Ch 68 Rheumatic Diseases Flashcards
Noninflammatory vs inflammatory Arthritis
Noninflammatory:
1) Chronic - Progressive - Degenerative - Asymmetrical - Morning stiffness <30min
2) Pain - Tender - Swelling - Crepitus
3) High viscosity low WBC/PMN normal ESR
4) Joint space narrow - Cartilage loss - Subchondral sclerosis - Bony spurs
Inflammatory:
1) Acute - Progressive - Symmetrical Morning stiffness >30
2) Pain - Tender - Swelling - Inflammation - Erythema - Fever
3) Low viscosity high WBC/PMN/ESR
4) Extra-articular - Swelling - Perioitis - Bony erosion & cartilage los
NSAIDs subgroups
COX1 : ASA - Ketrolac - Naproxin? > GI
COX2: Diclofnac - Celebrix - Mobic - Arcoxia > CV
Non Selective: Ibuprofen
ASA Mechanism of action
Antipyretic : inhibit PG synthesis in anterior hypothalamus
Analgesic : Inhibit PG synthesis
Mechanism of action of NSAIDs & S/E
MOC:
PG synthesis inhibition
Inhibit leukocyte migration
Inhibit COX
S/E
GI Bleeding - Decrease renal blood flow - Pancreatitis - Hepatotoxic
S/E methotrexate
- Hepatotoxic : Transaminitis
- GI Toxicity
- Pulmonary toxicity
- Teratogenic
Traditional DMARDs
Biologic DMARS
Traditional DMARDs
Immunity: Methotrexate - CellCept - Azathioprine
Others: Hydroxychloroquin - Cyclosporin
Biologic DMARDs
TNF-a: Infliximab + Humera
CD20 AB / B Cells: Rituximab
TNF-a S/E
Injection site pain / Erythema
Headache
Flu / Infection
Auto Antibody
Superficial heat and Arthritis
Contraindication
3min to elevate 3 degrees in 1cm depth.
- Decrease pain (pain receptors)
- Relive muscle spasm
- Improve tendon extensibility
- Increase joint ROM
Contraindication: Impaired cognitive function / sensation Skin infection - Acute inflammation Impaired circulation Malignancy
Beneficial effect of exercise program
- Strengthen muscle
- Aerobic capacity
- Muscle endurance
- Bone density
- Functionalists & well being
- Better joint function and ROM
Indication and contraindication of passive and active ROM in R.A patient
Indication: Subacute or chronic joint disease Severe weakness Prevent contracture * many reps may increase inflammation *
Contraindication:
Inflamed tendon or joint
Will lead to rupture or increase inflammation or joint subluxation
Causes of fatigue in R.A patients
- Chronic inflammation
- Anemia of chronic disease
- Abnormal posture ang gait
- Weak atrophied muscles
- Joint mal alignment
- Poor sleep cycle
- Cardiovascular and pulmonary diseases
Think about patient’s condition, disease affecting his muscles/joints + chronic pain + medication + co-morbidity
Benefits of orthodontics in R.A
- Prevent joint deformity, contructure
- Improve joint alignment
- Decrease pain an inflammation
Or any another disease (1+2 combined answer)
Rheumatoid arthritis extra-articular manifestations
Systemic: fatigue, malaise, fever
CNS: myelopathy, entrapment Eyes: scleritis Cardio: pericarditis, valve dysfunction Pulmonary: ILD Heme: Felty syndrom, anemia Derma: Rhu nodules, vasculitis
From head to toes
R.A. Criteria
- Morning stiffness >1 hr
- Arthritis in 3 joints
- Hand involvement
- Bilateral involvement
- Rhu Nodules
- Serology RF
- Radiographic changes
4/7 for diagnosis
1-4 for at least 6 weeks
Rhu Factor
Immunoglobulin present in 85% of R.A.
Other diseases: psoriatic arthritis - Reiter syndrome - eldarly - normal healthy
Good prognostic value
Radiology for R.A. Joint
- soft tissue swelling
- jarrow joint space
- bony erosion
R.A. presents with neck pain
1st to r/o
Atlanto-axial subluxation
When to stop exercise for Rhu patients?
- Increase weakness
- Increase soreness
- Flaring of inflammation
4.
Define spondyloarthropathies
Which joint should we check prior Dx of spondyloarthropathies?
seronegative inflammatory arthritis
Examples: ankylosing spondylitis, psoriatic arthritis, dieter syndrome/reactive arthritis, IBD
Check for hip joint: bony erosion - progressive sclerosis - narrowing of joint space - ankylosing
Reiter Syndrome?
Reactive arthritis, due to bacterial antigens
Hx of 1 month
- Urethritis
- Conjunctivitis
- Arthritis
A) Pathophysiology of OA
B) Which Joints? (pattern)
A) Overuse or overload lead to cartilage degeneration and result in cartilage wear and tear, decrease joint space, osteophyte formation.
B) sparing elbow and shoulder (unless occupational)
Cervical - lower lumbar - hip - knee.
Exercise for O.A.
- Isomertic
- Aerobic
- Pool
Foot deformity in OA
- Hallux Valgus > bunions
2. Hallux rigidus
Diagnostic criteria for SLE
SOAP BRAIN MD Serositis Oral ulcers Arthritis Bleeding disorder Renal involvement ANA + Immunology dsDNA anti-SM Neurological manifestation Malar + Discoid Rash
MSK involvement in SLE
- Arthralgia (weakness - pain)
- Ligamanet laxity (tendon rupture - knee instability)
- Fatigue
- Necrosis of knee and hips (2nd steroid)
Diagnostic criteria for Polymyositis
“Inflammation”
- Weakness > 2. EMG
- High CPK
- Biopsy
- Skin (dermatomyositis)
Exercise for polymyositis
- Isometric
- Aerobic
- Sretch
