Chapter 18 Flashcards
Osteophytes
Bone spurs
Crepitus
Grating sound caused by the loosened bone and cartilage
Primary OA
Caused by aging and genetic factors
Secondary OA
Joint injury or obesity
Heberdens nodes
Nodules on the distal interphalangeal joints
Bouchards nodes
Nodules at the proximal interphalangeal joints
Labs for OA
ESR
hsCRP
Drugs for OA
Tylenol (not a primary inflammatory disease) Lidocaine topical Buspirone Cox 2 NSAID Steroid injections Muscle relax & weak opioids
Cox2
Causes cardiovascular disease (MI)
Glucosamine
Decrease inflammation
Chondroitin
Strengthen cartilage
Osteonecrosis
Secondary to lack of blood flow. Trauma or chronic steroid therapy
Subluxation
Dislocation
Pannus (RA)
Vascular granulation tissue of inflammatory cells that erode articulate cartilage and eventually destroy bone
Vasculitis (RA)
The organ supplied by the vessel can be affected, leading to organ failure
Gel phenomenon (RA)
Late manifestations. Morning stiffness of joint
Periungeal lesions
Ischemic skin lesions that indicate vasculitis
Sjögren’s syndrome (RA)
Dry eye
Xerostomia
Dry vagina
Felty’s syndrome
Enlarged liver and spleen
Leukopenia
Caplans syndrome
Rheumatoid nodules in the lungs
Tests for RA
Rheumatoid factor >1:80
Antinuclear antibody (ANA) > 1:40
Arthrocentesis
Aspiration of effusion from the joint to decrease pressure
Disease modifying antirheumatic drugs DMARD
Methotrexate
4-6 weeks to start working
Methotrexate no-no’s
Alcohol -liver
Birth control- must have!!!!!!!!!!!!!!
Infection risk
Plaquenil
May cause retinal damage
BRM biological response modifiers
Enbrel, humira, Remicaide
Plasmapheresis
Not common
Filter plasma for disease causing antibodies
Non pharm interventions for RA
Rest, position, ice/heat, plasmapheresis, alternative therapy, enhance body image, manage fatigue
SLE
Vasculitis is a big concern, kidneys seem to be attacked.
Autoimmune, connective tissue disorder
Butterfly rash*
Raynaud’s phenomenon
Cold or stress- red white or blue with extreme pain. SLE
Primary gout
Errors of purine metabolism
Inherited
Middle aged &a older men
Postmenopausal
Secondary gout
All ages Renal insufficiency Diuretic (dehydration) Crash diets Chemotherapy Obese Cardiovascular problems
Labs for gout
Consistent level of 6.5 is abnormal
Uric acid production of 750mg per 24 hours
Athrocentensis of synovial joint
Tophi
Deposit is of sodium irate crystals
Manifestations of gout
Renal calculus
Renal dysfunction
Changes in urinary output
Acute gout treatment
Colchicine
NSAID
4-7 days
Chronic gout treatment
Allopurinol
8 glasses of H2O
Periodic follow up
CBC w/ diff
Nutrition in gout
Limit protein Starvation diets Alcohol Diuretics Aspirin Increase fluid Stress
Stage one Lyme disease
Flu like symptoms
Doxycycline
Amoxicillin
Stage two Lyme disease
Cardiac problems
CNS disorder
IV antibiotics 30 days
Ceftriaxone
Fibromyalgia
Chronic pain syndrome
NOT inflammatory
Burning, gnawing!!!!
Fibromyalgia treatment
Lyrica, cymbalta, SSRIs (neuropathy)
Tricyclics -sleep, spasm Tramadol NSAIDs PT Exercise Avoid triggers
