Exam IV: RA Flashcards
Most common _____ _____ disease - 1% of adults
More _____ than _____ —2-3x more
chronic inflammatory
women than men
_____ etiology—thought to be genetic, environmental, autoimmune?
Unknown
proximal interphalangeal/metacarpophalangeal joints of hands and feet
VS
OA - ____ ____ joints and _____ interphalangeal joints
weight bearing
distal
_______ and remissions
Exacerbations
Pathophysiology
Exact etiology remains ______
* Heredity - minor
* Autoimmunity pivotal
elusive
Circulating _______ “rheumatoid factors” in ___-___ of patients
autoantibodies
70-80%
- ______ assault
- Cartilage, ligament, tendons and bones
- _____ and ______ of skeletal structures
- Deformed joints that have no _____ and minimal or no _____
Immune
Dislocation and dissolution
stability
ROM
RA - SYSTEMIC INVOLVEMENT
- Inflammatory ______
cytokines
RA - SYSTEMIC INVOLVEMENT
_____ of articular surfaces and _____ of adjoining cartilage, tendons, and ligaments
Erosion
destruction
RA - SYSTEMIC INVOLVEMENT
Tumor necrosis factor inhibitors:
- Etanercept - Enbrel®
- Infliximab - Remicade®
- Adalimumab - Humira® (“human monoclonal Ab in RA”)
- Golimumab - Simponi®
RA-systemic involvement
Heart - aortic or mitral ____ _____ _____
regurgitation pericardial effusion
_____ _____: RA, splenomegaly, neutropenia
Felty’s Syndrome
Peripheral neuropathy — ____ ____ is most common
Carpal Tunnel
Joint Involvement (4)
- limits ROM
- severe pain
- joint instability
- crippling deformities
most important to the CRNA joint involvement
- TMJ
- Cricoarytenoid joint
- Atlanto-axial joint
Cricoarytenoid joints of the larynx may be _____, ______, or ______ in a position that obstructs airflow
swollen, inflamed, or fixed
_____ may be friable
mucosa
CRICOARYTENOID JOINTINVOLVEMENT
sensation of foreign body - ____% of patients
hoarseness - ____% of patients
sensation of fullness - ____% of patients
dyspnea - ____% of patients
17
15
14
10
TMJ INVOLVEMENT - Flexion contractures and soft tissue swelling may lead to marked limitation in _____ to _____ _____
ability to open jaw
TMJ INVOLVEMENT - ____ to ____ have involvement of the Temporomandibular joint
30% to 80%
TMJ INVOLVEMENT - *** Patient may be able to open mouth only ___ or ___ ____
1 or 2 cms
RA – CERVICAL SPINAL INVOLVEMENT
RA and ankylosing spondylitis have major cervical spinal involvement
Involvement of the cervical spine may be extensive causing (3)
- instability
- limited movement of the neck
- severe laryngeal deviation
_____ _____ may occur in 20-40% of population
Atlantoaxial subluxation
____-_____ most common site for cervical involvement
C1 - C2
Anesthetic Implications
- ______ History (NSAIDs, steroids, methotrexate, tumor necrosis factor inhibitors)
- airway assessment (TMJ, cricoarytenoid joints)
- MRI or radiographic evaluation cervical spine for advanced disease
- careful positioning - ______, _____
- observe closely for post-extubation _____ _____ and stridor
- dry eyes (_____ Syndrome)
Medication
osteopenic, steroids
laryngeal edema
Sjogren’s