Musculoskeletal Autoimmunes and Gout

Question 1

Autoimmune Inflammatory

Answer 1

RA, Lupus, Polymyalgia Rheumatica, Psoriatic Arthritis

Question 2

Autoimmune and noninflammatory

Answer 2

sjogren’s syndrome, scleroderma

Question 3

Not autoimmunes

Answer 3

osteoarthritis (not inflammatory), Gout (inflammatory)

Question 4

what is an autoimmune

Answer 4

body mistakenly recognizes its own tissue as a foreign antigen, immune system attacks healthy cells, often leads to inflammation, pain, tissue destruction

Question 5

Facts about rheumatoid arthritis

Answer 5

affects women 2.5x more than men, reproductive hormones may play a factor, usually diagnosed ages 40-60, chronic and progressive, exacerbations and remission

Question 6

Risk factors and etiology for RA

Answer 6

family history with 1st degree relative, smoking, obesity, viral illness, stress

Question 7

Patho of RA

Answer 7

IgM and IgG attack healthy tissue, leads to inflammation and destruction of synovium, often has systemic effects

Question 8

Systems affected in RA

Answer 8

Small joints: hands, wrists, feet
Inflammation can compress nerves&raquo_space;> CNS symptoms
Vasculitis (blood vessels)&raquo_space;> organ damage & failure
Can also affect: skin, heart, lungs, kidneys, eyes

Question 9

RA symptoms

Answer 9

bilateral joint pain, nodules may be palpable over bony joints, swelling, warmth, morning stiffness >1 hour, decreased function of joint, fever, lymphadenopathy, weight loss, anemia

Question 10

Diagnosis of RA

Answer 10

physical exam, thorough history, Xray joints (to develop baseline), lab tests may aid diagnosis but do not confirm it

Question 11

Rheumatoid factor

Answer 11

antibody marker, elevated in RA, normal is <14 IU/ml

Question 12

ESR

Answer 12

measures degree of inflammation, elevated in RA

Question 13

CRP

Answer 13

substance produced by liver, marker of nonspecific inflammation, normal < 3-10, variable, better indicator of CV risk

Question 14

CBC

Answer 14

often accompanied by anemia

Question 15

RA assessment

Answer 15

Fatigue, Morning stiffness, Swelling of 3 or more joints, Redness, Tender or painful joints, Bilateral & symmetric involvement, Fever, Weight loss

Question 16

Meds for RA

Answer 16

pain meds, steroids, Biologics, Immunosuppressants (slides 13 and 14)

Question 17

RA Nursing care

Answer 17

heat and cold, relaxation techniques, allow for rest periods, administer anti-inflammatory, analgesic and anti-RA meds, dietary changes (slide 16), ROM and exercise, use of assistive devices and splints, referral to PT/OT, patient and family teaching, identify environmental barriers, safety at home

Question 18

Lupus

Answer 18

6-10x more common in women, 15-40, 3x more common in african americans

Question 19

Lupus etiology

Answer 19

cause unknown, may be related to genetics (higher incidence in identical twins), or hormones (estrogen)

Question 20

Lupus Patho

Answer 20

Chronic, progressive, inflammatory connective tissue disorder, develop antibodies to nuclear and cytoplasmic antigens

Question 21

Systems Lupus affects

Answer 21

CV & Respiratory
 valve incompetence
 atherosclerosis
 pericarditis
 pleural effusions
Kidneys
 Glomerulonephritis
 “lupus nephritis”
Musculoskeletal
 joint pain & swelling
CNS
 peripheral neuropathy

Question 22

Lupus symptoms

Answer 22

fever, malaise, weight loss, butterfly facial rash, discoid rash, oral ulcerations, alopecia, joint pain and swelling, migraines, depression, cognitive impairment, change in behavior, pericarditis, HTN, dysrhythmias, symptoms of renal failure

Question 23

Lupus diagnosis

Answer 23

no specific test, physical exam, thorough history, diagnostic results

Question 24

Lupus labs

Answer 24

ESR- elevated
ANA titer- measures presence of antibodies, complement levels
Syphilis test- false positive
CBC- thrombocytopenia, leukopenia/leukocytosis

Question 25

Lupus meds

Answer 25

steroids, pain meds, antimalarials, immunosuppressants, MoABs (slide 23)

Question 26

Lupus Nursing care

Answer 26

Monitor renal status closely
Monitor CV status closely
Thorough skin assessment
Promotion of skin integrity
Patient education:
 Avoid sun exposure – can increase disease
activity
 Medication use & side effects
 Routine follow up & monitoring
 Smoking cessation
 Annual eye exams
 Report fever – may indicate “flare

Question 27

Gout

Answer 27

inflammatory form of arthritis, affects men 3x more than women, hyperuricemia- uric acid crystalizes in joints (great toe, knee, fingers, elbow) very painful, redness, swelling

Question 28

Gout treatment

Answer 28

steroids, colchinine- oral med, anti inflammatory, contraindicated in pts with renal failure

Question 29

Gout prevention

Answer 29

allopurinol, probenecid, low purine diet, limit alcohol use

Question 30

fibromyalgia

Answer 30

non degenerative, non inflammatory, autoimmune, chronic disorder, 6x more frequent in women, similar to chronic fatigue syndrome

Question 31

Fibromyalgia patho

Answer 31

abnormal sensory processing in the CNS, may be triggered by a viral illness

Question 32

Fibromyalgia symptoms

Answer 32

Widespread burning throughout body
 Stiff and painful neck and shoulders
 Widespread non-articular musculoskeletal pain
 Fatigue
 Difficulty sleeping
 Depression, anxiety
 Migraines

Question 33

Fibromyalgia treatment

Answer 33

Rest, Analgesics, Antidepressants, Muscle Relaxers: Flexeril, Valium, Klonopin

Question 34

Fibromyalgia chronic care

Answer 34

Emotional support
Massage therapy, relaxation, meditation
Diet: Limit caffeine, sugar, alcohol- Are muscle irritants