Rheumatic Diseases Flashcards
What are the 3 most prevalent types of arthritis?
1) Osteoarthritis
2) Rheumatoid arthritis
3) Gout
In short, describe Rheumatic Diseases and Arthritis.
1) Rheumatic Diseases - Diseases involving the joints, bones, and muscles.
2) Arthritis - Inflammation of the joint.
Define Osteoarthritis
Osteoarthritis is a chronic, noninflammatory, progressive disorder that causes cartilage deterioration in synovial joints and vertebrae.
What are the 3 major risk factors for Osteoarthritis?
1) Age
2) Obesity
3) Estrogen reduction
What are the 4 clinical manifestations of Osteoarthritis?
1) Cartilage degradation
2) Joint stiffening
3) Pain
4) Loss of movement and function
(T/F) Regular and moderate exercise decreases the risk of Osteoarthritis.
True
What are the 3 characteristics of joint stiffness associated with Osteoarthritis?
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
Describe Heberden and Bouchard’s syndrome. What is the difference between the two?
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
(T/F) Heberden and Bouchard’s nodes do not cause significant loss of function?
True
Describe the difference in diagnostic testing for early OA and progressed OA?
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.
Management of OA focuses on which 3 things?
1) Management of pain and inflammation
2) Preventing or limiting disability
3) Maintaining and improving joint function
Which 6 methods are used to manage OA?
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
(T/F) Even though OA is an NONINFLAMMATORY Chronic disease, inflammation may be present.
True
What are the characteristics of Heat and Cold applications used for patients with OA?
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
Name the 7 complementary and alternative therapies used in the management of OA
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
What are the 9 characteristics of Rheumatoid Arthritis (RA)?
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
What are the 3 SxS of RA?
1) Joint pain, swelling, warmth and erythema
2) Lack of function
3) Extra-articular symptoms
What are the 4 pharmacologic methods of managing RA?
1) NSAIDs
2) COX2 inhibitors
3) DMARDs (immunosuppressants)
4) Rheumatrex (Methotrexate)
The cause of RA is unknown but what are the 2 different etiologies of the disease?
1) Autoimmune etiology - When the inflammatory process is activated
2) Genetic factor etiology
Describe the diagnostic studies associated with RA in the following areas:
1) Nodules
2) Synovial fluid
3) X-rays
4) Lab findings
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.
What are the 7 possible complications that may arise from RA Nodules?
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
What are the 3 SxS of Felty Syndrome associated with RA?
1) Inflammatory eye disorders
2) Pulmonary disorders
3) Blood dyscrasias i.e., thrombocytopenia and anemia
What is the drug class of Rheumatrex (Methotrexate), and what is the most important nursing intervention during therapy?
1) Drug Class - Antineoplastic or antimetabolite
2) Monitor CBC and chemistry
How should heat and cold therapy be used in the management of RA?
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
Describe a diet intended to manage RA?
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
Describe Systemic Lupus Erythematosus (SLE).
SLE is a chronic inflammatory immune disease that causes an exaggerated production of autoantibodies and antigens and manifests as myalgias and arthralgias.
Describe Fibromyalgia
Fibromyalgia is a chronic pain syndrome characterized by diffuse musculoskeletal achiness, stiffness, fatigue, and exaggerated tenderness at 18 specified tender points.
Scleroderma begins with skin changes, but pathogenesis integrates what 3 cardinal features?
1) Vascular injury/damage
2) Activation of innate and adaptive arms of the immune system
3) Interstitial and vascular fibrosis
Describe Gout
Gout is a metabolic disorder marked by the deposition of monosodium urate crystals within joints and others tissues and is the result of hyperuricemia.
What are the four phases of Gout?
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.
Describe the difference between primary and secondary Gout.
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.
Define Tophi
Tophi is an accumulation of crystalline deposits in articular surfaces, bones, soft tissue, and cartilage.
What are the 5 pharmacologic methods used to treat Gout?
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
Describe a diet intended for a patient with Gout.
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
Define Podagra
Gout in the big toe
How is a definitive diagnosis of Gouty Arthritis made?
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.
What is Pannus?
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.
(T/F) Palpation of a joint affected by RA reveals a spongy or boggy tissue.
True
What are the 5 characteristics of RA according to Brooks?
1) Systemic Inflammatory
2) Autoimmune
3) NSAIDs, DMARDs and Immunosupressants
4) Symmetrical
5) small joints affected
What are the 6 characteristics of OA according to Brooks?
1) Localized
2) Caused by wear and tear
3) Bony nodules
4) Uni or bilateral
5) ⬇ Weight bearing
6) Steady progression
What are the 4 similarities between RA and OA?
1) Pain
2) ⬇ Mobility
3) Stiffness
4) Body image issues
The immune abnormalities that characterize SLE occur in what 5 phases?
1) Susceptibility
2) Abnormal innate & adaptive immune responses
3) Auto antibody immune complexes
4) Inflammation
5) Damage
With Scleroderma, the patient may manifest a subset of limited cutaneous symptoms referred to as CREST syndrome. What does the acronym CREST stand for?
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
(T/F) Morning joint stiffness is an expected symptom of a patient with OA.
True
What are 3 expected lab result of a patient with SLE?
1) Increased C-Reactive proteins
2) Positive ANA
3) Positive RF
(T/F) Increased creatinine may indicate renal damage in SLE and in Scleroderma
True
(T/F) RBC count is ⬇ in patients with RA
True
What 5 foods high in purine should a patient with gout avoid?
1) Liver
2) Anchovies
3) Shellfish
4) Cod
5) Sardines
What are the visual manifestations of a limb that has a hip fracture on that side?
1) Leg is shorter
2) Leg is adducted
3) Leg is externally rotated
What is the difference in when the following 2 Gout medications are administered to a patient with Gout:
1) Colchicine
2) Allupurinol
1) Colchicine - Acute Gout attacks
2) Allupurinol - Used to lower Uric acid levels in treating chronic Gout
