Rheumatic Diseases

Question 0

What are the 3 most prevalent types of arthritis?

Answer 0

1) Osteoarthritis
2) Rheumatoid arthritis
3) Gout

Question 1

In short, describe Rheumatic Diseases and Arthritis.

Answer 1

1) Rheumatic Diseases - Diseases involving the joints, bones, and muscles.
2) Arthritis - Inflammation of the joint.

Question 2

Define Osteoarthritis

Answer 2

Osteoarthritis is a chronic, noninflammatory, progressive disorder that causes cartilage deterioration in synovial joints and vertebrae.

Question 3

What are the 3 major risk factors for Osteoarthritis?

Answer 3

1) Age
2) Obesity
3) Estrogen reduction

Question 4

What are the 4 clinical manifestations of Osteoarthritis?

Answer 4

1) Cartilage degradation
2) Joint stiffening
3) Pain
4) Loss of movement and function

Question 5

(T/F) Regular and moderate exercise decreases the risk of Osteoarthritis.

Answer 5

True

Question 6

What are the 3 characteristics of joint stiffness associated with Osteoarthritis?

Answer 6

1) Occurs after periods of rest or static position
2) Early morning stiffness usually resolves within 30 mins
3) Overactivity can cause mild joint effusion, temporarily increasing stiffness

Question 7

Describe Heberden and Bouchard’s syndrome. What is the difference between the two?

Answer 7

These are complications that can happen to patient with Osteoarthritis. It is a misalignment of joints in the fingers caused by osteophyte formation that causes redness, swelling, tenderness and loss of joint space.

1) Heberden’s Nodes - Enlargement of the DIP joints
2) Bouchard’s Nodes - Enlargement of the PIP joints

Question 8

(T/F) Heberden and Bouchard’s nodes do not cause significant loss of function?

Answer 8

True

Question 9

Describe the difference in diagnostic testing for early OA and progressed OA?

Answer 9

1) Early OA Testing - Detects changes in joints via bone scan, CT scan, or MRI.
2) Progressed OA testing - Detects joint space narrowing, bony sclerosis, and osteophyte formation via X-rays.

Question 10

Management of OA focuses on which 3 things?

Answer 10

1) Management of pain and inflammation
2) Preventing or limiting disability
3) Maintaining and improving joint function

Question 11

Which 6 methods are used to manage OA?

Answer 11

1) NSAIDs and COX-2 inhibitors
2) Corticosteroids used for more severe cases
3) Surgery - Arthroplasty
4) Antibiotics - i.e., doxycycline helps to ⬇ loss of cartilage
5) Topical agents i.e., capsaicin cream and aspercreme
6) Hyaluronic acid

Question 12

(T/F) Even though OA is an NONINFLAMMATORY Chronic disease, inflammation may be present.

Answer 12

True

Question 13

What are the characteristics of Heat and Cold applications used for patients with OA?

Answer 13

1) Helps to reduce pain and stiffness
2) Heat is used more often than ice (ice is appropriate for acute inflammation)
3) Heat therapy is especially helpful for stiffness

Question 14

Name the 7 complementary and alternative therapies used in the management of OA

Answer 14

1) Acupuncture
2) Yoga
3) Massage
4) Guided imagery
5) Therapeutic touch
6) Nutritional supplements i.e., glucosamine and chondroitin
7) Dieting to reduce weight

Question 15

What are the 9 characteristics of Rheumatoid Arthritis (RA)?

Answer 15

1) Chronic, systemic autoimmune disease
2) Inflammation of connective tissue in the diarthrodial (synovial) joints
3) Periods of remission and exacerbation
4) Frequently accompanied by extra-articular manifestations
5) Occurs globally, affecting all ethnic groups
6) occurs at anytime in malice but incidence increases with age (peaks between 30s and 50s)
7) Women are 3x more affected than men
8) Symptoms occur symmetrically
9) Mostly affect the small joints in the hands and feet but larger peripheral joints may be affected

Question 16

What are the 3 SxS of RA?

Answer 16

1) Joint pain, swelling, warmth and erythema
2) Lack of function
3) Extra-articular symptoms

Question 17

What are the 4 pharmacologic methods of managing RA?

Answer 17

1) NSAIDs
2) COX2 inhibitors
3) DMARDs (immunosuppressants)
4) Rheumatrex (Methotrexate)

Question 18

The cause of RA is unknown but what are the 2 different etiologies of the disease?

Answer 18

1) Autoimmune etiology - When the inflammatory process is activated
2) Genetic factor etiology

Question 19

Describe the diagnostic studies associated with RA in the following areas:

1) Nodules
2) Synovial fluid
3) X-rays
4) Lab findings

Answer 19

1) Nodules - Present, especially on extensor surfaces
2) Synovial fluid - Straw like color of the synovial fluid because it contains fibrin and WBCs count > 20,000/microliters with mostly neutrophils
3) X-rays - Joint space narrowing, erosion with bony over growths, subluxations with advanced disease, osteoperosis related to corticosteroid use.
4) Lab findings - Positive for RF in 80% of patients, positive for ANA, ⬆ ESR, CRP indicative of active inflammation.

Question 20

What are the 7 possible complications that may arise from RA Nodules?

Answer 20

1) Cataract development/loss of vision from scleral nodules
2) Skin ulcers
3) Vocal cord hoarseness
4) Cardiopulmonary complications i.e., pleurisy, pleural effusion, pericarditis, and cardiomyopathy
5) Carpel tunnel syndrome
6) Sjogren’s Syndrome - Dry eyes and dry mucous membranes
7) Felty Syndrome - Occurs with severe nodule formation

Question 21

What are the 3 SxS of Felty Syndrome associated with RA?

Answer 21

1) Inflammatory eye disorders
2) Pulmonary disorders
3) Blood dyscrasias i.e., thrombocytopenia and anemia

Question 22

What is the drug class of Rheumatrex (Methotrexate), and what is the most important nursing intervention during therapy?

Answer 22

1) Drug Class - Antineoplastic or antimetabolite

2) Monitor CBC and chemistry

Question 23

How should heat and cold therapy be used in the management of RA?

Answer 23

1) Heat helps to relieve pain, stiffness and muscle spasms and can allow a patient to participate in therapeutic exercises but application should not exceed 20 mins.
2) Ice can be used during exacerbations but should not exceed 10-15 mins at a time

Question 24

Describe a diet intended to manage RA?

Answer 24

An anti inflammatory diet is a predominantly plant-based diet, avoiding excess and high sugar calories. The majority of the diet should be derived from four areas:

1) Whole-grain products
2) Fresh fruits and vegetables
3) Legumes
4) Seeds and nuts

Question 25

Describe Systemic Lupus Erythematosus (SLE).

Answer 25

SLE is a chronic inflammatory immune disease that causes an exaggerated production of autoantibodies and antigens and manifests as myalgias and arthralgias.

Question 26

Describe Fibromyalgia

Answer 26

Fibromyalgia is a chronic pain syndrome characterized by diffuse musculoskeletal achiness, stiffness, fatigue, and exaggerated tenderness at 18 specified tender points.

Question 27

Scleroderma begins with skin changes, but pathogenesis integrates what 3 cardinal features?

Answer 27

1) Vascular injury/damage
2) Activation of innate and adaptive arms of the immune system
3) Interstitial and vascular fibrosis

Question 28

Describe Gout

Answer 28

Gout is a metabolic disorder marked by the deposition of monosodium urate crystals within joints and others tissues and is the result of hyperuricemia.

Question 29

What are the four phases of Gout?

Answer 29

1) Phase 1 - Asymptomatic hyperuricemia
2) Phase 2 - Initial attack of gout
3) Phase 3 - Symptom free period after an attack of gout
4) Phase 4 - Increase in frequency and length of attacks, and involving more joints which all leads to sequlae.

Question 30

Describe the difference between primary and secondary Gout.

Answer 30

1) Primary Gout - Caused by an overproduction of Uric acid, a ⬆ urate excretion by the kidneys or impaired ability to metabolize purine.
2) Secondary Gout - Caused by drugs, medications or another disease leading to hyperuricemia.

Question 31

Define Tophi

Answer 31

Tophi is an accumulation of crystalline deposits in articular surfaces, bones, soft tissue, and cartilage.

Question 32

What are the 5 pharmacologic methods used to treat Gout?

Answer 32

1) NSAIDs
2) Colchicine
3) Xanthine Oxidase Inhibitors i.e., Allopurinol & Febuxustat
4) Corticosteroids (used in acute phase when not responding to NSAIDs or Colchicine)
5) Probenecid

Question 33

Describe a diet intended for a patient with Gout.

Answer 33

1) No alcohol
2) Limit consumption of foods with purine i.e., anchovies, liver, and shellfish)
3) Low-protein foods
4) Avoid starvation diets
5) Drink plenty of fluids

Question 34

Define Podagra

Answer 34

Gout in the big toe

Question 35

How is a definitive diagnosis of Gouty Arthritis made?

Answer 35

Via Polarized light microscopy of the synovial fluid of the involved joint. Uric acid crystals can be seen within the polymorphonuclear leukocytes in the fluid.

Question 36

What is Pannus?

Answer 36

Pannus is formation of vascular granulation tissue and is a characteristic of RA that differentiates it from other forms of inflammatory arthritis. Pannus has a destructive effect on the adjacent cartilage and bone.

Question 37

(T/F) Palpation of a joint affected by RA reveals a spongy or boggy tissue.

Answer 37

True

Question 38

What are the 5 characteristics of RA according to Brooks?

Answer 38

1) Systemic Inflammatory
2) Autoimmune
3) NSAIDs, DMARDs and Immunosupressants
4) Symmetrical
5) small joints affected

Question 39

What are the 6 characteristics of OA according to Brooks?

Answer 39

1) Localized
2) Caused by wear and tear
3) Bony nodules
4) Uni or bilateral
5) ⬇ Weight bearing
6) Steady progression

Question 40

What are the 4 similarities between RA and OA?

Answer 40

1) Pain
2) ⬇ Mobility
3) Stiffness
4) Body image issues

Question 41

The immune abnormalities that characterize SLE occur in what 5 phases?

Answer 41

1) Susceptibility
2) Abnormal innate & adaptive immune responses
3) Auto antibody immune complexes
4) Inflammation
5) Damage

Question 42

With Scleroderma, the patient may manifest a subset of limited cutaneous symptoms referred to as CREST syndrome. What does the acronym CREST stand for?

Answer 42

1) Calcinosis - Calcium deposits in the tissue
2) Raynauds Phenomenon - Spasms of blood vessels in response to cold or stress
3) Esophageal Dysfunction
4) Scerodactyly - thickening and tightening of skin on hands and fingers
5) Telangiectasia - Capillary dilation that forms vascular red marks on the surface of the skin

Question 43

(T/F) Morning joint stiffness is an expected symptom of a patient with OA.

Answer 43

True

Question 44

What are 3 expected lab result of a patient with SLE?

Answer 44

1) Increased C-Reactive proteins
2) Positive ANA
3) Positive RF

Question 56

(T/F) Increased creatinine may indicate renal damage in SLE and in Scleroderma

Answer 56

True

Question 57

(T/F) RBC count is ⬇ in patients with RA

Answer 57

True

Question 58

What 5 foods high in purine should a patient with gout avoid?

Answer 58

1) Liver
2) Anchovies
3) Shellfish
4) Cod
5) Sardines

Question 59

What are the visual manifestations of a limb that has a hip fracture on that side?

Answer 59

1) Leg is shorter
2) Leg is adducted
3) Leg is externally rotated

Question 60

What is the difference in when the following 2 Gout medications are administered to a patient with Gout:

1) Colchicine
2) Allupurinol

Answer 60

1) Colchicine - Acute Gout attacks

2) Allupurinol - Used to lower Uric acid levels in treating chronic Gout