Inflammatory Disorders ( RA and Lupus) Flashcards
RA and Lupus
inflammatory conditions that result in pain limited movement destruction/erosion of joints, muscles, ligaments they are autoimmune systemic
what is RA?
systemic autoimmune disease
type II hypersensitivity
inflammatory disease of synovium
etiology of RA
environmental and genetic factors (genetic link + triggering event, or inappropriate response to injury) age 40-60 women tobacco
pathogenesis of RA
autoimmune attack of synovial tissue lymphocytes, macrophages activated produces RF (rheumatoid factor)
what is Rheumatoid factor (RF)
IgG
formation of immune complexes and activates compliment
Is RA progressive?
Yes, inflammation intensifies
cartilage is destroyed by osetoclasts
pannus develops
what is pannus?
extra growth in your joints that can cause pain, swelling, and damage to your bones, cartilage, and other tissue
pannus causes?
bone erosion
bone cysts
fissure development
eventual clinical manifestations of RA
symmetrical
pain, stiffness, limited motion
inflammation, heat, swelling, tenderness
advanced clinical manifestations of RA
joint deformity and disability
joint subluxation
what is joint subluxation?
partial dislocation of joint
systemic involvement of RA
fatigue, malaise
potential to effect all body systems
rheumatoid nodules and Sjogren’s syndrome
Rheumatoid nodules
immune mediated granulomas
develop around inflamed joints and in lungs
sub-q, firm
sometimes painful
Sjogrens syndrome
a disorder of your immune system identified by its two most common symptoms dry eyes (gritty, dry, itchy eyes) dry mouth (fissured tongue)
Meds for RA
NSAIDS- immediate relief Glucocorticoids: short term relief DMARDS- to slow progression used to stop and slow progression relieve pain and inflammation
Systemic Lupus Erythematous (SLE)
autoimmune attack against your DNA inflammatory acute flare ups unpredictable effects multiple organ systems 2 major forms
what are the two major forms of lupus
discoid
systemic
Discoid Lupus
chronic skin condition of sores with inflammation and scarring favoring the face, ears, and scalp and at times on other body areas.
predisposing factors of SLE
genetics females age 15-44 (child bearing age) race (African, Asian and Hispanic) environmental triggers allergy to antibiotics hormonal factors
pathogenesis of SLE
hyperactive B-lymphocytes produce autoantibodies ANA formation of immune complexes all major organ systems inflammation destroys tissue
manifestations of SLE
BUTTERFLY RASH RAYNAUDS NEPHRITIS extreme fatigue myocarditis vasculitis pleuritis
warning signs of SLE flare
fatigue
pain
headache
how to prevent SLE flares
sunlight exposure
infection
learn to recognize warning signs and triggers
meds for SLE
relieve pain and swelling stop or prevent progression NSAIDS glucocorticoids DMARDS
corticosteroids
prednisone prednisolone rapid suppression of inflammation only used if symptoms are NOT controlled with NSAIDS short term therapy no more than 10mg/day
methotrexate
first line therapy
antineoplastic, antirheumatic
immunosuppression
administered weekly PO, sub-q/IV
side effects of methotrexate
GI upset
bone marrow suppression
shortened life expectancy
nursing implications of methotrexate
11 Black box warnings folic acid supplementation REQUIRED NO ETOH NO pregnant contact HCP with signs of infection
hydroxychloroquine
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
side effect of hydroxychloroquine
Rare: retinopathy
similarities between RA and SLE
autoimmune disease
systemic inflammation
multiple body systems
pharmacotherapy
differences between RA and SLE
RA= joints (sometimes organs) SLE= multisystem (sometimes joint)
