Chapter 34: Assessment and management of inflammatroy rheumatic disorders Flashcards
What are the three distinct characteristics of rheumatologic disorders?
- I____________
- D_____________
- A_____________
Inflammation - complex process resulting in pan u.s.
Degeneration. -secondary process for inflammation
Autoimmunity - Hallmark of rheumatologic disease; Body recognizes own tissue as foreign antigen
-
-
-
-
-
pain
joint swelling
limited movement
stiffness
weakness
fatigue
When using medications for rheumatic diseases, they are used to _________ symptoms, control ______________, and sometimes ________ the disease
control
inflammation
modify
Disease modifying anti rheumatic drugs can (DMARDs) can:
- Suppress the ____________ response
- Alter __________ progression
- Stop or decrease further tissue damage on _______, ________, and __________
autoimmune
disease
joints, cartilage, organs
NONPHARMACOLOGIC PAIN THERAPY FOR RHEUMATIC DISEASE
- __________ application
- Assistive devices — _________/__________
heat
braces/splints
Rheumatoid arthritis has evidence of __________ predisposition and development of immunologically mediated join _____________
genetic
inflammation
RA is classified by the number of _______ involved, positive rheumatoid factor test, abnormal C-reactive protein or erythrocyte sedimentation rate (ESR) and duration of symptoms greater than ___ weeks
joints
6
RA is initially symmetric joint pain and __________ joint stiffness lasting longer than ___ hour
morning
1
Classic symptoms of RA include :
symmetric joint pain, swelling, warmth, erythema, and lack of function
With patients with RA, ______ can be aspirated from inflamed joints
fluid
In RA, patient often guards __________ joints and immobilizes them; too much immobilization can lead to _____________
affected
contractures
Systemic symptoms of RA include:
Fever
weight loss
fatigue
anemia
lymph node enlargement
Raynaud’s phenomenon
Treatment of early RA includes ________ like (MTX) to prevent inflammation and joint damage; benefit usually seen within ___ weeks and tolerate med well; can use ________________ as a bridge in early treatment but shouldn’t use long term. JAK inhibitors can also be used.
DMARDs
6
corticosteroids
Treatment for established RA can include ___ and ____, pace activities, muscle strengthening, ROM; may need to ________ medication regimen and take multiple meds; may need surgery to help with ________________; corticosteroids can be used but for shortest time possible; can do ___________ injections to joint but only sparingly
OT, PT
adjust
functionality
cortisone
Systemic Lupus Erythematous (SLE) is when the ___________ system inaccurately recognizes one or more components of cell’s __________ as foreign and creates antibodies to the nuclear “antigen”; over production of multiple __________ by B cells
immune
nucleus
cytokines
Common manifestations of systemic lupus erythematous
- ___________ rash
- Lupus _________________
- Osteoporosis
- Myositis and _____________
butterfly
glomerulonephritis
poly arthritis
Treatment / management of systemic lupus erythematosis
- M___________ antibodies (Rituxan)
- C______________
- A___________ agents
- NSAIDs
- I______________ drugs
Monoclonal
Corticosteroids
Antimalarial
Immunosuppressant
Primary Sjögren’s Syndrome is when lymphocytic infiltration leading to failure of ________ and ____________ glands
lacrimal
salivary
Manifestations of Primary Sjögren’s syndrome :
- Dry ______
- X__________ (dry mouth)
- Pain and fatigue
eyes
Xerostomia
Treatment / management of Primary Sjögren’s syndrome
- Symptom management and improving QOL — ( __ _____)
- Use of artificial ______, biotene_______ rinse
- No smoking, no anticholinergic medications, no spicy / salty / irritating foods
- Small frequent ______
- Monitor for depression and sleep disturbances
- Education may be challenging due to pain, fatigue, and depression
- Education on self management techniques
no cure
tears, oral
meals
Ankylosing Spondylitis (AS) if an inflammatory disease of the ________; cartilaginous ______ and surrounding tissues become rigid
spine
joints
Manifestations of Ankylosing Spondylitis include:
- ______ pain
- _____________ mobility
- K___________ (stooped position)
back
decreased
Kyphosis
Treatment / Management of Ankylosing Spondylitis include:
- NSAIDs
- M______________ can help with skin and peripheral joint disease, but not spine changes
- C_____________ injections periodically
- Surgery — with advanced cases, osteotomy can improve QoL
- Staying ______ and good _________
- Monitor for and address d___________ and _____________ stress
Methotrexate
Corticosteroids
active, posture
depression, emotional
Gout is caused by hyper___________ due to increased purines which is usual found in meat products. An attack happens when _____________ in joint space phagocytize urate crystals
Hyperuricemia
Macrophages
Where is the most common site of gout?
Big toe
Common signs and symptoms of gout
pain
redness
swelling
warmth
often at night
Treatment for gout:
- Acute attack: colchicine, NSAIDs, corticosteroid
- After resolved: Xanthine oxidase inhibitors to lower levels
- Avoidance of _______-rich foods (organ meats, etc.)
- _________ loss
- Decreasing __________ intake
- Avoid certain _____________
Education is important — medication adherence is critical
purine
weight
alcohol
medications
Does gout affect men or women more?
Men
Fibromyalgia occurs when then CNS pathways that regulate and moderate pain processing functions ____________
abnormally
Manifestations of Fibromyalgia include :
- Chronic __________
- Generalized m________ aching and stiffness
- ________ disturbances
- Functional ____________
fatigue
muscle
Sleep
impairment
Treatment/management for fibromyalgia :
- N________ for muscle aching and stiffness
- T______________ antidepressants ( amitriptyline and nortriptyline)
- Sleep hygiene
- __________ relaxants (cyclobenzaprine)
- Cognitive behavioral therapy
- SNRIs (fluoxetine, sertraline, paroxetine
-Anti___________ (gabapentin, pregabalin)
NSAIDs
Tricyclic
Muscle
Anticonvulsants
