Intro to Rheum Flashcards
many rheum diseases involve what two processes?
autoimmunity and inflammation (also some with non immune and non inflammatory processes)
intra-articular and inflammatory diseases (8)
RA Systemic lupus erythematosus Septic arthritis Gout Pseudogout spondyloarthropathy Polymyalgia rheumatica psoriatic arthritis
extra articular and inflammatory diseases (4)
tendinitis
bursitis
myositis
vasculitis
non inflammatory and intraarticular disease
osteoarthritis
extra-articular and noninflammatory disease
fibromyalgia
RA is a __________ disease, with an ________ in baseline over time. Its pattern is ______
progressive; increase; wavy
Gout is characterized by acute ______ over time; how is the pain severity over time?
acute attacks (periods of symptoms); pain severity decreases over time (first is the worst)
Fibromyalgia process pattern
increases in pain severity until a plateau is hit (plateau is hit early on)
osteoarthritis process pattern
slow incline in pain severity over time and then sharp increase
Traumatic arthritis process pattern
present over time but no pain until a traumatic event triggers pain/flare
autoimmunity: problem with what? not _____, usually ______, just
problem with the immune system failing to recognize self; not weak (immunosuppressed), usually strong, just misdirected
what is the goal of drugs used to treat rheum diseases?
goal is to suppress cell division so that there is less release of cytokines
adiponectin is beneficial in fighting what? its decreased in what?
fighting inflammation; decreased in obesity
activation of the immune system leads to ______ ______ through _________
tissue damage through inflammation
inflammation occurs when?
there is tissue death and inflammatory cells called (macrophages, white cells, complement, and enzymes)
immunity usually leads to _________
inflammation
can have inflammation without ______ ________ being active
immune system
what two types of effects can you have with inflammation?
local and systemic (fever, fatigue)
Hadley says this test is pretty good at detecting systemic inflammation
sed rate
factors that increase ESR (6)
1) . advancing age
2) . female sex
3) . pregnancy
4) . hypercholesterolemia
5) . B cell neoplasm
6) . Renal failure
factors that decrease ESR (8)
1) . congestive heart failure
2) . sickle cell
3) . altered erythrocyte shape
4) . polycythemia
5) . extreme leukocytosis
6) . cachexia
7) . hypofibrinogenemia
8) . hyper viscosity attributable to paraproteinemia
what are the two types of inflammation?
acute and chronic
Local effects of inflammation (5)
redness, swelling, heat and pain, loss of function
local effects of inflammation: ______ blood flow and migration of ______
increased; WBCs
what two chemicals have a role in local inflammation?
histamine and prostaglandins
what response occurs during systemic inflammation?
acute-phase
what are some acute phase reactants? (4)
CRP, ESR, and WBCs
labs that go up with any severe illness or trauma (very non specific)
4 symptoms with systemic inflammation
fever, lethargy, malaise, weight loss
acute inflammation: _________ response with release of ________ and ________ to bring in blood and cells
vascular response; histamines and vasodilation
chronic inflammation: releases ______ that cause _____ formation (more _______)
cytokines; scar; damage
sometimes inflammation causes _________ damage
permanent
____________ is the most commonly involved process with rheum illnesses
autoimmunity
autoimmunity: can occur in almost any ______ or any _____; causes damage by activation of the _______ system and then __________ system
tissue or cell; immune or inflammatory
is autoimmunity simple or complex?
complex, usually a series of things go wrong to lose tolerance and recognize self as foreign antigen
what gene causes an increased risk of RA?
HLA-DR4
increased autoimmunity in what gender?
female
Woman get a preponderance of rheumatologic illness with exception of ______ and ______________
gout; spondyloarthropathy
what are the three major drug groups used to tx autoimmunity?
1) . steroids- suppress cell division but can cause skin atrophy
2) . immunosuppressants
3) . biologic txs
what do WBC levels tell you? <200 <3000 3000-50000 >50000
<200- normal
<3000 non inflammatory
3000-5000: inflammatory (could be infected)
>50,000- assume infected
what does pauciarticular mean?
2-4 joints
examples of peripheral, girdle and axial joints
peripheral- shoulder
girdle- hip
axial- spine
acute is less than ____ weeks; three examples of acute inflammation
6 weeks: gout, infection, fracture
chronic is more than ____ weeks; two examples of chronic inflammation
6 weeks: RA and osteoarthritis
two pauciarticular conditions
psoriatic arthritis, juvenile idiopathic arthritis
example of polyarticular condition
RA (more than 5 joints)
what three conditions involve the DIP joints?
Gout, PSA, OA
what condition more often involves the PIP and MCP joints?
RA
what are three asymmetric diseases?
SNA, Lyme arthritis, crystal arthritis
inflammatory conditions involve the _____ _____ (have what consistency?) VS non inflammatory have ______ ______
inflammatory- soft tissue (gooey or gummy)
non inflammatory- bone spurs (osteophytes)
extra-articular manifestations are always suggestive of __________ disease
systemic
female to male ratio: SLE, RA, OA, AS
SLE 9:1
RA 3:1
OA 1:1
AS 1:5
the F:M ratio disappears for SLE and RA after age ___
50
gout is very ___ in women before menopause
rare
what two conditions occur mainly in Caucasians?
PMR, Wegner’s
what two conditions occur mainly in African americans?
SLE, sarcoidosis
acute conditions usually affect how many joints? chronic?
acute- more common for monoarticular
chronic- more common for polyarticular
