Joint stuff and SLE Flashcards
Synovial joints
moveable bc of synovial fluid
- outer fibrous joint capsule, internal synovial mem, articular cartilage, and synovial fluid
- joint capsule connects bone and inner membrane lining
Function of articular cartilage
Prevent friction btwn bones
Arthropathy
joint disorder of inflammation of at least one joint leading to arthritis
Osteoarthritis
Degeneration of the joints from aging and stress
- most common cause of disability in the US
- inc bc longer life and obesity
- localized inflam from wear and tear
Joints that OA affects more
often the back–cervical spine and lumbosacral, hip, knee, hands, BIG TOE
Risks for OA
age, obesity (strain, inc load, b/d cartilage), hx team sports, hx trauma or overuse of joints, misaligned pelvis, hip, knee, ankle, feet, men before 45 and women after 45
Causes of OA
Degen in articular cartilage from excess load of healthy or previously injured joints and stress applied
- chronic process
Patho of OA
- pressure wears on cartilage and subchondral bone exposed–cyst develops
- cyst moves thru cartilage and destroys more
- local inflam causes more degradation
- chondrocytes synthesize fluid called proteoglycans to try and repair–swelling
- osteoblasts activate–bone spur and synovial fluid thickens
- loss of cartilage causes narrow joint space
CM of OA
Deep aching joint pain esp with exertion and relieved with rest
- stiffness in the morning
- crepitus of joint with motion
- joints swell–hard swelling
- limited ROM
- altered joint gait
- deformities
- tenderness
- dec ROM
- Heberden’s nodes (distal) and Bouchard’s (proximal)
non-pharm for OA
- dec risk and prevent
- manage pain, mobility and disability
- no pharm to improve sx
- diet supps - chondroitin sulfate and glucosamine
- artificial joint fluid with hyaluronic acid
- joint replacement or arthropathy
Pharm for OA
- tylenol or NSAIDs
- mild-mod topical capsaicin
- mod-severe NSAIDs w/ colchicine, acet and tramadol, opioids, steroid IJ in joint
Degenerative disc disease (DDD)
OA of the lumbar or cervical spine causing back pain with lifting or twisting
DDD Patho
Same as OA; intervertebral disc compression with age
- motor or sensory spinal nerves enter and exit spinal cord and travel thru vertical bone
- discs dehydrate with age and bone is compressed–impinge on nerves
- motor or sensory nerves impede mvt and sensation in extremes, cause weakness and paresthesia
Lumbar DDD CM
- lower back pain that radiates down one leg “sciatica”
- pain in butt or thighs
- worse with twist, sit, bed lift
- dec with walking, lying down, chx position
- numb, tight, weak legs
- foot drop
Cervical DDD CM
- chronic neck pain that can radiate to shoulders and down arms
- numb or tingle in arm/head
- weak arm or hand
What can DDD lead to?
herniation or ruptured disc
Rheumatoid arthitis
- systematic autoimmune disease
- type 3 hypersensitivity
- poorly understood genetic, enviro factors, triggered by infx, injury
- risks 40-60, fem, tobacco, FAM
RA patho
- autoimmune compounds deposit in synovial tissue
- immune cells attach syn tissue (lympho and macros) and attract cytokines
- make inc rheumatic factor
- phagocytosis releases enzymes that damage tissue–chronic and destructive
- cartilage destroyed by clasts forming scar tissue
- pannus develops–inflam and prolif of synovium–leads to bone erosion, cysts, fissures dev that contain imm cells
What is pannus
Vasc scar tissue
RA CM
- early–few joint pain/discomfort
- symmetrical degen
- general stiffness, dec ROM, pain
- inflam–heat, swell, tender
- bone loses potential contact with surface
- deformity and disability, joint subluxation
- systemic fatigue
- can affect all body sys based on severity incl heart
- Rheumatoid nodules–imm granulomas around joints, SQ and firm pain; LUNGS
- Sjogren’s syndrome–lose moisture glands; eyes and mouth
RA pharm
- relieve pain and swelling
- slow or stop disease
- long term NSAIDs, glucocorts, DMARDs, slow or stop prog
- steroids (often pred)
Gouty arthritis
disruption in uric acid metabolism and deposits in joints (uric crystals)
- acute and painful
- DISEASE OF KING - wine and smoked stuff
Gout patho
uric acid crystals from b/d of purines made by bod (b/c of nitrogenous waste)
- uric acid does not dissolve in blood and excrete thru kids like meant to
- causes hyperuricemia–inc uric acid prod and dec uric sec
Sources of uric acid
organ meats, shellfish, anchovies, mushrooms, asparagus
Risk fx for gout
men, obese, HTN, DM, renal, SCA, alc, diet rich in meat and seafood, diuretics, AfAm
Phases of gout
- asymp - inc serum uric acid levels and deposits in tissue (crystals accum and damage tissue–acute inflam)
- acute flares of hyperuricemia
- clinically inactive, hyperuricemia (month to year before next flare; attacks may start to get closer)
- chronic arthritis - joint pain and other sx present most of the time
CM of gout
PAIN - mild or awful, often in lower extremes and BIG TOE
- burn
- red
- swell, warmth
- fever
Comps of gout
- tophi - hard nodules of uric acid in soft tissue (risk kid stones)
- may be below skin or around joints
- local inflam, may drain chalky material
gout pharm
dec sx and prevent recurrent attacks
- NSAIDs first line
- second line allo, clochine, probenecid
Systemic lupus erythematosus (SLE) patho
- autoimmune
- b lymph are hyperactive and make antinuclear antibodies (ANA)–drain from plasma
- type 3 that attach all major organ sys–kids most common (glom)
- activated by own DNA
- form immune complexes
- inflammatory response destroys tissue
Risk factors for SLE
female, genetics, 20-40, Black, enviro (sun exp), abx allergy, hors (estrogen), tobacco, women who menstruate before 10
CM for SLE
Sx often flare at diff times
- FATIGUE
- butterfly rash
- photosensitive
- edema, fever, hair loss, Raynaud’s–restrict BF
- CNA–dizzy, HA, sz, stroke
- lungs–pleuritis and effusion
- myocarditis and endocarditis
- nephritis
- vasculitis
- arthritis
SLE flares
- exac and remiss
- warning signs are fatigue, HA and pain
- prevent by avoiding triggers like infx, stress, sun, abrupt stop meds
Pharm for SLE
- NSAIDs, steroids (high dose–kid and CNS) or low (athritis)
- immunosupp–severe organ involve
- hydroxychloroquine–skin, mscktl; prevent kid and CNS damage
Sim btwn RA and SLE
- autoimmune
- systemic
- pharm similarities
RA of joints and SLE of all organs
Which dx is soft and spongy
RA
Which dx is firm
OA
Which dx can lead to myocarditis and pericarditis?
RA
