use), -Methotrexate, Leflunomide (Arava), -Corticosteroids, Biological response modifiers, -other immunosuppressive agents
-aging, -genetic factor (possible), -obesity, -trauma, -occupation
(disease pattern): may be unilateral, single joint, affects weight-bearing joints and hands, spine, -metacarpophalangeal joints spared, -NON-systemic
(lab findings): normal or slightly elevated ESR
(common drug therapy): NSAIDs (short-term use), -Acetaminophen, -other analgesics
(a.) ANALGESIC ADMINISTRATION- Tylenol (although patients are at risk for liver damage if more than 4000 mg daily), topical drug applications (i.e. Lidocaine 5% patches), NSAIDs, opioids (when all other drugs fail), cortisone (single joint temporary relief),
(b.) PAIN MANAGEMENT (nonpharmacologic) like: rest, joint positioning, heat or cold applications, weight control
(c.) COMPLEMENTARY & ALTERNATIVE THERAPIES (CAMs): accupuncture, acupressure, tai chi, music therapy, and cognitive-behavioral therapies (i.e. imagery, prayer, topical capsaicin products- blocks substance P, a neurotransmitter for pain), GLA (gamma-linolenic acid)- which is an omega-6 fatty acid, glucosamine, and chondroitin
-inspect your hip incision every day for redness, heat, or drainage, call doc if these present
-cleanse your hip incision with mild soap and water every day, dry thoroughly
-continue walking & leg exercises
-report pain, redness, or swelling to doctor
-report chest pain or SOB to doctor
-if on anticoagulant, follow the precautions learned in hospital to prevent bleeding; avoid straight razor, avoid injuries, report bruising, bleeding, etc.
is a reportable systemic infectious disease caused by the spirochete Borrelia burgdorferi and results from the bite of an infected deer tick, also known as the black-legged tick.
-it is the most common vector-borne disease in the USA & Europe
STAGE I - flue like Sx, rash, pain & stiffness in muscles & joints. Tx- antibiotics
STAGE II - carditis, SOB, dizziness, meningitis. Tx- IV antibiotics x 30 days
-if not diagnosed & treated in early stages, chronic complications such as arthralgias, fatigue, and memory & thinking problems can result.
-for some patients, the 1st & only sign of Lyme disease is arthritis
-chronic pain syndrome, *not an inflammatory disease
-pain & tenderness are located at specific sites in the back of the neck, upper chest, trunk, low back & extremities.
-these tender points: "trigger points" - can be palpated to elicit pain in predictable pattern
-pain is burning & gnawing
-most Pt's are women- 30-50 yrs
-Pre-existing factors: Serotonin receptors, endorphins
-Precipitating factors: Muscle microtrauma, deconditioning, sleep disturbances
-possible precipitating factors: CFS (chronic fatigue syndrome), Lyme disease, trauma, medications, & flu-like illness; also by deep-sleep deprivation