Inflammatory Disorders ( RA and Lupus)

Question 1

RA and Lupus

Answer 1

inflammatory conditions that result in
pain
limited movement
destruction/erosion of joints, muscles, ligaments
they are autoimmune
systemic

Question 2

what is RA?

Answer 2

systemic autoimmune disease
type II hypersensitivity
inflammatory disease of synovium

Question 3

etiology of RA

Answer 3

environmental and genetic factors
(genetic link + triggering event, or inappropriate response to injury)
age 40-60
women
tobacco

Question 4

pathogenesis of RA

Answer 4

autoimmune attack of synovial tissue
lymphocytes, macrophages activated
produces RF (rheumatoid factor)

Question 5

what is Rheumatoid factor (RF)

Answer 5

IgG

formation of immune complexes and activates compliment

Question 6

Is RA progressive?

Answer 6

Yes, inflammation intensifies
cartilage is destroyed by osetoclasts
pannus develops

Question 7

what is pannus?

Answer 7

extra growth in your joints that can cause pain, swelling, and damage to your bones, cartilage, and other tissue

Question 8

pannus causes?

Answer 8

bone erosion
bone cysts
fissure development

Question 9

eventual clinical manifestations of RA

Answer 9

symmetrical
pain, stiffness, limited motion
inflammation, heat, swelling, tenderness

Question 10

advanced clinical manifestations of RA

Answer 10

joint deformity and disability

joint subluxation

Question 11

what is joint subluxation?

Answer 11

partial dislocation of joint

Question 12

systemic involvement of RA

Answer 12

fatigue, malaise
potential to effect all body systems
rheumatoid nodules and Sjogren’s syndrome

Question 13

Rheumatoid nodules

Answer 13

immune mediated granulomas
develop around inflamed joints and in lungs
sub-q, firm
sometimes painful

Question 14

Sjogrens syndrome

Answer 14

a disorder of your immune system identified by its two most common symptoms 
dry eyes (gritty, dry, itchy eyes) 
dry mouth (fissured tongue)

Question 15

Meds for RA

Answer 15

NSAIDS- immediate relief
Glucocorticoids: short term relief
DMARDS- to slow progression
used to stop and slow progression
relieve pain and inflammation

Question 16

Systemic Lupus Erythematous (SLE)

Answer 16

autoimmune attack against your DNA 
inflammatory
acute flare ups
unpredictable
effects multiple organ systems
2 major forms

Question 17

what are the two major forms of lupus

Answer 17

discoid

systemic

Question 18

Discoid Lupus

Answer 18

chronic skin condition of sores with inflammation and scarring favoring the face, ears, and scalp and at times on other body areas.

Question 19

predisposing factors of SLE

Answer 19

genetics
females
age 15-44 (child bearing age)
race (African, Asian and Hispanic)
environmental triggers
allergy to antibiotics
hormonal factors

Question 20

pathogenesis of SLE

Answer 20

hyperactive B-lymphocytes produce autoantibodies
ANA
formation of immune complexes
all major organ systems
inflammation destroys tissue

Question 21

manifestations of SLE

Answer 21

BUTTERFLY RASH
RAYNAUDS
NEPHRITIS
extreme fatigue
myocarditis
vasculitis
pleuritis

Question 22

warning signs of SLE flare

Answer 22

fatigue
pain
headache

Question 23

how to prevent SLE flares

Answer 23

sunlight exposure
infection
learn to recognize warning signs and triggers

Question 24

meds for SLE

Answer 24

relieve pain and swelling
stop or prevent progression
NSAIDS
glucocorticoids
DMARDS

Question 25

corticosteroids

Answer 25

``` prednisone prednisolone rapid suppression of inflammation only used if symptoms are NOT controlled with NSAIDS short term therapy no more than 10mg/day ```

Question 26

methotrexate

Answer 26

first line therapy antineoplastic, antirheumatic immunosuppression administered weekly PO, sub-q/IV

Question 27

side effects of methotrexate

Answer 27

GI upset bone marrow suppression shortened life expectancy

Question 28

nursing implications of methotrexate

Answer 28

``` 11 Black box warnings folic acid supplementation REQUIRED NO ETOH NO pregnant contact HCP with signs of infection ```

Question 29

hydroxychloroquine

Answer 29

``` DMARD, antimalarial, antirheumatic anti-inflammatory properties slows progression of RA when used in combo with other DMARD can be used alone or in combo early/mild RA ```

Question 30

side effect of hydroxychloroquine

Answer 30

Rare: retinopathy

Question 31

similarities between RA and SLE

Answer 31

autoimmune disease systemic inflammation multiple body systems pharmacotherapy

Question 32

differences between RA and SLE

Answer 32

``` RA= joints (sometimes organs) SLE= multisystem (sometimes joint) ```