Musculoskeletal (OA, RA, SLE) Flashcards
4 major parts of a joint
subchondral bone plate
articular cartilage
synovium
joint capsule
synovial or diarthrodial joint is any joint that allows __________.
movement
three phases of bone healing
- inflammatory
- reparative
- remodeling
inflammatory phase of bone healing
hematoma forms at fx site
provides stability
aseptic inflammation occurs
duration
1-3 days for hematoma
3 days - 2 weeks for early repair
reparative phase of bone healing
- fibrous cartilage → formation of granular tissue containing blood vessels, fibroblasts, osteoblasts
- formation of callus → when granular tissue has matured
- ossification → space in bone is bridged and fx ends are united; callus replaced by trabecular bone
duration → 6 weeks
remodeling phase of bone healing
bone consolidation with final remodeling
healing complete
osteoarthritis (oa)
degeneration of joints cause by aging and stresses
most common cause of disability in US
obesity and aging are ↑ oa in U.S.
commonly affected joints of oa
cervical spine lumbosacral spine hip knee hand first metatarsal phalangeal joint (big toe)
spared joints of oa
wrist
elbow
ankle
etiology of oa
stresses applied to joints (weight bearing)
degeneration of cartilage (begins in articular cartilage)
chronic disease
osteophytes
- small bony projections that develop along the rim of bone adjacent to cartilage loss
- important hallmark of OA
sxs of oa
- deep aching joint pain, esp. after exercise, relieved with rest
- joint pain during cold weather
- stiffness in the morning
- crepitus of joint during motion
- joint swelling
- altered gait
- limited range of motion (thickening of synovial fluid)
OA physical exam
joint
deformity
tenderness
↓ ROM
fingers often involved
distal interphalangeal joint (DIP) - Herbeden’s nodes
proximal (PIP) - Bouchard’s nodes
both caused by osteophytes
dietary supplement for oa
both also naturally occur in the body
glucosamine sulfate - maintains cartilage health
chondroitin sulfate - might slow cartilage breakdown
s/s of DDD in lumbar spine
- pain in low back that radiates down back of leg (sciatica)
- pain in buttocks or thighs
- pain that worsens when sitting, bending, lifting, or twisting
- pain that’s minimized when walking, changing positions or lying down
- numbness, tingling, or weakness in the legs
- foot drop
s/s of DDD in cervical spine
- chronic neck pain that can radiate to the shoulders and down arms
- numbness or tingling in the arm or hand
- weakness of the arm or hand
rheumatoid arthritis
type III hypersensitivity
systemic, autoimmune disease of the synovium
RA etiology & risk factors
not fully understood
environmental and genetic factors
40s-60s
women (2.5x higher risk than men)
tends to show up after pregnancy
tobacco use
RA patho
autoimmune attack against the synovial tissue
Immune cells activated
-lymphocytes
-macrophages
-produce rheumatoid factor (RF) → auto-antibody against IgG
-formation of immune complexes & activates complement
measure RF in serum and that’s how RA’s diagnosed
progression of RA
- cartilage is destroyed by osteoclasts
- pannus develops → type of scar tissue that’s vascularized so it’s able to get nutrients but also contains inflammatory cells
- pannus very destructive
- causes: bone erosion, bone cysts, fissure development
RA clinical manifestations
- early → vague sxs of fatigue, malaise, wt loss, generalized stiffness
- joint manifestations → symmetrical (different from OA); pain, stiffness, motion limitation; inflammation: heat, swelling, tenderness
advanced disease → deformity & disability; joint subluxation
RA nodes feel spongy, soft
OA hard bc it’s bone
Swan neck deformity - common; joint has lost structure so it bends down (tip of finger)
RA can also be systemic
important to assess other systems
rheumatoid nodules - occur in about 25% of RA pts
- immune-mediated granulomas
- develop around inflamed joints & lungs
- subcut and firm, sometimes painful
systemic lupus erythematous (SLE)
type III hypersensitivity autoimmune inflammatory disease -multiple organ systems -acute flare-ups -unpredictable
attacks body’s dna
two forms
- discoid - targets skin
- systemic - internal organs
SLE predisposing factors
genetic factors female 20-40 blacks sun exposure/uv rays allergy to abx prolonged exposure to estrogen tobacco use
SLE patho
- beta lymphocytes are hyperactive & produce autoantibodies (antinuclear antibody)
- activated against DNA
- formation of immune complexes
- can impact all major organ systems
- inflammatory response destroys tissue
- kidneys often affected
SLE manifestations (early?)
extreme fatigue photosensitivity (butterfly rash) fever wt changes unusual hair loss edema raynaud's phenomenon - capillary constriction in distal extremities, often triggered by cold
SLE manifestations
CNS: HA, dizziness, seizures, stroke
Lungs: pleuritis, pleural effusions
heart: myocarditis & endocarditis
kidneys: nephritis (50% develop kidney damage)
blood vessels: vasculitis
blood: anemia, leukopenia, thrombocytopenia, blood clots
joints: arthritis
SLE flares
warning sign: fatigue, pain, HA
prevention → recognize warning signs and avoid triggers
triggers: sunlight exposure, infection, abruptly stopping a med (steroids), stress (try to manage)
Sjogren syndrome (seen in RA & SLE)
autoimmune destruction of any moisture producing gland
enlarged glands with decreased functioning
lacrimal: ↓tearing, burning, itchy dry eye
salivary: dry reddened deeply fissured tongue; loses its papilla; ↑ risk for candida infections
methotrexate
classification: antineoplastic (folic-acid antimetabolite)
DMARD (disease modifying anti-rheumatic drug)
moa: immunosuppressive
administered weekly via PO or SQ/IV route
methotrexate SEs
GI: N/V, anorexia, liver toxicity
bone marrow suppression
shortened life expectancy
Pt teaching: watch for signs of infection; expect GI effects
methotrexate nursing implications
11 black box warnings
folic acid supplementation is necessary
NO ETOH
Teratogenic
Contact HCP if s/s of infection develop
hydroxychloroquine
DMARD
antimalarial, antirheumatic
MOA: unknown, antiinflammatory properties
slows progression of RA when used with another DMARD
SE: retinopathy (rare)
