rheum Flashcards
what to treat RA 3
Disease modifying anti-rheumatic drugs (DMARDs)- Hydroxychloroquine - suppress overactive immune systems, and limit inflammation.
Good for autoimmune diseases, interferes w/ communication of cells in the immune system.
Sulfasalazine and methotrexate (Current standard of care)
Hydroxychloroquine (retinopathy) - need eye exam
urethritis + joint pain > 1 month is…
usually occurs when?
other s/s
risk factors? 2
Reactive Arthritis
occurs after infection
s/s Conjunctivitis( or uveitus)
Balanitis
Skin lesions
fever
Risk factors include:
HLA-B27 gene
commonly in young males age 20-50yr
reactive arthritis
Rest Splinting Mild exercises after inflammation Meds: Treat any infection NSAIDS Steroids Sulfasalazine,methotrexate, anti-TNF agents(entercept,infliximab,adalimumab) rheumatology referral
Ankylosing Spondylitis
chronic inflammatory systemic autoimmune arthritis stiffening & fusion (ankylosing) of the spine & sacroiliac joints HLA B27 antigen +ve Sero negative spondyloarthropathy neg ANA neg RF
things to remember
RA - hand pain, systemic signs SLE - rash, systemic symptoms OA - joint pain, not trigger point pain Ank spon - young men, low back PMR - usually above 50 yr, acute onset, respons to steroids hypothyroid - TSH T4
fm tx
Duloxetine (only anti.depressant approved for FM) TCA’s - Amyitriptyline, SSRIs Anticonvulsants (Lyrica, Gabapentin) Avoid opioids, steroids CBT Gentle exercise(10-20 min walking 3x/wk) PT, OT, yoga, relaxation Chronic Pain Centres Referral for psychiatry or psychology
dx chronic fatigue syndrome
must be 4/8 of these symptoms present for > 6 months: Poor memory or concentration Sore throat Tender cervical or axillary lymph nodes Muscle pain Multijoint pain Onset of new headaches Poor sleep Malaise after exertion
s/s to ask for in conditions such as SLE RA, reactive systemic and symmetry non systemic and asymmetry joints affected DIP vs MCP and PIP
rash - SLE fever - RA, reactive systemic - symmetrical non systemic OA or trauma - asymmetrical RA does not affect DIP
3 condition NP needs to refer
3 NP can dx and tx
C - Rheumatoid Arthritis C - Sjogren’s syndrome C - Systeic Lupus Erythematosus D - Fibromyalgia D - Chronic Fatigue syndrome D - Osteoarthritis
dx for RA? 4
clinical dx
RF - high RF titre - more likely RA
anti ccp - ordered by specialist
xray - for baseline
CRP - for inflammation
ACR 2010 criteria for RA
RA at risk for what? should monitor what
> 6 = RA
at risk for CVD x 2 - monitor BP, choles
what to use to dx OA
tx
clinical dx
Xray for dx clarification, specify OA series.
reduction in joint space and osteophytes.
tyl, NSAIDS topical, duloxetine, heat/cold
steroid injections
Physiotherapy
Exercise (ROM, strengthening and aerobic activity).
Weight loss
Supportive foot-wear, orthotics
Location of Heberden nodes: _________
Location of Bouchard nodes: __________
Heberden is DIP
Bouchard is PIP
Chronic dysfunction of exocrine glands in many areas of body
what other autoimmune associated with this
affects what organ
Sjogren’s Syndrome - autoimmune, inflammatory disease of the exocrine glands
RA
dry eyes: keratitis corneal ulcers
dry mouths: dental carries, fissure
- ) Dry mouth(Xerostomia)
- ) Dry eyes(Xeropthalmia)
- ) Extraglandular Manifestations
labs for Sjogren
refer to? 3
95% have ANA 65% Anti-Ro and Anti-La often present in Sjogren’s 75% have RF anemia of chronic disease
refer
rheumatology
ophthalmology
dentist
