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Lifespan > Rheumatic Disease > Flashcards

Rheumatic Disease Flashcards

1
Q

RA

A

Systemic auto-immune disease characterized by pannus that destroys articular cartilage

Chronic inflammatory polyarthritis (5+ joints)

Primarily affects synovial joints (blood vessels, heart, lungs, etc)

MOST COMMON OF THE INFLAMMATORY DISEASES

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2
Q

Three disease courses

A

Monocyclic
Polycyclic
Progressive

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3
Q

Monocyclic

A

One episode which ends within 2-5 years of initial diagnosis and did not reoccur

May result from early diagnosis and/or aggressive treatment

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4
Q

Polycyclic

A

The levels of disease activity fluctuate over the course of the condition

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5
Q

Progressive

A

RA continues to increase in severity and is unremitting

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6
Q

RA: Natural History

A

Radiographic erosion typically fastest in the first year of disease

75% of people with RA experienced remission within 5 years of dx

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7
Q

Female hormones

A

Appear to influence development of RA

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8
Q

RA Incidence

A

Peak onset 60 years of age

Decrease incidence with the use of oral contraceptives; remission of symptoms during pregnancy

Increase in symptoms after menopause

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9
Q

RA Primary Pathological Event

A

Takes place in synovium

^^^ Suggesting the offending agent is carried to the joint via the bloodstream

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10
Q

RA Etiology

A

Pannus production

Catabolic enzymes produced which causes collagen break down

Joint effusion further stresses articular cartilage

Effusion stretches the capsule and causes ligamentous instability

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11
Q

RA Characteristics

A

Rheumatoid factors

Insidious development of symptoms

Symmetric early involvement in hands, wrist, feet, and ankles

LATER - develop joint deformities, contractures, which affect WB and NWB joints

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12
Q

Who should be tested?

A

Patients that have at least 1 joint with definite clinical synovitis with it not being explained by another disease

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13
Q

Classification criteria for RA

A

> 6/10 needed for definite RA classification

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14
Q

RA Differential dx

A

Systemic lupus erythematosus
Psoriatic arthritis
Gout

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15
Q

Comorbidities

A

CVD (ischemic heart disease)
Infections (TB)
Mental health conditions (anxiety and depression)
Malignancies (leukemia and multiple myeloma)

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16
Q

RA Clinical Features

A

Morning stiffness at least 1 hour

Arthritis in at least 3 joint areas with swelling or fluid

Arthritis of hand joints (1 wrist, MCP, PIP joint swollen)

SYMMETRIC joint swelling and involvement

Positive Rh factor

Radiographic changes typical of RA

Subcutaneous nodules

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17
Q

RA Radiologic Features

A

Soft tissue changes EARLIEST sign of disease

Articular erosions within first 2 years

Osteoporosis

Joint space narrowing

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18
Q

RA Joint Deformities

A

Subluxations and dislocations occur secondary to capsular and ligamentous laxity, destruction of joint surfaces, and tendon ruptures

Flexion contractures result

Swann neck/boutonniere deformity

Hallux valgus, hammer toe

Joint ankylosis

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19
Q

Boutonniere deformity

A

DIP extension

PIP flexion

20
Q

Swan neck deformity

A

PIP hyperextension

DIP flexion

21
Q

RA Changes in Cervical Spine

A

Narrow facet joints

Narrow intervertebral joints

Subluxation of atlanto-axial joint from laxity of transverse ligament

22
Q

RA treatment

A

Initially - education, protection, splinting

PT indication depends on whether acute exacerbation or period of remission

Medications

Orthopedic surgeries

23
Q

RA Medications

A

Traditionally NSAIDs

DMARDS within 3 mos

24
Q

DMARDs

A

Disease-modifying

Slow the progression of RA and save the joints and other tissues from permanent damage

SE - liver damage, bone marrow suppression, severe lung infections

25
Q

Biologic agents

A

Newer class of DMARDs

Can target parts of the immune system that trigger inflammation that causes joint and tissue damage

Also increase the risk of infections

26
Q

Pannus

A

Inflammatory synovitis

An invasive granulation tissue that invades and erodes subchondral bone and cartilage

27
Q

Steroids

A

Reduce inflammation, pain, and slow joint damage

SE - thinning of bones, weight gain

MDs may prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication

28
Q

NSAIDs

A

Side effects may include ringing in your ears, stomach irritation, heart problems, and liver and kidney damage

29
Q

Deep heat

A

NOT RECOMMENDED DURING ACUTE INFLAMMATION

30
Q

Pain post exercise

A

Should not have > 1 hour post-exercise

31
Q

Acupuncture for RA

A

Limited studies have shown it can help

32
Q

Fish Oil

A

May be as effective as NSAIDs

33
Q

Juvenile RA

A

Juvenile Ideopathic Arthritis

Onset before age 16

Symptoms last from 6 weeks to 3 mos

One or more joints

Often accompanied by fever, rash, eye inflammation

34
Q

ARA list of criteria for dx

A

Chronic synovial inflammation of unknown cause

Onset in children younger than 16

Evidence of arthritis in 1 or more joints for 6 consecutive weeks

Exclusion of other diseases...
Lyme disease
Lupus
Bone disorders
Cancer
35
Q

RA Sx/sy

A 
Limping
Stiffness upon wakening
Reluctance to use arm or leg
Reduced activity level
Fever
Joint swelling
Difficulty with fine motor activities
36
Q

Pauciarticular/oligoarticular JRA

A

4 or fewer joints after 6 mos of symptoms

1/2 cases of JRA

Most common pattern onset before 4 yo

Morning stiffness, reluctance to play

Begins at one joint - knee, ankle, wrist, fingers

May span multiple joints and go into adulthood

37
Q

Polyarticular JRA

A

5 or more joints

Symmetric involvement of knees, wrist, fingers, ankle

More common in girls

Seronegative 1-3

Seropositive in adolescence (indistinguishable from adult RA)

38
Q

Systemic JRA

A

Illness begins with high spiking fevers likely complicated by pericarditis, pleural effusions, enlargement liver, spleen, lymph nodes

10% all cases

Onset between 4-9 years

Salmon pink rash that comes and goes

Joint swelling until months after fevers begin

Arthritis may persist after other symptoms resolve

39
Q

Psoriatic JRA

A

Arthritis with psoriasis

40
Q

Overall treatment goals

A

Control symptoms
Prevent joint damage
Maintain function
Maintain activity and participation levels

41
Q

Medication Lines

A

1st - NSAIDs
2nd - DMARDs
Caution with steroids

42
Q

Ankylosing Spondylitis

A

Chronic progressive inflammatory arthritis characterized by joint sclerosis and ligamentous ossification

Men affected 7x greater that women

Begins in 20s

Early dx confirmed by lab studies elevated ESR

43
Q

Sx/sy Ankylosing Spondylitis

A

Early state have LBP and morning stiffness

Spondylitis and marked limitation of LS motion
***Skin distraction test to confirm

Will spread to thoracic and cervical spines later on

Decreased lumbar lordosis

Increased thoracic kyphosis

Immobile cervical spine

44
Q

Radiographs with Ankylosing Spondylitis

A

Bamboo spine

45
Q

Ankylosing Spondylitis Treatment

A 
Psychological considerations
Pharmacology
Orthopedic appliances
PT
Possible orthopedic surgery

Lifespan (18 decks)

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