Chapter 3.1

Question 1

1. Describe the joint changes characteristic of osteoarthritis

Answer 1

progressive wear and tear of large joints. Hypertrophy and spurring of bone and erosion of cartilage

Question 2

2. List the categories of drugs used in the management of osteoarthritis.

Answer 2

analgesics and joint protection and restoration

Question 3

3. Indicate the stage of osteoarthritis that is best managed by acetaminophen and NSAIDs.

Answer 3

Early to mod stages for acetaminophen

NSAID’s: any stage of OA

Question 4

4. List the advantages and disadvantages of the categories of drugs used in the management of osteoarthritis.

Answer 4

Acetaminophen is easier on stomach and anti-inflammatory effects not needed
NSAID’s are more helpful in later stages if synovitis develops

Question 5

5. Define viscosupplementation.

Answer 5

try to supplement the viscous property of joint fluids. Helps restore the viscosity of synovial fluid and keeps joint better lubricated. Done by injecting hyaluronan into joint

Question 6

6. State the mechanism of action of glucosamine and chondroitin sulfate in the management of osteoarthritis.

Answer 6

Provide substrates to help regenerate and maintain strength of cartilage and synovial fluid

Question 7

7. Describe the joint changes characteristic of rheumatoid arthritis

Answer 7

pain, stiffness, inflammation and damage in various joints

Question 8

8. State the role of autoimmunity in the development of rheumatoid arthritis using the terms systemic and synovial inflammation, tumor necrosis factor-alpha, and interleukins.

Answer 8

Immune system goes haywire and does this via chemical and cellular factors like tumor necrosis, factor alpha or interleukin 1 or 6.

Question 9

9. Indicate the role of the following agents in the management of rheumatoid arthritis: acetaminophen, NSAIDs

Answer 9

NSAID’s are the cornerstone of treatment in RA and are good at treating mild inflammation and pain.

Question 10

glucocorticoids

Answer 10

are powerful inflammatory supressents. These drugs are great after a flare up. Huge side effects doe

Question 11

and disease-modifying anti-rheumatic drugs (DMARDS)

Answer 11

modifying the course of RA and try to slow it down.

Question 12

10. State the mechanism of action of the traditional DMARDs.

Answer 12

inhibit the autoimmune response underlying RA. Inhibit cytokine synthesis or inhibit cellular activation of monocytes, T and B lymphocytes

Question 13

11. State the mechanism of action of tumor necrosis factor inhibitors

Answer 13

Suppresses a specific messenger that promotes the immune response called TNF-alpha.

Question 14

12. State the mechanism of action of anakinra.

Answer 14

blocks effects of interleukin 1 on joint tissues. It spars immune functions

Question 15

13. Indicate the therapeutic categories of the following agents: ibuprofen

Answer 15

NSAID

Question 16

prednisone

Answer 16

glucocorticoid

Question 17

methotrexate, hydroxychloroquine, auranofin, penicillamin

Answer 17

DMARD

Question 18

adalimumab, etanercept

Answer 18

Tumor necrosis factor inhibitor

Question 19

anakinra

Answer 19

Other DMARD

Question 20

14. State the role of DMARD combination therapy for rheumatoid arthritis.

Answer 20

Provides better effects at lower doses of each drug and they don’t necessarily increase risk of toxicity over monotherapy.

Question 21

15. State the adverse effects of the DMARDs.

Answer 21

GI problems, lung toxicity, hematological disorders, fever

Question 22

16. List the special considerations when using methotrexate, hydroxychloroquine

Answer 22

Periodic ophthalmic exams recommended to check for retinal toxicity

Question 23

adalimumab

Answer 23

Risk of infection

Question 24

etanercept

Answer 24

Risk of infection

Question 25

17. State the special considerations of a physical therapist caring for a patient being treated for rheumatoid arthritis

Answer 25

may cause headache and nausea, which may be bothersome during the therapy session. Joint pain and swelling may also occur with drugs such as methotrexate and penicillamine