autoimmune dx Flashcards
rheumatoid arthritis (RA)
- chronic, systemic autoimmune dz
- inflammation of connective tissue in the synovial joints
- periods of remission and exacerbation
- can occur at any time, incidence increases with age
causes of RA
- autoimmune
- *genetics
- smoking
diagnosing RA
- H/P
- +rheumatoid factor
- ESR and CRP=active inflammation
- xray: for later disease
RA classification criteria
- morning stiffness that lasts at least an hour
- polyarthritis
- arthritis in the wrist, or finger joints
- symmetrical arthritis
- positive rheumatoid factor
- radiological abnormalities of hands or wrist
nonspecific s/s of RA
- fatigue
- anorexia
- wt loss
- generalized stiffness
specific articular s/s of RA
- pain
- stiffness
- limited motion
- s/s inflammation
extraarticular s/s of RA
- rheumatoid nodules
- Sjogren’s syndrome
- Felty syndrome
- pleural effusion, pericarditis, pericardial effusion, cardiomyopathy
- cataracts
- depression
rheumatoid nodules
firm, non tender granuloma type masses locate over joints
Sjogren’s syndrome
- diminished lacrimal and salivary gland secretion
- photosensitivity
Felty syndrome
- splenomegaly
- leukopenia
tx for Sjogren’s syndrome
- goal: to relieve symptoms
- dry eyes: artificial tears, eye lubricating ointments, or cyclosporine liquid
- dry mouth: H2O, chewing sugarless gum
tx for RA
- rest
- joint protection
- heat/cold application
systemic lupus erythematosus (SLE)
- multisystem inflammatory autoimmune dz
- chronic, unpredictable course
- periods of exacerbation and remission
causes of SLE
- **unknown
- genetics
- hormones
- environment: sun exposure, infx
- drug reactions
diagnosing SLE
- ANA, anti ENA
- complement system levels
- electrolytes
- renal function
- liver enzymes
- CBC
diagnosing SLE
- SOAP BRAIN MD
- serositis
- oral ulcers
- arthritis
- photosensitivity
- blood dx
- renal dx
- antinuclear antibody test positive
- immunological dx
- neurological dx
- malar rash
- discoid rash
general s/s of SLE
- fever
- malaise
- joint pains
- myalgias
- fatigue
- temp loss of cognitive abilities
dermatological s/s of SLE
- cutaneous vascular lesions
- butterfly rash over cheeks
- oral/nasopharyngeal lesions
- alopecia
musculoskeletal s/s of SLE
- arthritis
- polyarthralgia with morning stiffness
- swelling
- increased risk for bone loss and fx
cardiopulmonary s/s of SLE
- increased RR
- cough
- dysrhythmias
- HTN
- increased cholesterol
- increased risk for clots
renal s/s of SLE
- lupus nephritis
- proteinuria
- ESRD
nervous system s/s of SLE
- sz
- peripheral neuropathy
- cognitive dysfunction
- depression
- psychosis
- HA
hematological s/s of SLE
- anemia
- mild leukopenia
- thrombocytopenia
- excessive bleeding
- clot formation
infection in SLE
- increased susceptibility to infx
- major cause of death
- avoid live virus vaccines
tx of SLE
- NSAIDs, antimalarials
- disease modifying anti rheumatic drugs
- immunosuppresants
- analgesics
- lifestyle changes
- renal transplant
good prognosis for SLE
- early dx
- prompt recognition of organ involvement
- good therapeutic regimens
fibromyalgia
- widespread, non articular musculoskeletal pain and fatigue
- multiple tender points
etiology of fibromyalgia
- genetics
- stress
- central dopamine dysfunction
- abnormal serotonin metabolism
- deficient human growth hormone
tender points
- palpation elicits pain
- not all at a time
- can change points throughout the day
s/s of fibromyalgia
- burning, widespread pain
- fatigue
- tingling of the skin
- prolonged muscle spasms
- weak limbs
- nerve pain
- TMJ pain
gout
- type of recurring acute arthritis
- accumulation of uric acid crystals in one or more joints
causes of gout
- increase in urban acid production
- underexcretion of uric acid
- high purine diet will trigger
high purine foods
- shellfish
- lentils
- asparagus
- spinach
- meats
diagnosing gout
- serum uric acid level above 6mg/dL
- 24 hour urine: decreased renal excretion vs overproduction
- synovial fluid aspiration
s/s of acute phase gout
- arthritis in one or more joints
- joints are dusky or cyanotic
- tenderness
- podagra (inflamed great toe)
s/s of chronic phase gout
- multiple joint involvement
- tophi
- kidney/urinary tract stones
collaborative care of gout
- terminate acute attack: colchicine
- prevent future attacks
- diet and weight reduction: avoid etoh and purine
- meds
