Musculoskeletal – Answers

Compare Osteoarthritis to Rheumatoid arthritis.  What are the causes?  When do the affected joints get stiff?  Are they more painful with rest or with use? 


  • Slowly progressing and non-inflammatory (no swelling with this kind of arthritis!)
  • Joint pain increases when used, and pain decreases with rest.
  • Stiffness after long rest (like overnight) is common, but joints warm back up within 30 minutes of use
  • Heberden’s and Bouchard’s nodes looks like finger joints are enlarged.  Aren’t usually painful, but probably looks strange to patient
  • Main goal of nursing care is managing pain and preventing disability


Rheumatoid arthritis

  • Chronic, and progressive, systemic autoimmune disease.
  • Connective tissues at joints get inflamed and permanently damaged over time
  • Not sure of the causes
  • Also has stiffness after inactivity.  The morning stiffness (after sleeping) tends to last longer than in osteoarthritis
  • Will probably lead to deformity/disability of joints (looks like crooked finger)


What are the primary types of medications used for Osteoarthritis?  What are the nursing considerations?

The primary medication is going to be pain relievers like acetaminophen or ibuprofen.  Be careful using NSAIDs (i.e. ibuprofen) in the elderly, though, because NSAIDs can have a blood thinning effect and since the elderly are more likely to have osteoarthritis they are also more likely to be on blood thinners like warfarin or heparin.  These patients are also more likely to be at increased risk for GI bleeds, which is one of the potential adverse effects of NSAIDs so be careful!


What are the primary types of medications used for Rheumatoid Arthritis?  What are the nursing considerations?

Rheumatoid arthritis will usually require disease modifying anti-rheumatic drugs, the most common of which is methotrexate (Rheumatrex).  Since rheumatoid arthritis is a progressive disease, they need this kind of drug to help counteract symptoms and disease progress.  Pain relievers may also be used, but would not e the priority.  After all, if you had Rheumatoid arthritis and could only take one drug, which would it be?  The drug that helps prevent the rheumatoid arthritis from getting worse, or the drug that covers up the pain as your pain gets worse and worse over time?


A big nursing consideration for patients taking methotrexate (Rheumatrex) is to monitor their lab values.  In particular, we want to keep an eye on their WBCs and liver function, because methotrexate (Rheumatrex) can have a negative effect on WBCs and the liver.





What is Muscular Dystrophy?  What are the early symptoms?  What causes it?  How is it diagnosed?

In Muscular Dystrophy, the skeletal muscle symmetrically wastes away without harming any of the neural pathways.  It’s purely a loss of muscle.  The order in which muscle is loss usually varies from person to person.  The earliest symptom tends to be loss of strength that has no obvious explanation.  Muscular Dystrophy is a genetic disease, so if you have it then that means you inherited it from your parents.  The diagnosis of Muscular Dystrophy is confirmed by doing a muscle biopsy.


What medications are commonly given for Muscular Dystrophy?  What are the goals of nursing care?  What special considerations should you have for people who have Muscular Dystrophy in their family? 

Corticosteroids are commonly given to slow the progress of Muscular Dystrophy, but it is only a short-term slowing.  They will not stop the progression of the disease, and they are not a cure.  The goals of nursing care are to preserve mobility and independence for as long as possible, by encouraging exercise, physical therapy, and orthopedic appliances to help make the most of their remaining muscle strength.


People who have Muscular Dystrophy in their family should consider getting genetic testing or genetic counseling done since Muscular Dystrophy is a genetically transmitted disease.  They may have the disease themselves, and early treatment will help to maintain function for as long as possible.  Or they may be a carrier, which would be important to know before deciding to have children.


What is Systemic Lupus Erythematosus (SLE)?  What causes it?  What are the effects of SLE on the body?  What are some common types of medications used to manage SLE? 

SLE is an autoimmune inflammatory disease.  Basically, that means that the body attacks itself, causing an inflammatory reaction in the places that it attacks.  SLE is a multi-system disease, which means it will attack not only the joints, but also the skin or other body systems like renal or cardiopulmonary.


Nobody’s sure exactly what causes SLE, or even what triggers the onset of symptoms in susceptible patients.  There appears to be a genetic component, but there is also probably a hormonal influence (disease is more common is menstruating women), and a stress component.


SLE has many effects on the body, but they all involve the body attacking and destroying things that it really shouldn’t.  The disease usually targets DNA, RBCs, platelets, and WBCs among other things.  Since there is such a wide variety of things the disease could potentially destroy, SLE will end up presenting a little differently in each patient depending on what their own disease “chooses” to attack.  Many patients with SLE also show the classic “butterfly rash” on their face.  It looks exactly like it sounds like:  a red rash the covers both cheeks and cross their nose, just like a butterfly laying flat on their face would.


There are three common classes of medications used to treat SLE: NSAIDs, corticosteroids, and immunosuppressant medications.  NSAIDs can help manage pain and reduce inflammation.  Corticosteroids can help reduce inflammation and somewhat suppress the immune system when taken long-term.  The immunosuppressant medications (duh) work to suppress the immune system.  Each of these classifications of medication comes with a set of therapeutic effects and adverse effects that you need to know as a nurse.  For example, even though the immunosuppressant medications help control SLE by stopping the body’s autoimmune attacks (therapeutic effect), it also prevents the body from attacking bad invaders like viruses and bacteria.  Can anybody say Risk for Infection?