Arthritis

Question 1

Osteoarthritis

Answer 1

most common - Slow progressive non inflammatory joint disease

Question 2

Where does OA occur?

Answer 2

Common to synovial joints-distruction of cartiledge

Question 3

Who is affected by OA

Answer 3

Men before 50, women after 50

Question 4

Causes of OA

Answer 4

No single cause- 
decreased estrogen, 
genetic, 
obesity, 
inactivity or overuse, 
acl injury

Question 5

Clinical Manifestations of OA

Answer 5

seak tx d/t pain
No systemic- joint pain/discomfort.
Early relieved by rest, advanced- pain and activity and rest
Morning stiffness common, resolved w/in 30 min
Crepitation
Deformity

Question 6

Deformity associated with OA

Answer 6

Heberden- DIPS (distal)
Bouchards- PIPS (proximal)
INTERPHALANGEAL

Also, MCP , knee/hip, MTP (foot) gout, cervical and lower lumbar

Question 7

DX of OA

Answer 7

Bone scan, 
CT, 
x-ray (not always consistant w pain report), 
synovial fluid analysis, 
no labs

Question 8

Acute Interventions for OA

Answer 8

meds,
temp,
relaxation,
splints

Question 9

Chronic Interventions for OA

Answer 9

environmental mod.
Assistive device,
sex counsel

Question 10

Rheumatoid Arthritis

Answer 10

systemic autoimmune disease- Inflammation of synovial joints, remission/exacerbation,

Question 11

Population for RA

Answer 11

all ethnic groups,
any age,
peak at 30 & 50
. Women 2-3x more

Question 12

Causes of RA

Answer 12

Autoimmune to antigen triggers- IgG
Genetic- development of leukocyte antigen, variations.
Smoking increases risk

Question 13

Clinical Manifestations of RA

Answer 13

Nonspecific manifestation may precede arthritic complaints

Weight loss, fatigue, anorexia, generalized stiffness

Many clients report hx. of a preceding stressful life event or stressor

No research to correlate directly with onset of RA

Question 14

Joint Symptoms with RA

Answer 14

Joint symptoms occur symmetrically
Small joints of hand and feet most often affected
PIP, MCP of hands and MTP of feet
Joint stiffness after periods of inactivity, Joint pain increases with activity

Question 15

Pain/Stiffness with RA

Answer 15

Morning stiffness longer than 60min. To several hours.
Pain does not always correlate with degree of swelling, inflammation
Inflammation and fibrosis may lead to deformity and disability
Atrophy of muscle / Destruction of tendons

Question 16

DX of RA

Answer 16

H&P
*RF- rheumatoid factor (80% of RA pts = positive)
*Erythrocyte sedimentation rate
*c-reactive protein
anti-nuclear antibody
Anti ccp
Synovial fluid analysis

Question 17

Synovial fluid analysis for RA

Answer 17

early detection = strawberry fluid w fibrin flecks

tissue biopsy- confirms inflammation

Question 18

Problems associated with RA

Answer 18

septic arthritis, 
sjogren syndrome,
 neuropathy, 
anemia, 
leukopenia diabetes, 
CA

Question 19

GOUT

Answer 19

sodium urate crystals in joints, subcu tissue

Question 20

Primary Gout

Answer 20

90%

Hereditary, middle age men rare in women

Question 21

Secondary Gout

Answer 21

related to 2nd disorder

Question 22

Risk factors of Gout

Answer 22

obesity,
 HTN, 
thiazides, 
etoh, 
purine rich foods

Question 23

Acute Gout

Answer 23

more than one joint,
dusky,
tenderness (big toe)

often precipitated by another event (trauma, EtOH, infection)

Question 24

Onset of Acute Gout

Answer 24

rapid, at night,
low fever,
subside in 2-10 days

Question 25

Chronic Gout

Answer 25

Multi, tophi visible, elbow/vertebrae, hands.

Question 26

Complications of Chronic Gout

Answer 26

Kidneys can lead to renal failure (urinary stones)

Question 27

DX of Gout

Answer 27

H&P (80% of cases)
Joint aspiration, serum uric acid levels (above 6mL/dL)
24 hr urine collection
X-ray of affected joints (chronic)`

Question 28

Care for Gout

Answer 28

Joint immobilization,
 heat/cold,
 aspiration
Drugs
Avoid high purine foods
monitor renal function

Question 29

Drugs for Gout

Answer 29

corticosteroids, 
colchicine, 
probenecid, 
allopurinol, 
adrenocorticotropic hormone

Question 30

Complications of Gout

Answer 30

Pain
Stiffness
Limitation of Mov’t
Signs of inflammation (heat/swelling/tenderness)