Chapter 34: Assessment and management of inflammatroy rheumatic disorders

Question 1

What are the three distinct characteristics of rheumatologic disorders?
- I____________
- D_____________
- A_____________

Answer 1

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

Question 2

-
-
-
-
-

Answer 2

pain
joint swelling
limited movement
stiffness
weakness
fatigue

Question 3

When using medications for rheumatic diseases, they are used to _________ symptoms, control ______________, and sometimes ________ the disease

Answer 3

control
inflammation
modify

Question 4

Disease modifying anti rheumatic drugs can (DMARDs) can:
- Suppress the ____________ response
- Alter __________ progression
- Stop or decrease further tissue damage on _______, ________, and __________

Answer 4

autoimmune
disease
joints, cartilage, organs

Question 5

NONPHARMACOLOGIC PAIN THERAPY FOR RHEUMATIC DISEASE
- __________ application
- Assistive devices — _________/__________

Answer 5

heat
braces/splints

Question 6

Rheumatoid arthritis has evidence of __________ predisposition and development of immunologically mediated join _____________

Answer 6

genetic
inflammation

Question 7

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

Answer 7

joints
6

Question 8

RA is initially symmetric joint pain and __________ joint stiffness lasting longer than ___ hour

Answer 8

morning
1

Question 9

Classic symptoms of RA include :

Answer 9

symmetric joint pain, swelling, warmth, erythema, and lack of function

Question 10

With patients with RA, ______ can be aspirated from inflamed joints

Answer 10

fluid

Question 11

In RA, patient often guards __________ joints and immobilizes them; too much immobilization can lead to _____________

Answer 11

affected
contractures

Question 12

Systemic symptoms of RA include:

Answer 12

Fever
weight loss
fatigue
anemia
lymph node enlargement
Raynaud’s phenomenon

Question 13

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.

Answer 13

DMARDs
6
corticosteroids

Question 14

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

Answer 14

OT, PT
adjust
functionality
cortisone

Question 15

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

Answer 15

immune
nucleus
cytokines

Question 16

Common manifestations of systemic lupus erythematous
- ___________ rash
- Lupus _________________
- Osteoporosis
- Myositis and _____________

Answer 16

butterfly
glomerulonephritis
poly arthritis

Question 17

Treatment / management of systemic lupus erythematosis
- M___________ antibodies (Rituxan)
- C______________
- A___________ agents
- NSAIDs
- I______________ drugs

Answer 17

Monoclonal
Corticosteroids
Antimalarial
Immunosuppressant

Question 18

Primary Sjögren’s Syndrome is when lymphocytic infiltration leading to failure of ________ and ____________ glands

Answer 18

lacrimal
salivary

Question 19

Manifestations of Primary Sjögren’s syndrome :
- Dry ______
- X__________ (dry mouth)
- Pain and fatigue

Answer 19

eyes
Xerostomia

Question 20

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

Answer 20

no cure
tears, oral
meals

Question 21

Ankylosing Spondylitis (AS) if an inflammatory disease of the ________; cartilaginous ______ and surrounding tissues become rigid

Answer 21

spine
joints

Question 22

Manifestations of Ankylosing Spondylitis include:
- ______ pain
- _____________ mobility
- K___________ (stooped position)

Answer 22

back
decreased
Kyphosis

Question 23

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

Answer 23

Methotrexate
Corticosteroids
active, posture
depression, emotional

Question 24

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

Answer 24

Hyperuricemia
Macrophages

Question 25

Where is the most common site of gout?

Answer 25

Big toe

Question 26

Common signs and symptoms of gout

Answer 26

pain
redness
swelling
warmth
often at night

Question 27

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

Answer 27

purine
weight
alcohol
medications

Question 28

Does gout affect men or women more?

Answer 28

Men

Question 29

Fibromyalgia occurs when then CNS pathways that regulate and moderate pain processing functions ____________

Answer 29

abnormally

Question 30

Manifestations of Fibromyalgia include :
- Chronic __________
- Generalized m________ aching and stiffness
- ________ disturbances
- Functional ____________

Answer 30

fatigue
muscle
Sleep
impairment

Question 31

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)

Answer 31

NSAIDs
Tricyclic
Muscle
Anticonvulsants