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Med Conditions > RA and Fibromyalgia > Flashcards

RA and Fibromyalgia Flashcards

1
Q

Rhumatoid Arthritis definition

A

Chronic, systemic, inflammatory autoimmune disease

Symmetric , erosive synovitis of Peripheral joints
Can be associated with
Extra-articular manifestations

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2
Q

What is the difference between RA and OA?

A

RA systemic , bilateral joints, autoimmune , affects the synovial fluid, extra-articular , reversible i caught early

OA: may just be an issue on one side, wear and tear

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3
Q

RA is characterized by _____ and _____

A

Synovitis (inflammation of the synovium) and joint destruction

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4
Q

70 percent of patients develop joint damage /erosion within ___ years of the onset

A

2 years

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5
Q

33% of patients are work disabled at __ years

A

5

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6
Q

WHO functional classification RA
1-4

A

Class 1: symptom free when PA or rest
Class 2: no symptoms at rest, but normal activities cause discomfort and SOB
Class 3: no symptoms at rest but normal activities are greatly limited
Class 4: symptoms at rest

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7
Q

True or false , RA is present before the first symptoms

A

True

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8
Q

Etiology / risk factors for RA

A

Antigens
Genetic susceptibility

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9
Q

Pathophysiology of RA

A

Immune hyper activation cycle : no off signal

  1. Antigen (toxic /foreign substance)
  2. Synovial inflammation
  3. Cytokines (immune response) release by macrophages
  4. Cytokines induce fibroblasts - result inn bone destruction
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10
Q

Screening tool for inflammatory arthritis (RA)

A
  1. significant discomfort in squeezing MCP, MTP
  2. prescience of 3 or more swollen joints
  3. more than 1 hour of morning stiffness
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11
Q

Extra-articular manifestations

A

– Scleritis (red eyes) referral ASAP
– Rheumatoid nodules (bumps)
– Vasculitis (necrosis )
– Interstitial lung disease
– Pericardial disease

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12
Q

Poor prognostic factors of RA

A

earlier onset
female sex
polyarticular synovitis (>13 joints)
lab tests:
high titer Rheumatoid factor / anti CCP
elevated ESR rate or CRP level
HLA-DR4
erosion of cartilage loss on x ray in less than a year
poor functional status
extra-articular manidestations

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13
Q

HAQ

A

Health assessment questionnaire assesses ADL’s / fine motor and gross motor

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14
Q

RA joint manifestations

A

C spine: atlantoaxial subluxation due to laxity /rupture of transverse lig.
shoulder: H/AC joint , RTC and or bicep tendonitis/rupture,
elbow: nerve entrapment, olecranon bursitis
hip:bursitis, avascular necrosis
knee: quad atrophy, bakers cyst

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15
Q

Hand and wrist joint manifistatitons

A

MCP,PIP wrist synovitis
ulnar drift
swan neck, butonniere deformity
tenodynovitis

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16
Q

RA treatment

A

NSAIDS
multidisciplinary care
Steroid/glucocorticoids
Disease modifying drugs (start within 2-3 months of diagnosis
-immunosuppressive drugs
later: biologic therapies

17
Q

Heath care maintenance RA

A

Osteoprosis: DEXA scans, calcium /vit D , Bisphosphonates (meds)

CVD: asses risk modiphy
Smoking cessation
Infection risk

18
Q

Fibromyalgia Syndrome definition

A

chronic noninflammatory non autoimmune diffuse central pain processing syndrome

widespread pain, diffuse tenderness on exam, fatigue, depression, general somatic hyperawareness, cognitive problems, poor sleep

19
Q

Demographic of FMS

A

young middle aged women

consider alternative diagnosis if male and >55

20
Q

Secondary FMS

A

occurs with other conditions
ex: ppl with RA are at risk

21
Q

FMS has an unknown cause / etiology but hypothesis supports

A

Genetic component
Functional MRI
CSF (substance P, inflammatory cytokines)

22
Q

Pain experience with ppl with FM

A

FMS associated with lower pain threshold
innocuous pressure to healthy ppl evokes sig. less pain

can be seen on brain imaging

23
Q

S & S FMS

A

pain from head to toe , everywhere
fatigue
difficulty falling asleep/non restorative sleep
depression n
physical examination and labs normal

24
Q

Medical treatment for FMS

A

symptom based treatment
NON-pharmacological therapy is KEY

start slow go slow
exercise (aerobic is best, resistance )
pt , CBT
sleep
fatigue control
avoid opiods, NSAIDS don’t work
change one med at a time
target CENTRAL neurologic mechanisms

Med Conditions (6 decks)

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