Disorders of the Skeletal System : Metabolic and Rhuematic Disorders Flashcards
What is Osteoporosis?
a metabolic bone disorder
characterized by a decrease in bone mass and density, combined with loss of bone matrix and mineralization
What may be the first indicator of osteoporosis?
bone fracture
What is the patho behind Osteoporosis?
bone reabsorption exceeds bone formation
remaining bone is normal
Who is osteoporosis usually seen in?
post menopausal women (b/c lack of estrogen)
short women more than tall women
thinner women more than thicker women
Why don’t we just give estrogen to post menopausal women?
because estrogen has been linked to cancer
What are the predisposing factors for Osteoporosis?
smoking
calcium deficit
sedentary lifestyle
aging
Osteopenia
Hormonal Factors (Hyperparathyroidism or Cushing’s Syndrome)
Long Term intake of glucorticoids (steroids) such as Prednisone
What is osteopenia?
mineral bone density lower than normal but not osteoporosis
can contribute to the pathology of all metabolic bone diseases
mostly diagnosed after a bone fracture
When does bone density peak?
30 years old
Which race is at a higher risk of Osteoporosis?
European and Asian have higher risk
If your mother had osteoporosis are you at a greater risk to develop osteoporosis in your lifetime?
yes, at up to an 80% increase in likelihood
What are the modifiable risk factors for osteoporosis?
excessive alcohol, Vitamin D deficiency (calcium carrier), tobacco smoking, malnutrition, underweight, inactivity
How does tobacco increase the risk of osteoporosis?
tobacco smoking increases the breakdown of estrogen(look like a man)
What is Osteomalacia?
defective mineralization of bone WITHOUT the LOSS of bone matrix
What are the two causes of Osteomalacia?
inadequate calcium
inadequate phosphate
Osteomalacia is highly seen among…
the elderly
Can Osteomalacia be treated?
can be treated with diet if that is the cause
What is a matrix?
intracellular substance of tissue/s from which a structure develops
Children with what disease are at risk for Osteomalacia?
Rickets
What is Rickets?
Failure or delay in calcification of the growth plate
seen in children
several forms
may be nutritional: Vitamin D dependent or Vitamin D resistant
What is Rickets generally caused by?
Vitamin D deficiency
Premature Osteoporosis is being seen in who?
female athletes (they don’t menstruate)
What is Paget’s Disease?
Chronic
significant bone reabsorption followed by hectic bone reformation
bones are irregular and fracture easily
bones tend to bow or take abnormal shapes
Clinical features are going to vary depending on the extent of the disease
What are the commonly affected areas with Paget’s Disease?
pelvis, femur, lower lumbar vertebrae
*this differentiates this disease from osteoporosis
What is Rheumatoid Arthritis (RA)?
autoimmune disorder causing chronic systemic inflammatory disease
can effect tissue or organs but primarily flexible synovial joints
major cause of disability, can cause loss of function
Remissions and exacerbations
Severity varies from mild to severe, reflecting the number of joints involved (polyarticular)
often larger joints but can be in smaller joints
What does Polyarticular mean?
involving many joints
RA has a higher incidence in who?
women than men
Discuss the development of RA
1) ABNORMAL IMMUNE RESPONSE, causing inflammation of the synovial membrane with vasodilation, increase permeability, and formation of exudates, causing the typical red, swollen, and painful joint
2) Rheumatoid Factor (antibody against immunoglobin G) is present in the majority of patients with RA
3) After the FIRST period of acute inflammation (in capsule around joints in the synovium), the joint MAY RECOVER COMPLETELY….. but….
* During subsequent EXACERBATIONS the process will CONTINUE into……….
- Synovitis
- Pannus Formation
- Cartilage Erosion
- Fibrosis
- Ankylosis
Define Pannus
fibrous tissue in synovium
Define Fusion
when you cant move a joint
What is Ankylosis?
fusion
Define exacerbations?
flare ups
Synovitis
inflammation of the synovial membrane
Pannus formation
unique to RA. (HALLMARK)
Not seen in other inflammatory arthritis
Cartilage Erosion
abnormal layer of fibrovascular tissue or granulation tissue
Ankylosis
Stiffness of a joint due to abnormal adhesion and rigidity of the bones of the joint
What are the complications of RA?
- atrophy of muscles
- alignment shifts
- inflammation/pain
- contractures/deformities
- mobility impaired
- systemic effects
What are some nonpharmalogical things we can suggest for RA patients?
Physical Therapy
Occupational Therapy
Nutritional Therapy
What are some Pharmalogical treatments of RA?
Analgesics (pain killers)
Steroids (to decrease autoimmune response)
What is Systemic Lupus Erythematosus (SLE)?
Chronic Inflammatory Condition-NO CURE
Unknown etiology
UNPREDICTABLE- each person with SLE may experience different manifestations
Harms heart, joints, skin, lungs, nervous system tissues
can be FATAL, esp. due to cardiovascular disease
What is the patho behind Systemic Lupus Erythematosus ?
for some unknown reason patients with SLE develop AUTOANTIBODIES that damage different tissues around the body.
some SLE patients produce antibodies against RBC
What are the Clinical Manifestations of SLE?
can affect many systems: musculoskeletal, skin, cardiovascular, lungs, kidneys, CNS
Onset could be Acute or Insidious (creeps up like an old pair of undies)
Exacerbations and Remissions
Arthralgia and Arthritis (early) [joint pain is a common early symptom]
Skin (Butterfly Rash) - don’t always have this
Wide range of S/S so diagnosis can be elusive
Butterfly Rash is a hallmark of which disorder?
SLE
Systematic Lupus Erythematosus
What is the difference between Arthralgia and Arthritis?
Arthralgia is non-inflammatory and Arthritis is Inflammatory
What is SLE often called? Why?
The Great Imitator
b/c it mimics so many diseases with the wide range of S/S
What is Scleroderma?
Autoimmune disorder characterized by fibrosis (or hardening “sclero”), vascular alterations and autoantibodies
Effects the CONNECTIVE TISSUE, primarily skin
What is the Classic Characteristic of Scleroderma?
Fibrosis
Who is Scleroderma most often seen in?
women
Is there treatment for Scleroderma?
no
Limited Vs. Diffuse Systemic Sclerosis (scleroderma)
- Limited Cutaneous = skin only (forearms, fingers and face)
- “CREST”
- Diffuse is progressive skin involvement and other organs
What does the acronym CREST stand for?
Clinical Manifestations of LIMITED scleroderma
Calcinosis Raynaud's Esophageal Dysfunction Sclerodactyly Telangiectasias
Calcinosis (in LIMITED SLE)
deposits of calcium nodules in skin
Raynaud’s (in LIMITED SLE)
exaggerated vasoconstriction in hands
Sclerodactyly (in LIMITED SLE)
skin thickens on fingers
Telangiectasias (in LIMITED SLE)
dilated capillaries on the face, hands, and mucus membranes
What is Ankylosing Spondylitis ? (and what does it effect?)
Autoimmune disease
Chronic
Progressive
Inflammatory
Effects….
- Sacroiliac joints
- intervertebral spaces
- Costovertebral joints of the axial skeleton
Discuss the progressive process of Ankylosing Spondylitis?
Vertebral joints become inflamed
Fibrosis and calcifications or fusion of joints
Inflammation begins and progresses up spine
Kyphosis
Osteoporosis
Lung expansion may be limited
How does inflammation present in Ankylosing Spondylitis?
progresses up the spine
Why does Kyphosis develop in Ankylosing Spondylitis patients?
kyphosis develops as result of rigidity and loss of normal curvature
Why is Osteoporosis common in Ankylosing Spondylitis patients?
because of pathological compression fractures
What is Bamboo Spine?
complete fusion and rigidity of spine from Ankylosing Spondylitis
In what autoimmune disease to the patients become plasticized?
Scleroderma
Can Scleroderma be fatal?
Yes because they can develop organ system complications that can be fatal ( Diffuse Systemic Sclerosis)
What is Osteoarthritis ?
Degenerative “non-inflammatory” joint disease
Osteoarthritis is often seen in which joints?
frequently occurs in weight bearing joints
Discuss the mechanisms and patho behind Osteoarthritis?
Articular cartilage of joints is lost through erosion from excessive mechanical stress. Surface becomes rough and worn interfering with easy joint movement.
Tissue damage appears to cause release of enzymes from the cells that accelerates degeneration of the cartilage.
Subchondral bone may be exposed and damaged, leading to bone spurs developing. Pieces of bone spurs break off in the joint, causing further irritation
joint space becomes narrow
(evidenced by crepitus and grinding)
What are the S/S of OA (osteoarthritis)?
joint pain (can be debilitating), crepitus, stiffness
*no systemic S/S with OA which is how it is differentiated from RA
What is the treatment for OA?
exercise
Analgesics (pain killers)
Nutrition
OA can lead to bone spurs… why?
Because of the degeneration of the cartilage Subchondral bone may be exposed and damaged which leads to the development of bone spurs.
What is a complication of bone spurs with OA?
Pieces of bone spurs could break off in the joint causing further irritation
T/F The risk of Osteoarthritis does not increase with age.
FALSE
Osteoarthritis is associated with increased risk with age
Discuss the Evolution of Osteoarthritis. (in what order are things effected?)
- Bone
- Cartilage
- Thinning of Cartilage
- Cartilage Remnants
- Destruction of Cartilage
What is Gout/Gouty Arthritis?
deposits of URIC ACID/urate crystals in joints. Cause an acute inflammatory response.
affects a single joint
What are the S/S of Gout?
affects a single joint
redness/swelling of joint pain with severe pain
What is a common site for Gout to be seen?
the Big Toe
What could precipitate and attack of gout?
a sudden increase in serum uric acid levels
How do we diagnose Gout?
attain a sample of the fluid
What is Gout sometimes called?
“The King’s Disease” because it is associated with a diet that a rich person would have (red wines, Red Meats)
Who is Gout commonly seen in?
men over 40
How do we treat Gout?
diet modifications (less uric acid) and medications
