class 3 immunity Flashcards
arthritis & lupus
commonalities between Rheumatoid Arthritis (RA) and Juvenile Idiopathic Arthritis (JIA)
-chronic, inflammatory, autoimmune
-progressively worsens w/ each flare
-primarily synovitis
-secondary degeneration of cartilage, muscles, tendons, and ligaments
-remissions & exacerbations
RA onset age
20-50 yrs
-mostly women
JIA onset age
<16 yr age
RA clinical manifestations
-symmetric joint pain that resolves hours after waking
-swelling, warmth, and erythema of joints
-progressive deterioration to larger joints, pannus formation
-extra-articular involvement(plerua, pericardium, fever, weight loss, fatigue, anemia)
-rheumatoid nodules(indication of rapid progress, “lumpy joints”)
assessments for rheumatoid nodules
-visual assessment
-lumpy joints= + for rheumatoid factor needed
-swan neck & bationniere derformities in hands
-non-tender & moveable nodules
-can spontaneously disappear
clincial manifestations for JIA
insidious or abrupt onset
-arthritis for 6w
-may refuse to use limb/limp
-may see stiffness or swelling
-child may be reluctant to do passive ROM in affected joint
90% are not pos for rheumatoid factor
symptoms of oligoarthritis in JIA
enlarged joints in 4 or less
-eyes commonly affected (uveitis) in 8-20% can cause blindess
symptoms of polyarthritis in JIA
5 or more joints affected
-smaller joints bilaterally
symptoms of systemic JIA
one or more joints affected + 2 weeks of fever,
evanescent rash on trunk & extremities
, lymph node enlargement, hepatosplenomegaly, serositis
-fever typically comes at the same time every day and lasts 3 days for 2 weeks
-pain for ~6weeks
-lymph node enlargement
clinical evaluation to diagnose RA and JIA
history
head to toe exam
labratory tests to diagnose RA and JIA
-rheumatoid factor (RF) assay (70-80% in RA have it)
-erythrocyte sedimentation rate (ESR) & C-reactive protein(CRP)(inflammation)
-anti-cyclic citrullinated peptide (anti-CCP) assay (protein associated with RA)
-antinuclear antibody (ANA) assay (autoimmunity)
-CBC(inc WBC, platelets, dec hemoglobin in active flare)
imaging to diagnose RA and JIA
ultrasound
MRI
arthrocentesis for diagnosis of RA or JIA
-milky, cloudy, dark yellow fluid + indication for inflammation
slit lamp exam to diagnose RA and JIA
tests for uveitis in JIA
major goals of therapy in RA and JIA
control pain
preserve joint range of motion and function/ADLs
minimize effects of inflammation, such as joint deformity
promote normal growth and develop
NSAIDs for RA and JIA
reduce pain and inflammation
e.g.ibuprofen, naproxen, indomethacin, COX-2 inhibitors
Nonbiologic DMARDs for RA and JIA
first line
prevents joint damage, obtain remission
-slow the attack of immune system
-methotrexate is most common, hydroxychloroquinine(off label use)
biologic DMARDs for RA and JIA
block tumour necrosis factor a and interleukin-1 “security guards for the joints”
“-mabs”
-TNF-a: adalimumab(humira), etanercept(enbrel), infliximab(remicade)
-IL-1 blocker: anakinra(kineret)
corticosteroids for RA and JIA
-severe systemic disease
-used to bridge the time it takes for DMARDs to work or fpr active systemic disease
-temporary
-topical, PO, IV, direct joint injection
physical management of RA or JIA
-relieve pain (non-pharmacologic)
-exercise
-ADLs
nutrition management for RA and JIA
well-balanced diet
iron supplementation
surgery management for RA and JIA
arthroscopy
joint replacement
arthrodesis
synovectomy
eye surgery
what is systemic lupus erythematosus (SLE)
-chronic, inflammatory, autoimmune disease
-multi-system disorder
-remissions and exacerbations
-onset common in 20s-30s
cutaneous manifestations of SLE
butterfly rash
oral ulcers
Raynaud’s syndrome
joint manifestations of SLE
arthralgias
arthritis/synovitis
cardiac manifestations of SLE
pericarditis
hypertension
atherosclerosis
valve insufficiency
CNS manifestations of SLE
psychosis
cognitive impairment
seizures
strokes
diagnosis for SLE
-assess for typical manifestations
-blood work: anemia, thrombocytopenia, leukocytosis, leukopenia, positive ANA’s
corticosteroids for SLE
topical, low dose oral, high dose oral/IV
antimalarials for SLE
cutaneous, MSK, mild systemic
pharmacological interventions for pain for SLE
NSAIDs
Immunosuppressive agents (DMARDs)
nursing management for SLE
-hospitalization for severe flares
-monitor for side effects of medications
-education: rest and exercise, nutrition, skin protection, coping, reproductive issues
