Exam 1 Flashcards
3 stages of Primary Gout
1) Hyperuricemia
2) Acute Gouty Arthritis
3) Chronic Tophaceous Gout
- Deposits of urate crystals under skin
- Other major organs (renal)
- Kidney stone formation
- 3-40 years after acute episode
- Uncommon in US
Chronic Tophaceous Gout
- Sodium urate deposited in synovium
- Excruciating pain
- Inflammation in small joints, usually great toe (podagra)
Acute Gouty Arthritis
Most common inflammatory arthritis in older adults
Gout
- May be genetic X-linked
- Inborn errors of purine metabolism
- Production of uric acid exceeds excretion
Primary Gout
-Excessive uric acid in the blood caused by another dz
Renal insufficiency, crash diets, diuretics, chemo
Secondary Gout
Allopurinol pt instructions
Take after meals with a glass of water to prevent GI distress
DOC for Gout
Allopurinol
What can cause a gout attack?
Alcohol and starvation diets
Diet instructions for gout
Increase alkaline ash foods (to increase pH) such as citrus fruits, juices, dairy products
How to treat Polymyositis
- High dose steroids
- Immunosuppressive agents
- Monitor nutrition for swallowing problems
What is Polymyositis coupled w/ a rash?
Dermatomyositis
What type of rash w/ Dermatomyositis?
Heliotrope rash (iliac) & periorbital edema
What Dz?
- Mostly men
- Involves every body system
- Renal and cardiac problems: leading cause of death
Polyarteritis nodosa
What Dz?
Most common form of vasculitis
Skin lesions as an allergic response
Hypersensitivity vasculitis
What Dz?
- Japanese women in 20s
- Aortic arch syndrome
- Cerebral ischemia
- Visual changes, syncope, vertigo
Takayasu’s arteritis
DOC for vasculitis dzs?
Steroid therapy (prednisone)
First symptoms of systemic Necrotizing Dzs?
Arteritis, ischemia
DOC for Temporal Arteritis
- Corticosteroids URGENTLY
- Calcium and Vitamin D for prevention of osteoporosis
What Dz?
- 20% of patients with PMR
- Systemic affecting large and mid size arteries
Temporal Arteritis
Women over 50 report declining vision, probably have?
Polymyalgia rheumatica (PMR)
What Dz?
- Stiffness, weakness, aching
- Low grade fever, arthralgias, stiffness, fatigue, weight loss
- Neck, shoulder, hip joints most affected
Polymyalgia rheumatica (PMR)
What Dz?Exact cause unknown
-Genetic risk: HLA-B27 alleles
Affects vertebral column, spinal deformities
-White men
Ankylosing Spondylitis
What Dz?
- Genetic association: HLA-B27 antigens
- Mostly young white men
- From exposure to STD or Intestinal infection
Reiter’s Syndrome
Reiter’s Syndrome Triad of Symptoms
- Arthritis
- Conjunctivitis
- Urethritis
* May also experience balantitis circinata (inflammation around penis)
What Dz?
- Autosomal dominant
- Abnormalities of skeletal, ocular, cardiopulmonary & CNS
- Excessively tall, scoliosis, funneled chest
- Decreased visual acuity or glaucoma
- Hyperextensibility of joints
- Elongated hands and feet
Marfan Syndrome
Why do most deaths from Marfan Syndrome occur?
- Cardio problems (usually in 30s)
- Mitral valve prolapse
- Mitral valve regurgitation
- Aortic aneurysm rupture
Treatment of Marfan Syndrome?
- Palliative (deal w/ symptoms, not cause)
- Monitor CV status
- CV medications
- Orthopedic surgery
What Dz?
- Systemic infectious disease
- Borrelia burgdorferi spirochete
- Bite of infected deer tick
- Most common vector borne disease in US
Lyme Dz
Stage 1 Lyme Dz
- Localized, flu-like symptoms
- Round or oval, flat or slightly raised rash
- Pain and stiffness in muscles and joints
- Bull’s-eye lesion
- Symptoms usually 7-14 days after bite
- With treatment (ABX), no symptoms 4-5 weeks
Stage 2 Lyme Dz
- Early disseminated (spread), 2-12 weeks after bite
- Pt may develop carditis, dysrhythmias, dyspnea, dizziness, palpitations, CNS disorders, Meningitis, facial paralysis, peripheral neuritis
Treatment of Stage 2 Lyme Dz
IV antibiotics for 30 days
Stage 3 Lyme Dz
Chronic persistent Arthritis Chronic fatigue Memory and thinking problems Months to years after bite
What Dz?
- Mimics gout
- Deposited crystals are calcium pyrophosphate
- Crystals migrate to cartilage
- Older hospitalized males
- Highest in men with metastatic cancer
Pseudogout
What Dz?
- 30% of people with psoriasis
- 30-50 years of age
- Genetic, environmental, infectious agents, immune system dysfunction
- Early morning stiffness, neck and back pain
- Fingernail and toenail lifting
Psoriatic arthritis
Psoriatic Arthritis Tx
- Manage joint pain and inflammation
- Control skin lesions
- Health teaching similar to skin care for lupus
- Management similar to rheumatoid arthritis
What Dz?
- Chronic pain syndrome, not inflammatory
- Arthritis commonly present
- Pain, stiffness, tenderness
- Neck, upper chest, trunk, low back, extremities (trigger points)
- Pain intermittent but worsens with stress, increased activity, weather
- 30-50 years of age
Fibromyalgia
Precipitating factors of Fibromyalgia
- Chronic fatigue syndrome
- Lyme disease
- Trauma
- Flu-like illness
Fibromyalgia Tx
- Antidepressants
- Teach that these drugs cause drowsiness
- Avoid alcohol
- NSAIDS
- Sleep aids
- Be careful with older pts (may cause confusion and orthostatic hypotension)
- Muscle relaxants
- Physical Therapy
What Dz?
- Chronic illness w/ fatigue 6 months or longer
- Flu-like symptoms
Chronic Fatigue Syndrome
Four of more of what criteria must be met for Chronic Fatigue Syndrome?
- Sore throat
- Substantial impairment in short-term memory or concentration
- Tender lymph nodes
- Muscle pain
- Multiple joint pain with redness or swelling
- Headaches of a new type, pattern, or severity (not familiar to the patient)
- Unrefreshing sleep
- Postexertional malaise lasting over 24 hours
Supportive Treatments for Chronic Fatigue Syndrome
- Aches and Pains: NSAIDS
- Sleeplessness and depression: Antidepressants
- Teach: adequate sleep, proper nutrition, regular exercise, stress management, energy conservation, CAM
What Dz?
- Symptoms atypical of any one connective tissue disease
- 10% of patients with CTD
- 2 diseases may overlap at one time
- Systemic lupus erythematosus AND systemic sclerosis
- Rheumatoid arthritis AND SLE
Mixed Connective Tissue Dz
What Dz?
“I’m sick of always being sick”
Mixed Connective Tissue Dz
What do you assess for Scleroderma?
-Skin: painless pitting edema of hands and fingers, taunt, shiny, wrinkle free, decreased ROM, ulcerations, contractures
-Myocardial fibrosis: EKG changes, dysrhythmias, chest pain
-Vasculitic lesions
-Nailbeds: digit necrosis
Autoamputation
-Renal:malignant HTN, urine output and BP
-Respiratory: pulmonary fibrosis, pulmonary HTN
-Gastrointestinal: ability to swallow
Main cause of death in Scleroderma?
Renal
Important teaching priorities for SLE
Skin Protection, monitor body temperature
SLE leading cause of death?
Renal: Lupus Nephritis
Classic sign of exacerbation for SLE
Fever
What Dz?
-Affects skin ONLY, round coin-like scarring lesions
Discoid DLE
What Dz?
- Alopecia (hair loss), dry, scaly, raised rash on the face (butterfly rash), mouth ulcers
- Autoimmune
- Combination of genetic and environmental factors
- Onset 20-40 years of age
- Women 10 times more than men
- Women of color more often affected
SLE
Patho of SLE
-Antinuclear Antibodies (ANA) affect DNA, RNA
-Immune complexes form in serum & organ tissues
-Inflammation, damage, destruction
-Invade organs or vessels (vasculitis)
*Particularly attracted to kidney glomeruli
(leading cause of death)
-Deprives organs/tissues of arterial blood & oxygen
Chronic therapy complications of RA
-Diabetes mellitus, infection, fluid/electrolyte imbalances, HTN, Osteoporosis, Glaucoma
Teaching for RA
- Take steroids with calcium plus vitamin D
- Rest and ice after injection in single joint
DOC for RA
Prednisone
Cox-2 inhibitor for RA
- Celebrex
* Cardiovascular WARNING!
Pts with MS or TB cannot take what drugs?
BRMs
BRMs for RA
etanercept (Enbrel) Monitor CBC, creatinine, liver panel infliximab (Remicade) Infusion reaction: tachycardia, shortness of breath, lightheadedness adalimumab (Humira) anakinra (Kineret) Patients with MS or TB cannot take this drug abatacept (Orencia)
Most pts w/ RA are managed with what initially?
DMARDs
DMARDs for RA
- Leflunomide (Arava)
- Hair loss, diarrhea, decreased WBCs/platelets, increased liver enzymes, avoid alcohol, pregnancy not recommended
- Hydroxychloroquine (Plaquenil), Antimalarial drug
- Retinal damage, generally tolerated well, mild stomach discomfort, light-headedness/headache
DOC for RA
Methotrexate (MTX) (Rheumatrex)
*Immunosuppressive= decreased WBCs, platelets, elevated liver enzymes/creatinine, pregnancy not recommended, risk for infection, avoid crowds
Arthrocentesis
Fluid is drained from a joint, can be done with RA
Sjögren’s Syndrome
- Dry eyes, dry vagina, dry mouth
- Seen in RA
Infectious organism possibly causing RA?
Epstein-Barr virus
