arthritis

Question 1

synovial joints

Answer 1

outer fibrous capsule, interior synovial membrane, articular cartilage (prevent friction btw bones), and synovial fluid
bones come together and move easily bc of smooth surfaces of articular cartilage and lubricating synovial fluid

Question 2

arthropathy

Answer 2

inflam of 1+ joints -> arthritis (joint disorder)

Question 3

osteoarthritis

Answer 3

localized, not systemic
degeneration of joints from aging and stress
most common disability in US -> d/t obesity and increased life expectancy
common joints: cervical spine, lumbosacral spine, hip, knee, hands, 1st metatarsal phalangeal joint (big toe)

Question 4

osteoarthritis: rf

Answer 4

M <45, F >45
aging - decreased cartilage
obesity - increased stress and decreased cartilage
hx of participation in team sports (repetitive work)
hx of trauma or overuse of joint
heavy occupational work
misalignment of pelvis, hip, knee, ankle, foot
(women have wider hips = built in misalignment)

Question 5

osteoarthritis: etiology

Answer 5

stress applied to joint (weight bearing)
cartilage degen: excessive loading of healthy joint, normal loading of previously injured joint
chronic

Question 6

osteoarthritis: patho

Answer 6

prolonged excessive P on joint wears away cartilage and subchondrial bone exposed -> leads to cyst dev
cysts move through remaining cartilage and destroy rest
inflam = more degradation
chondrocytes synthesize proteoglycans (fluid) to try and repair -> swell
osteoblast activation -> spur (osteophytes) + thickening synovial fluid (decreased movement)
decreased cartilage narrows around joint space

Question 7

osteoarthritis: cm

Answer 7

deep, aching joint pain, esp with exertion -> relieved with rest
joint pain with cold weather (better in dry climate), stiff in morning, crepitus with motion (decreased ROM), joint swelling, gait change
PA: joint deformity, tender, decreased ROM
- fingers: herbenden’s nodes (distal interphalangeal joint), bouchard’s nodes (proximal interphalangeal joint)

Question 8

osteoarthritis: tm

Answer 8

prevent
goals: manage pain, maintain mobility (PT/OT), decrease disability
no pharm to regress, stop damage:
just decrease pain and swlling
mild - mod = acetaminophen, topical capsacin, NSAIDS (decrease prostaglandins)
mod - severe = rx NSAIDs, NSAIDs and colchine, acetaminophen and tramadol, opioids, steroid injection (into joint)
diet supplements: chondroitin sulfate and glucosamine
artificial joint fluid -> hyaluronic acid
joint replacement, arthroplasty
lifestyle -> canes/walkers, etc

Question 9

osteoarthritis: degenerative disc disease

Answer 9

causes pain, motor weakness, neuropathy
most often occurs in lumbar or cervical spine
lifting/twisting motions -> nurses!
can lead to herniated/ruptured discs
tm goals are same as osteoarthritis

Question 10

osteoarthritis: degenerative disc disease - patho

Answer 10

intervertebral disc compression with age -> vertebraes touch
motor and sensory spinal nerves enter and exit from spinal cord and travel through narrow openings of vertebral bone
with age, intervertebral discs dehydrate and vertebral bone compressed -> impinge on entering and exiting nerves
dysF of motor and sensory spinal nerves impedes movement and sensation in extremities (can be one sided)
may see weakness and paresthesias

Question 11

osteoarthritis: degenerative disc disease - cm (lumbar)

Answer 11

pain in lower back that radiates down back of leg (sciatica)
butt or thigh, worsens with sitting, bending, lifting, twisting
minimized pain when walking, position change, lying down
numb, tingling, weakness in legs
foot drop

Question 12

osteoarthritis: degenerative disc disease - cm (cervical)

Answer 12

chronic neck pain that can radiate to shoulders and down arms
numb/tingle in arm or hand
weak of arm or hand

Question 13

rheumatoid arthritis

Answer 13

systemic, autoimmune, type 3 hypersensitivity -> body attack synovial, immune complexes deposited, inflam and destruction
inflam disease of synovium

Question 14

rheumatoid arthritis: etiology

Answer 14

not well understood
env and genetic factor -> genetic link and triggering event
inappropriate immune response to injury
other rf: 40 - 60, F, tobacco, fam hx (significant)

Question 15

rheumatoid arthritis: patho

Answer 15

immune cells attack synovial joint (lymphocytes and macrophages)
cytokines secreted and attract more immune cells, produce RF
RF: specific/special antibody against our own IgG antibodies, form immune complex, we can measure this along with other inflam lab levels
chronic, persistant, destructive

Question 16

rheumatoid arthritis: progressive disease

Answer 16

intensifying inflam response -> cartilage destroyed by osteoclasts
pannus (v vascular, scar tissue) develops -> inflam exuberant proliferation of synovium (hypertrophied synovium), leads to bone erosion, cysts, fissure dev

Question 17

rheumatoid arthritis: cm - early

Answer 17

v little, maybe joint/pain discomfort, vague

Question 18

rheumatoid arthritis: cm - joint manifestations

Answer 18

symmetric, pain, stiff (morning, >1hr), motion limitation
inflam = heat, swell (spongy, soft, warm -> diff from osteoarthritis - hard), tenderness
muscle atrophy, tendon destruction, joint sublication -> bone displaced from normal joint position, decreased ROM, v painful, cant fix bc tissue erosion
advanced = deformity and disability -> joint subluxation

Question 19

rheumatoid arthritis: cm - systemic

Answer 19

fatigue/malaise, can affect all systems depending on severity
pericarditis, myocarditis
sjorgren’s s = destruction of moisture producing glands = salivary and lacrimal (dry mouth and dry/itchy eyes)
rheumatoid nodules = immune mediated granulomas, develop around inflammed joints, SQ and firm, sometimes painful, can also be in lungs

Question 20

rheumatoid arthritis: pharm

Answer 20

goals = relieve pain and swelling, slow/stop progression
long term drug therapy requires pt adherence: NSAIDs (immediate s relief), glucocorticoid (short term), disease modifying anti-rheumatic drugs (DMARDs - slow/stop progression)