Arthritis and Autoimmunity Disorders Flashcards
What is rheumatology?
study of connective tissue diseases
What is rheumatic disease?
any disease involving the musculoskeletal system
What is osteoarthritis?
non-inflammatory arthritis; it is not systemic or autoimmune
What is the biggest factor in the development of OA? Differentiate between primary and secondary OA?
– biggest factor = aging
– primary OA: result of aging
– secondary OA: result of medications
What are osteophytes? What is synovitis? What is subluxation?
– osteophytes: bone spurs that form as cartilidge and the bone beneath it begin to errode; this results in crepitus at the joints
– synovitis: inflammation of the synovial tissue; common in advanced OA
– subluxation: partial joint dislocation
What is a major cause for joint degeneration, especially in the knees?
obesity
What are 5 physical assessmenets that may indicate OA?
- joints – tenderness and crepitus
- Heberden’s nodes – swelling at distal fingers
- Bouchard’s nodes – swelling at proximal fingers
- joint effusions – excessive joint fluid, detectable by ballottment
- atrophy of skeletal muscle – use it or lose it!
What are 6 ways to nonsurgically manage chronic pain that accompanies OA?
- analgesics – Tylenol (NSAIDS), topical lidocaine, topical NSAIDS, weak opioids, muscle relaxants
- rest immobilization
- positioning
- thermal – hot or cold
- weight control
- CAM
What are 3 ways to surgically manage chronic pain that accompanies OA?
- TJA (total joint arthroplasty)/TJR (total joint replacement) – creation of a joint or replacement of a knee
- arthroscopy – removal of damaged cartilidge
- osteotomy – bone resection to correct a joint deformity
What condition do most DVTs result in?
pulmonary embolism – important to always assess ABCs!
What are the most life-threatening complications after total hip and knee arthroplasty? (2)
- venous thromboembolism
- pulmonary embolism
What are the preventative measures to take for patients after total hip and knee arthroplasties?
– PAC:
- pharmacology – lovenox or another anticoagulant (not a clot buster)
- ambulation
- compression – SCDs, TEDs
What is a TNA?
total knee arthroplasty
What types of medications do patients receive after TNAs?
- HTN
- antibiotics
- pulmonary meds
- cardiac meds
– NO blood thinners!
What is rheumatoid arthritis?
– systemic, autoimmune disease of musculoskeletal system – the body’s immune system attacks cells at synovial joints
- causes inflammation of synovial membrane
- synovial thickening
- cartilage and bone damage
- lung damage – more affected than other organs – results in toughened up lung tissue
What is a potential indicator of rheumatoid arthritis?
rheumatoid factor – present in about 80% of people with RA
What are 4 distinguishing characteristics of RA when compared with OA?
- RA joint inflammation is symmetrical; OA joint inflammation is not
- RA may have extra-articular manifestations like nodules
- RA may result in Baker’s cysts – basically an aneurysm of the synovial joint (usually popliteal)
- RA pain is worse in the morning; OA pain is worse at night
What are 2 associated syndromes with RA?
- Sjogren’s syndrome – dry eyes, mouth, and vagina
- Caplan’s syndrome – RA nodules in the lungs and pneumoconiosis (restricted lung disease)
What are 5 diagnostic assessments for RA?
- rheumatoid factor – measures presence of unusual antibodies of IgM
- anticyclic citrullinated peptide (anti-CCP) – specific test in detecting early RA
- antinuclear antibody titer (ANA) – measures titers of unusual antibodies that destroy cells and cause tissue death
- erythrocyte sed. rate (ESR) – measures inflammation
- C-reactive serum protein – measures inflammation
What is the primary medication used to manage RA?
– methotrexate
- slow-acting
- immunosuppressive
- takes 4 - 6 weeks to work – pt will be on steroids like prednisone in the meantime
- worry about liver and neutropenia with this medication
What is a glucocorticosteroid?
– fast-acting, anti-inflammatory, and immunosuppressive medication
- can be given in high doses for a short duration or low chronic doses
- most common is prednisone
What is one non-pharmacological intervention that should NOT be used to prevent complications of RA, but can be used to prevent complications of OA?
Ambulation
does not alleviate symptoms of RA since it is autoimmune
What is plasmapheresis, and how is it used to treat RA?
– process by which a cell separator removes plasma from blood
- cells are returned to the individual, but the plasma (which contains the antibodies which attack the self cells) are discarded and replaced with other fluids
What is lupus erythematosus?
– chronic, progressive autoimmune disorder
- results in inflammation and damage to organs
- results in vasculitis – compromises blood flow and oxygenation
What are the 2 forms of lupus erythematosus?
-
cutaneous lupus erythematosus (CLE)/discoid lupus
- chronic inflammatory skin condition of sores – inflammation and scarring of areas of the head and sometimes other parts of the body
- 70 - 80% of these pts will develop systemic lupus
-
systemic lupus erythematosus (SLE)
- chronic, progressive inflammatory condition of connective tissue
- results in failure of major body organs and systems
Which organ is mainly affected in patients with lupus erythematosus?
kidneys (specifically, glomeruli)
SLE pts tend to have some degree of kidney failure
What are the 4 major clinical manifestations of SLE?
- skin
- dry, scaly butterfly rash on face
- round skin lesions
- alopecia
- mouth ulcers
- intermittent fevers
- fatigue
- kidney changes
- usually kidneys but could be other organs
- heart
- lungs – pleural effusions
- Raynaud’s phenomenon – numbness/coolness in areas of the body
- usually kidneys but could be other organs
What is osteonecrosis, and how does it relate to lupus erythematosus?
– osteonecrosis: bone necrosis due to prolonged steroid use from constriction of blood vessels
- pts with lupus erythematosus are often on chronic steroid use and may suffer osteonecrosis
What are the 3 types of diagnostic tests for lupus erythematosus?
- skin biopsy – the only significant test to confirm diagnosis for CLE
- immunologic-based lab tests – same tests to diagnose RA
- body system function tests
- ESR/CRP – inflammation tests
- creatinine tests
- BUN tests
What are the 4 types of drugs that patients can take for treatment of lupus erythematosus?
- corticosteroids (like prednisone) – for acute exacerbations
- plaquenil – antimalaria med that decreases inflammatory response
- DMARDS (like Cytoxan or methotrexate)
- monoclonal antibodies – these aren’t as common
What is scleroderma?
– AKA systemic sclerosis
– chronic, inflammatory, autoimmune connective tissue disease
- not always progressive
- hardening of the skin
- similar to SLE but higher mortality rate
- scleroderma doesn’t respond well to meds
- scleroderma pts don’t live for very long after diagnosis
What is the major organ/system affected by scleroderma?
GI system – first thing to demonstrate symptoms
What are the symptoms of scleroderma? (CREST)
- Calcinosis – calcium deposits in skin
- Raynaud’s phenomenon – spasms of BVs in response to cold or stress
- Esophageal dysfunction – acid reflux; decrease in esophageal motility
- Sclerodactyly – thickening and tightening of skin on fingers and hands
- in later stages of scleroderma, if it’s progressive, sclerodactyly can advance to the face
- Telangiectasias – dilation of capillaries = red marks on skin
What are 3 major clinical manifestations of scleroderma?
- arthralgia – joint pain without inflammation or deformities
- GI tract problems (especially esophageal) – dysphagia, reflux, malabsorption
- pulmonary problems – fibrosis, pulmonary arterial hypertension
What is gout?
– AKA gouty arthritis
– systemic disease in which urate crystals deposit in the joints and body tissues, causing inflammation
What are the 2 forms of gout?
-
primary gout
- most common
- uric acid builds up from inability of the kidneys to excrete it
- genetic – often affects middle aged - older males and post-menopausal women
-
secondary gout
- possibly caused by renal insufficiency, diuretics, chemo, crash diets
What are the types of drug therapies used to treat gout?
– acute gout
- colchicine
- NSAIDs 4 - 7 days
– chronic gout
- allopurinol – reduces production of uric acid
What nutritional diet is recommended for patients with gout?
– low purine diet
- avoiding meats – especially organ meats and high protein meats
- avoiding seafood
What is lyme disease?
systemic infectious disease caused by Borrelia burgdorferi, transferred to humans by a bite from an infected deer tick
What are the most common and sometimes first and only signs of lyme disease?
bulls-eye rash and arthritis
What is important to note about OA?
- everyone will develop
- caused by wear and tear to the joints
- caused by age, weight, overuse
