Chapter 69: Arthritis & Connective Tissue Diseases

Osteoarthritis represents the most prevalent joint disorder, characterized by progressive cartilage degradation, osteophyte development, and joint space reduction, with management strategies encompassing weight control, physical rehabilitation, nonsteroidal anti-inflammatory medications, and surgical interventions including total joint replacement. Rheumatoid arthritis presents as a systemic autoimmune condition featuring symmetric joint inflammation, extraarticular manifestations, and distinctive deformities such as swan neck and boutonniere presentations, requiring treatment with disease-modifying antirheumatic drugs, biologic response modifiers, and corticosteroids. Gout emerges from hyperuricemia and urate crystal accumulation, manifesting as acute podagra episodes and chronic tophaceous deposits, managed through colchicine, allopurinol, febuxostat, and dietary modifications. The chapter addresses infectious arthropathies including Lyme disease with its characteristic erythema migrans pattern and septic arthritis requiring emergent joint aspiration and antibiotic therapy. Spondyloarthropathies encompass ankylosing spondylitis with bamboo spine formation, psoriatic arthritis combining joint and dermatologic involvement, and reactive arthritis following infectious triggers. Systemic lupus erythematosus demonstrates multisystem autoimmune pathology affecting skin, kidneys, cardiovascular, hematologic, and neurologic systems, treated with hydroxychloroquine, immunosuppressants, and targeted biologics. Systemic sclerosis presents with CREST syndrome features including calcinosis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia. Additional conditions include polymyositis and dermatomyositis causing inflammatory myopathy, Sjögren syndrome affecting exocrine gland function, fibromyalgia characterized by widespread pain and fatigue, and systemic exertion intolerance disease. Nursing management emphasizes comprehensive patient education, pain control strategies, mobility preservation, fall prevention protocols, and psychosocial support to optimize functional outcomes and quality of life.