lewis ch 64 - arthritis and connective tissue disease Flashcards
Slowly progressive noninflammatory disorder of the synovial joints
-more common in women
osteoarthritis
type osteoarthritis: caused by direct damage or
joint instability
secondary osteoarthritis
risk factors osteoarthritis (5)
- age
- decreased estrogen
- obesity
- ACL injury
- frequent kneeling/stooping
S+S osteoarthritis (4)
- joint pain
- early morning stiffness 30 mins
- asymmetric affect
- deformity
varus deformity
bowlegged
valgus deformity
knock kneed
Deformity on DIP joints d/t osteophyte formation
and loss of joint space (in osteoporosis)
heberdens nodules
deformity on PIP joints of the fingers and the MCP
joint of thumb (in osteoporosis)
bouchards nodules
drug therapy osteoarthritis (4)
- NSAIDs
- topical salicylates
- COX2 inhibitor
- intraarticular corticosteroid injections
what med can be given if pt is at high risk for GI side effects (osteoarthritis patient taking NSAIDs)
misoprostol (cytotec)
complications rheumatoid arthritis (4)
- deformities, stress fractures
- anemia
- pericarditis
- fibrosis, pneumonitis
3 stages RA
- synovitis
- pannus
- fibrous ankylosis
S+S RA (4)
- morning stiffness 1 hr+
- low fever
- anorexia
- fatigue
treatment RA (3)
- NSAIDs
- COX1 and 2 inhibitors
- disease modifying antirheumatic drugs (plaquenil, gold salts)
Chronic, systemic autoimmune
disease; inflammation of connective
tissue in diarthrodial (synovial) joints
rheumatoid arthritis
2 complications RA
heart attack
stroke
risk factors RA (3)
- older age
- sedentary lifestyle
- pollution
muscle atrophy and tendon destruction
subluxation
4 extraarticular manifestations RA
- sjogrens syndrome
- felty syndrome
- flexion contractures
- depression
extraarticular manifestation RA: Enlarged spleen and low WBCs result in increased risk of infection and lymphoma
felty syndrome
4 stages RA
- pre-clinical
- synovitis
- destruction
- deformity
2 side effects methotrexate
- bone marrow suppression
- hepatotoxicity
3 examples DMARDs for RA
- methotrexate
- sulfasalazine
- hydroxychloroquine
3 nursing considerations for pts taking DMARDs
- drink fluids
- wear sunscreen
- eye exam
what drug therapy can pts with RA take when they dont respond to DMARDs
biologic response modifiers (BRMs)
nursing considerations for tumor necrosis factor inhibitor (BRMs) (4)
- TB test and chest xray before starting
- monitor for infection
- avoid live vaccinations
- report bruising, bleeding, persistent fever
complications intraarticular injections for RA (2)
- osteoporosis
- avascular necrosis
Type of arthritis characterized by hyperuricemia and deposition of uric acid crystals in one or more
joints, periods of flare-ups
gout
what can cause secondary gout (2)
- more uric acid in body
- immunosuppressants
what causes gout (5)
- too much uric acid in body: kidneys can’t excrete enough or too much is being made
- metabolic syndrome
- increased intake high purine foods
- prolonged fasting
- excessive alcohol
examples high purine foods (3)
- red and organ meat
- shellfish
- fructose
2 processes of gout
- crystallization
- inflammation
S+S gout (4)
- dusky/cyanotic
- very tender
- symptom onset at night
- low grade fever
most common site gout
big toe
Painless nodules filled with uric
acid crystals
tophi of chronic gout
best diagnostic study for gout
synovial fluid aspiration
drug therapy for acute gout attack
- colchicine
- NSAIDs
- corticosteroids
what med used for acute gout attack can cause leukopenia
colchicine
drug therapy for longer management gout
-xanthine oxidase inhibitor (allopurinol): decrease production uric acid
adverse effects allopurinol (3)
- hypersensitivity syndrome
- GI effects
- neurologic effects
drug of choice for chronic tophaceous gout
allopurinol
characteristic sign lyme disease
bulls eye rash
probable causes lupus (3)
- genetic
- hormones (contraceptives, pregnancy)
- environmental factors (sun, UV light, stress, toxins)
S+S lupus (7)
- fever
- weight loss
- joint pain
- butterfly rash
- excessive fatigue
- alopecia
- vascular skin lesions
most common infection developed by pts with lupus
pneumonia
what should patients taking corticosteroids or cytotoxic drugs avoid
live vaccines
drug therapy for lupus (4)
- NSAIDs
- corticosteroids
- antimalarial drugs
- immunosuppressive drugs
Chronic central pain syndrome Widespread, bilateral, burning musculoskeletal pain and fatigue Multiple tender points
fibromyalgia
S+S fibromyalgia (5)
- pain
- fatigue
- nonrestorative sleep
- IBS
- anxiety
what cells are released in RA that can cause damage to cartilage and thicken synovial lining
neutrophils
2 criteria that must be met to diagnose fibromyalgia
- pain experienced atleast 11/18 tender points upon palpation
- history of widespread pain atleast 3 months
drug therapy fibromyalgia (7)
- pregabalin (lyrica)
- duloxetine (cymbalta)
- milnacipin (savella)
- antidepressants
- muscle relaxants
- OTC and nonopioid analgesics
- zolpidem (ambien)
