L14: Arthritis Flashcards
what is arthritis
- inflammation of joints or singular joint
- most common: osteoarthritis
is there a treatment for osteoarthritis
nope
what is osteoporosis
- aging is a risk factor
- NOT part of normal aging process
- cartilage destruction can begin between ages 20-30
- few pt experience sympt until after age 50-60
2 categories of arthritis
- idiopathic disorder
- secondary disorder
what does OA result in
- cartilage damage that triggers a metabolic response
- cartilage erodes at articular surfaces of joint
- bone spurs (osteophytes) may form
in OA what does cartilage become
- dull, yellow, and granular
- soft and less elastic
- less able to resist wear w heavy use
what is NOT a characteristic of OA
secondary synovitis may result
3 stages of OA manifestation
stage 1: predictable, sharp
stage 2: more constant, affecting daily activities
stage 3: constant dull/aching pain
crepitation
grating sensation due to loose particles of cartilage
does OA affect the joints asymmetrically or symmetrically
asymmetrically
what is the main restriction of OA
mobility restriction
heberden’s nodes
DIP joints
- osteophyte formation and loss of joint space
- can appear as early as 40 yrs
bouchard’s nodes
PIP joints
- similar disease involvement as heberden’s nodes
bow-leggedness
medial knee joint
- joint deformity
knocked-kneed
lateral knee joint
- joint deformity
diagnostic studies of OA
- bone scan, MRI, CT (detect early joint changes)
- x-ray
- inflammatory markers (erythrocyte sedimentation)
- synovial fluid analysis
clinical diagnosis of OA
- persistent joint pain for 1 or more joints
- age greater or equal to 45 yrs
- morning stiffness less than or equal to 30 min
collaborative care of OA
- no cure
- non-pharmacological interventions
- pt education and self-management
- drug therapy is considered adjunct therapy
- reconstructive surgery
drug therapy for OA
- NSAIDS (oral and topical): PPI’s, topical: one or a few joints only, oral: celebrex
- capsaicin cream (1 or few joints involved)
- tylenol (not more than 4g/day)
- duloxetine (multiple joints)
- corticosteroids (intra-articular injections of corticosteroids)
- hyaluronic acid injection
- doxycycline (decreased joint deterioration **investigational)
rheumatoid arthritis
chronic, systemic autoimmune disease characterized by inflammation of connective tissue in the diarthrodial (synovial) joints, typically w periods of remission and exacerbation
- early recognition and treatment are key
rheumatoid arthritis etiology
is unknown: possible autoimmune, enviro triggers genetic endowment, genetic factors, antigen triggers to form abnormal immunoglobulin G
how is RA characterized
- by the presence of autoantibodies against abnormal IgG - known as rheumatoid factor
does RA occur asymmetrically or symmetrically
symmetrically: affects small joints of hand and feet (PIP and MTP joints)
extra-articular manifestations of RA
- flexion contractors and deformity
- rheumatoid nodules
- sjögren’s syndrome
- felty’s syndrome
is OA more commonly idiopathic or secondary
idiopathic
what is sjögren’s syndrome in RA
- extra-articular manifestations
- decreases lacrimal and salivary gland secretion
what is felty’s syndrome in RA
- extra-articular manifestations
- splenomegaly, decreased WBCs
- increased risk for infection and lymphoma
complications of RA
- joint destruction begins as early as 1st yr w/o treatment
- flexion contractures and hand deformities
- cataracts and loss of vision
- later in the disease…cardiopulmonary
RA diagnostics
- history and physical
- positive RF: titers rise during active disease
- synovial fluid analysis: straw colored w fibrin flecks, increased WBC
- x-ray: baseline and monitoring of joint spaces (not specifically diagnostic)
- bone scan: can confirm a dx by detecting early joint changes
RA diagnostic criteria
- inflammatory arthritis involving 1+ joints
- +’ve rheumatoid factors and anti-CCP
- elevated levels of C-reactive protein (CRP) or the erythrocyte sedimentation rate (ESR)
- diseases w similar clinical features have been excluded
- duration of sympt is 6+ weeks
drug therapy for RA
- DMARDs (disease modifying antirheumatic drugs): methotrexate 1st choice!
- corticosteroids, NSAIDS for sympt management
OA
age of onset:
weight:
disease:
affected joints:
pain:
labs:
age of onset: usually over 40yrs
weight: usually overweight
disease: localized
affected joints: weight-bearing joints, asymmetrical
pain: subsides after 30 min of rising
labs: RF -‘ve; transient elevation of ESR in synovitis
RA
age of onset:
weight:
disease:
affected joints:
pain:
labs:
age of onset: young to middle age (mostly women), may have a genetic component
weight: lost or maintained weight
disease: systemic-fever, fatigue
affected joints: small joints 1st, usually bilateral and symmetrical
pain: pain lasts 1 hr to all day; variable
labs: RF +’ve in 80% of clients, anti-CCP; elevated ESR & CRP
what is the difference in bone impact btwn OA vs RA
OA: bone ends rub together
RA: swollen, inflamed synovial membrane
