Rheumatic Disorders Flashcards
rheumatic diseases are _____ diseases of the ________ tissue
chronic
connective
rheumatic diseases are characterized by ________, pain, and degeneration
inflammation
tissues that are affected by rheumatic diseases
joints
ligaments
tendons
cartilage
synovial membranes
skin
Two categories of rheumatic diseases
Systemic, autoimmune rheumatic disease
Non-systemic osteoarthritis
Systemic, autoimmune rheumatic disease examples
Rheumatoid arthritis, scleroderma, lupus, gout, fibromyalgia
Non-systemic osteoarthritis examples
Osteoarthritis, bursitis, tendonitis
Inflammation is a normal process:
Occurs to ___________ damaged tissues by _______________
Inflammation usually subsides after the tissue is healed/free of infection
protect & repair
moving blood & WBC to the site of injury
Inflammatory diseases is when
Inflammation continues out of control and causes more damage rather than repair
The inflammatory response is initiated by tissue injury
Release of _____, _____, _____, _____
initiates the ______________
histamine, prostaglandins, plasma proteases, cytokines
Arachidonic acid cascade
The Arachidonic Acid cascade releases ________, ________, and ________
Prostaglandin E2
Thromboxane A2
Leukotriene B4
what does Prostaglandin E2 do ?
pain, vasodilation
what does Thromboxane A2 do?
platelet aggregation, vasoconstriction
what does Leukotriene B4 do ?
attract WBC, inflammation
Most prevalent form of osteoarthritis
Osteoarthritis (OA)
Osteoarthritis is also called ___________________
Degenerative joint disease (DJD)
Osteoarthritis is characterized by loss of ___________, __________, and ____________
OA _____(is/is not) an autoimmune disease
loss of articular cartilage
vascular congestion
osteoblastic activity (abnormal bone growth)
Not
osteoarthritis results in _____ inflammation and destruction that is caused by joint overuse.
The OA is usually _____ in the body
can occur in ______, ______, _____, _____, and _____
cartilage
localized
knees
hips
ankles
spine
interphalangeal joints
clinical manifestations of OA include pain that worsens when ___________
also ______ after periods of _______
weight bearing and activity
stiffness after periods of inactivity
risk factors for OA
Obesity
Repetitive-use injury
Aging
Female gender
Caucasian
Greater bone density
Genetic factors
pharmacologic therapy for OA
NSAIDS
Corticosteroids (stronger than NSAIDS & more side effects)
NSAIDS side effects
decrease secretion in stomach = ulcers and bleeding
nausea
examples of NSAIDS
ibuprofen
naprozen
side effects of corticosteroids
calcium deficiency
raise blood sugar
hyperlipidemia
edema
hunger
Treatment for osteoarthritis
Physical therapy
Massage therapy
Exercise=>non-loading aerobic; range of motion; strengthening exercises
Surgical treatment=> total joint arthroplasty
MNT for osteoarthritis
weight loss to achieve desirable body weight
MNT for OA
Weight loss to achieve desirable body wt
Well-balanced diet
DRI for calcium & vitamin D
? Use of antioxidant supplements
Possible use of “____________” for MNT for OA
anti-inflammatory diet
Anti Inflammatory Diet
- Aims for variety, with a whole foods, plant-based diet with minimal _________ foods
- Increased fruits & veg
- High in ________ and ______ FA; lower in ______ fatty acids
- Low in SFA
- Low in______________ and added _________
processed
MUFA & omega-3
omega-6
refined CHO & added sugars
Complementary & Integrative Therapies for OA
Glucosamine & chondroitin sulfate
Glucosamine & chondroitin sulfate is involved in ________ production
Sold as ______________
Unclear whether ____________ helps with OA pain
____________ may improve OA pain slightly in the short term
No serious side effects
cartilage
dietary supplements
glucosamine
Chondroitin sulfate
Chronic, autoimmune, systemic disease characterized by inflammatory changes in joints & related structures resulting in crippling deformities
Rheumatoid Arthritis (RA)
Rheumatoid Arthritis (RA) is Marked by periods of ______ and _______
More common in ______
Peak onset: age _______ yrs
flare-up & remission
women
20-45
Pathophysiology of RA
Unknown etiology
Inflammation starts in the_________ and progresses to ___________
Small joints of extremities are the most affected=> __________________
_________ is a risk factor
synovial membrane
joint cartilage
interphalangeal joints of the hands & feet
Smoking
Manifestations of RA
Pain, stiffness, & swelling of joints
Decline in function/ability to perform _______________
______ syndrome=> __________=> ____________________
_________________ syndrome => _________________
Anorexia due to=> pain, fatigue, depression, FMI, & cytokines
activities of daily living (ADLs)
Sjögren’s
xerostomia
dental decay, dysgeusia, dysphagia
Temporomandibular joint syndrome (TMJ)
pain and chewing issues
Rheumatoid Cachexia Characterized by loss of _______ and elevated ______
Excessive __________ due to_________ and by __________
Causes muscle weakness, loss of function, and may hasten morbidity & mortality
muscle mass
REE
muscle catabolism
cytokines
disuse atrophy
Goal of Pharmacologic Therapy for RA
control pain & inflammation
Different types of medications for RA and examples
NSAIDS & salicylates
- aspirin
Methotrexate: FDI=> inhibits conversion of folate to active form
Corticosteroids
Azathioprine (Imuran): FDI=> can cause N/V, loss of appetite, steatorrhea
TNF-α inhibitors: adalimumab (Humira) => increases infection risk
Nutritional Assessment for RA
Current disease _____
Past ______ & ______ history
Food-medication interactions
Laboratory values
Weight ______ & anthropometrics
Nutrition-Focused Physical Examination
status
medical & surgical
history
Diet history for nutrition assessment for RA should include…
- Appetite
- Assessment of usual _____
- Ability to prepare food &_______
- Chewing & ________ ability
- _____ status
- Modified diets
- Supplement use; alternative therapies
intake
feed self
swallowing
GI
Energy needs for RA
_______ REE due to inflammatory process
TEE is often________ in individuals due to decreased physical activity
Need to assess individually
Elevated
lower
Protein for RA
Elevated whole-body protein catabolism
For individuals who are poorly nourished or having a flare-up=> _______ g/kg
1.2-1.5
Individuals with RA are at increased risk for _____
Change the type of fat in the diet=> “_______________ diet”)
______ animal fat, SFA, & trans-fats
_______ omega-3 fatty acids=> reduce inflammatory activity
CVD
anti-inflammatory
Decrease
Increase
Antioxidants->________
May need _______ & ___________ supplementation
Those on methotrexate=> _____________ supplementation daily
vit E
calcium & vit D
1 mg folic acid
MNT for Rheumatoid Arthritis
- Healthy diet with a variety of foods
- Consider use of the “____________ diet”
- TMJ: ___________ diet
- Self-feeding: Adaptive feeding devices—referral to __________
anti-inflammatory
easy-to-chew
an occupational therapist
Complementary & Integrative Therapies for RA
__________________
Can be converted in the body to _______________
May relieve______ and joint ________
side effects?
Gamma-linolenic acid (GLA)
anti-inflammatory prostaglandins
pain and joint stiffness
no serious side effects
Note for RA GLA as alternative or integrative therapy
some ____________ preparations contain ____________ that can cause________disease
Only preparations that are labeled as “_______” should be used
borage seed oil
pyrrolizidine alkaloids (PAs)
liver
PA-free
Gout is a disorder of ___________ metabolism
Resulting in accumulation of high levels of ______ in the blood=> ________________ are formed and become deposited__________________
These deposits destroy_________
Affects ____ gender more
Peak incidence is in the ______
purine
uric acid
monosodium urates
in and around small joints
joint tissue
male
50s
Common sites of Gout? ____________
Characterized by a sudden & _____ onset of _______ pain generally beginning in the_______ and continues__________
__________ & __________ may occur
large toe, elbow, wrist & finger joints, and helix of the ear
acute
localized
large toe
up the leg
Uric acid nephrolithiasis & renal disease
Risk Factors for Gout
Hereditary
_____ gender
Age
Obesity
Excessive alcohol use
Diseases: ____________________
Use of ______________________________
Male
HTN, DM, hyperlipidemia, renal insufficiency
thiazide diuretics (e.g., hydrochlorothiazide)
Medical management of Gout
Allopurinol
Probenecid
Colchicine
NSAIDS
Allopurinol function
inhibits uric acid production
Probenecid function
increases excretion of uric acid via the kidneys
Colchicine is used to ______________
treat joint pain in acute flares
MNT for Gout
Purines are found in a many ___________
Drugs have become the primary treatment and have replaced the “rigid” ________ diet because most ________ is produced endogenously
Avoid foods high in _______
high protein foods
low purine
uric acid
purines
MNT for Gout
Well-balanced diet with limited intake of ____________
Increase consumption of fluids to at least_____ cups/d=>aids in the _______
Attacks can be precipitated by=> ________________
Limit/avoid alcohol (especially _______)=> increases _______ production
During an acute flare=>avoid ___________
animal foods
8
excretion of uric acid
excessive eating, drinking alcohol, exercise
beer
uric acid
meat & alcohol
Some foods high in purines
Anchovies
bouillon
broth
organ meats
wild game
goose
gravy
scallops
sardines
mussels
herring
mackerel
roe
meat extracts
yeast taken as a supplement
MNT for Gout
______ restriction to promote gradual weight loss if overweight
Limit consumption of ______ which increases serum uric acid levels
Calorie
fructose
Systemic Lupus Erythematosus (SLE) is …
Chronic inflammatory, connective tissue disorder
Autoimmune disorder
Systemic Lupus Erythematosus (SLE) is characterized by periods of relapses and remissions
The cause is multifactorial involving multiple ____________ and __________ factors
Prevalence is greatest in ____________
More common in ___________
genes and environmental
women of child-bearing age
African Americans
Symptoms of SLE
Painful, swollen joints
Extreme fatigue
Muscle pain
Sun sensitivity
Skin rashes on the face
Mouth ulcers
syndrome that can occur with SLE ?
what organs are affected by SLE ?
Sjögren’s syndrome
Raynaud’s syndrome
Can affect organs:
1. Kidneys=>excessive protein excretion & renal failure
2. Pleurisy, pericarditis, primary pulmonary HTN
medical management of SLE
Corticosteroids
NSAIDS
Disease-modifying antirheumatic drugs (DMARDs)
Disease-modifying antirheumatic drugs (DMARDs) example
azathioprine (Imuran)
MNT for SLE
Protein considerations:
If on corticosteroids=> provide _______
If develops chronic kidney disease (CKD):
If not on dialysis yet, restrict protein to _______
If on dialysis, provide ________ protein
1 g/kg
0.55-0.6 g/kg
1.0-1.2 g/kg
MNT for SLE
Sodium & fluid=> may need to be___________
At risk for _________ deficiency
Calories as needed to attain/maintain desirable body weight
restricted if renal disease
vitamin D
Scleroderma is _____________________ characterized by _____________
Etiology: _________ with a ________ component
More common in ________
Subtypes:
____________
____________
cure ?
Chronic, systemic, sclerosis of the skin & visceral organs
deposition of fibrous connective tissue
autoimmune
genetic
women
Localized - skin
Systemic – skin and organs
no cure
Manifestations of Scleroderma
Widespread sclerosis of the skin & visceral organs with multisystem involvement
_______ stiffness/pain
________ syndrome
_______ syndrome
_____________
_______ dysfunction
Pulmonary _______
Joint
Sjögren’s
Raynaud’s
Hypertension
Renal
fibrosis
GI manifestations of Scleroderma
GERD
N/V/C/D
dysphagia
malabsorption
loss of peristalsis
small bowel bacteria growth
weight loss
malnutrition
MNT for Scleroderma
- No specific diet
- Individualize based on manifestations:
_______________ for dysphagia
______ for xerostomia
_______for GERD
Use of _______, _______ supplements
Modify diet texture
MNT
MNT
high-calorie, high-protein
MNT for Scleroderma
If fat malabsorption: _______________
_________ nutrition if needed
If malabsorption= ___________
End-Stage=> may need ___________ nutrition due to _________
40 g low fat diet
Enteral
semi-elemental formula
parenteral
GIT failure
Complementary & Alternative Therapies in Rheumatic Disorders are
commonly used among patients with rheumatological diseases because:
______________ and ____________
Many therapies are _______; some may be __________; lack of ________
No cure for diseases
Chronic pain
unproven
harmful
regulation
Unproven Therapies in Rheumatic Disorders
Comfrey=> contains pyrrolizidine alkaloids that are toxic to the liver
Alfalfa=> not recommended for auto-immune disorders
