Connective Tissue Disease Flashcards
common trait with connective tissue diseases
pain, mainly of the joints
rheumatoid arthritis
Autoimmune
inflammation of the connective tissue in synovial joints; triggers formation of the abnormal immunoglobulin G
May be environmental or genetic
*Will have Rheumatoid Factor (RF)
Early Stages of Rheumatoid Arthritis
joint stiffness, swelling, pain, morning stiffness
Weakness, weight loss
Late Stages of Rheumatoid Arthritis
joint pain and swelling worsens
joint deformities
loss of joint function r/t joint scarring
muscle atrophy r/t nonfunctioning joints
Goal of rheumatoid arthritis
for the disease to not progress into the late stage
clinical manifestations of rheumatoid arthritis
Slow
insidious, fatigue, weight loss, anorexia, stiffness, low grade fever
joint stiffness after period of inactivity -> worse in the morning
Swelling: symmetrical, impacts small joints of fingers, hands, feet; large peripheral joints, cervical spine, temporomandibular joint (TMJ)
Systemic complications of rheumatoid arthritis
Rheumatoid nodule - can be on skin, lungs, retina
Sjorgern’s syndrome - attacks salivary and lacrimal glands (dry mouth and eyes)
cardiopumonary disease
Psychosocial assessment rheumatoid arthritis
family support, coping skills, is the pt able to live independently?, job
Dx studies for rheumatoid arthritis
RF (80% positive) Antinuclear antibody (ANA)
erythrocyte sedimentation rate (ESR) and C-reactive protein test for inflammation
Synovial fluid analysis - checks WBCs
X-rays: initially not detected in early stages
Rheumatoid arthritis Tx
pain management, Heat and cold, PT, OT, plasmapheresis, nutrition
Meds: aspirin, NSAIDS, DMARDS, BMRs, corticosteroids
Plasmapheresis
taking the blood out, getting rid of the antibodies, replacing donor blood then putting the pt’s blood back
Ankylosing Spondylitits
Autoimmune
inflammation of the axial skeleton (next to sacral iliac joint)
white males under 40 y.o most commonly affective
genetic predisposition (HLA-B27 antigen)
*lots of back problems
Ankylosing Sondylitis manifestations
low back pain worsening during rest (morning), arthralgia, malaise, weight loss
Later -> pain taking deep breaths causing pulmonary complications
Ankylosing Sondylitis complications
severe postural deformities (balance and vision)
aortic insufficiency
pulmonary fibrosis
Lower extremity weakness and bladder dysfunction
spinal fractures
Cauda equina syndrome
compression of the spinal nerves (usually from inflammation); needs to be resolved immediately or it can cause permanent paralysis of the lower extremities
lower extremity weakness and bladder dysfunction
Ankylosing Spondylitis dx studies
pelvic x-rays, ESR, HLA-B27
Ankylosing Spondylitis Tx
Cannot be prevented
maintain mobility (PT/OT) Maintain respiratory function correct posture (firm mattress, legs outright) decrease pain and inflammation heat, exercise, surgery
NSAIDS/corticosteroids/DMARDS/BRMs
Lupus Erythematosus
Autoimmune; most common in childbearing year females
Discoid lupus erythematosus (DLE) vs Systemic lupus erythematosus (SLE)
overaggressive antibody response r/t B and T cell hyperactivity: immune complexes form in serum and tissues
Genetic and environmental
Discoid lupus erythematosus (DLE)
only affects the skin
Systemic lupus erythematosus (SLE)
chronic, progressive connective tissue disorder (more severe symptoms)
spontaneous remissions and exacerbations
can be fatal
Systemic Lupus Erythematosus assessment findings
malar rash, discoid rash photosensitivity, oral ulcers, arthritis pericarditis, raynaud's arthritis, nephritis fever, fatigue, vasulitis abdominal pain, headaches
Anti-DNA, Anti-smith, Antinuclear antibody, ESR & CRP, renal/liver/cardiac labs, psychosocial assessment
main cause of death in systemic lupus erythematosus
cardiac, renal failure, infection r/t altered immunity
systemic lupus erythematosus complications
dermatoligic musculoskeletal cardiopulmonary renal neurological hematological disease infection
Systemic Lupus Erythematosus Tx
prevention of complications
Drug therapy: NSAIDS, DMARDS (plaquenil, methotrexate), corticosteroids, plasmaphoresis, immunosuppressive drugs
skin protection, carefully watch renal function!, pregnancy concerns, psychosocial concerns
Scleroderma
autoimmune
AKA systemic sclerosis
chronic, inflammatory, autoimmune connective tissue disease
results in hardening of skin; proliferation of collagen disrupts function of internal organs
more common in women
environmental or genetic
scleroderma clinical manifestations
arthalgia
edema of hands/fingers, upper/lower extremities
skiny, taut skin
joint contractures
CREST syndrome
CREST syndrome
Calcinosis - decreased Ca deposits under skin
Raynaud’s Syndrome - worsens in the cold
Esophageal Dysfunction - difficulty swallowing
Sclerodactyly - tightening of the skin of hands
Telangiectasia - red spots on the hands and feet
scleroderma organ dysfunction
GI tract (constipation)
Cardiovascular system
Pulmonary system
Kidneys
scleroderma dx studies
similar to SLE
scleroderma tx
prevent or treat secondary complications
PT/OT - ROM exercises
Drug therapy: immunosuppressants, corticosteroids, NSAIDS
skin protection
Fibromyalgia
chronic widespread musculoskeletal pain and fatigue
Fibromyalgia clinical manifestations
widespread burning pain/tenderness on palpation difficulty concentrating memory lapse peripheral numbness/tingling headaches depression
Fibromyalgia Dx studies
exam findings
rule out other disorders
often not properly diagnosed
pain and tenderness on palpation
Fibromyalgia collaborative care
massage w/ ultrasound
restrict foods that are muscle irritants
relaxation techniques
meds: analgesias (AVOID OPIOIDS), Lyrics (prevents nerve firing), tricyclic antidepressants and SSRIs, skeletal muscle relaxants, benzos
Lyme Disease
infectious disease
Infection transmitted by a deer tick
Lyme Disease clinical manifestations
erythema migraines: “bulls eye appearance”
Carditis (inflammation around heart)
Acute viral symptoms Arthritis severe headaches facial paralysis (bell's palsy) poor motor coordination
Lyme Disease late manifestations
arthritis pain, swelling
neurological disorders (fatigue, memory/thinking problems)
Lyme Disease dx
hx of exposure
lyme disease AB screening
Western Blot IgG, IgM
Lyme diseae C6 peptide by ELISA
Lyme Disease tx
doxycycline, ceftriaxone
Lyme Disease education
wear long pants, light color
spray insect repellent on skin/clothing
provide pets w/ tick collars, check frequently
remove tick w. tweezers, flush down toilet
wash bitten area with soap and water, apply antibx ointment
report flu-like s/s
Gout
Not autoimmune or infectious
Crystal precipitate in a joint and subcutaneous tissue causing an inflammatory rxn
usually affects the big toe
Primary Gout
error of purine metabolism
foods high in purine: liver, sardines, kidney meat, pork, chicken, beef
Secondary Gout
hyperuricemia from a secondary cause: renal disease, diuretics, crash dieting, chemo
–cannot get rid of uric acid
Acute gouty arthritis “Attack”
pain/inflammation of 1 or more joints -> horrible pain
joint tenderness, swelling, warmth
asymptomatic hyperuricemic stage
no s/s
Chronic tophaceous gout
after multiple “attacks”
urate crystals (tophi) deposit under skin and kidneys
arthritis, renal calculi, 3-40yrs after initial s/s
Gout dx tests
serum uric acid, 24 hr urine uric acid levels, BUN and creatinine
synovial fluid aspiration
x-rays
Gout management
eliminate alcohol decrease foods high in purine increase fluids Avoid ASA and diuretics immbolization
drug therapy: NSAIDS (except ASA), colchicine, allopurinol, probenecid
