Musculoskeletal Flashcards
Osteoarthritis signs and symptoms
o Joint pain –aching (may be difficult to localize)
o Usually worsens with use or activity
o Relieved by rest
o “Gelling”
o Cracking of joints (crepitus), joint locking upon movement
o Limitations in joint motion and stability
o Joint enlargement
Rheumatoid arthritis patho
o Autoimmune disorder
o Abnormal immune response leads to synovial inflammation and joint destruction
o Inflammatory process progresses, synovial cells and subsynovial tissues undergo reactive hyperplasia
o Increased blood flow and capillary permeability result in joint swelling
o Destructive vascular granulation tissue forms (pannus) between cartilage and subchondral bone
o Destructive changes are irreversible
Rheumatoid arthritis articular manifestations
o Joint involvement is symmetric and polyarticular
o Pain and stiffness (lasting for 30 minutes – several hours)
o Progresses to larger joints
o Progressive joint destruction leads to subluxation, joint instability, and limitation of movement
o Stretching of joint capsule and ligaments leading to joint deformities resulting in loss of function
Rheumatoid arthritis extra articular manifestations (systemic)
o Fatigue o Weakness o Anorexia and weight loss o Elevated ESR and CRP o Rheumatic nodules o Dryness of the eyes, mouth and mucous membranes o Episcleritis, scleritis, scleromalacia o Pulmonary fibrosis, pericarditis o Also possible - splenomegaly and lymph node enlargement, vasculitis (as in ischemic areas in the nail folds)
RA diagnosis
4 criteria from ARA
- morning stiffness
- Simultaneous swelling for 6 + weeks
- Wrist joint swelling for 6+ weeks
- symmetric joint swelling
RA treatment
- Physical rest
- therapeutic exercises
- safe use of heat and cold
- relaxation techniques
- use of salicylates, NSAIDs, COX-2 inhibitors, DMARDs, corticosteroids, and biologic agents
RA treatment goals
- reduce pain
- minimize stiffness and swelling
- maintain mobility
- be an informed health care consumer
Gout patho
- Elevation of serum uric acid, attack occurs when monosodium urate crystals precipitate in joints resulting in inflammation
- Repeated attacks lead to chronic arthritis and tophi (large, hard nodules)
Gout signs and symptoms
- severe pain (hurts with blanket)
- redness
- swelling
- may begin at night
Gout Diagnosis
- Synovial fluid analysis
- serum uric acid levels
- 24 hours’ urine
- abrupt onset
Gout Treatment
- Reduce inflammation
- NSAIDs
- colchine
- steroids
Rheumatic disease in the elderly: mobility
- the weakness and gait disturbance may contribute to falls and fractures, decreased independence
Rheumatic disease in the elderly: Function
- pain stiffness, and muscle weakness affect daily life, threaten independence, and quality of life. May threaten duration of life.
Rheumatic disease in the elderly: Non-Pharm modalities
- Splints, walking aids, muscle-build exercise, local heat; muscle-strength & stretch particularly effective with early start
o Caution: excess rest causes lost muscle strength
Rheumatic disease in the elderly: Drug therapies
- NSAIDs less well tolerated & side effects more likely serious
o GI bleed, renal insufficiency, cognitive impairment
