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rheumatic & metabolic Flashcards

1
Q

living bone is constantly being

A

remodeled

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2
Q

bones are close to homeostatic equilibrium between

A

bone formation and bone resorption

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3
Q

16-20s bone mass

A

bone resorption > bone formation w age

due to calcium metabolism, vitamin D deficiency, and/or hormonal factors, such as changes of estrogen level

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4
Q

Measuring proteins produced by the _____ provides a real-time evaluation of bone turnover

A

osteoblasts and osteoclasts

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5
Q

disrupts bone tissue

A

osteoclasts

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6
Q

hyperactivty of this casses osteoporsis

A

osteoclasts

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7
Q

produces new bone tissue

A

osteoblasts

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8
Q

metabolic bone diseases are a spectrum of disorders caused by abrnormal levels of

A

minerals (ca, phos, magn, vit D)

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9
Q

Disorders of bone strength related to bone mass or structure:

A

osteoporsis + osteopenia

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10
Q

most common metabolic bone disorder is (“silent thief as you age”)
untreated, can lead to fragility fractures, bone deformities and serious disability

A

osteoporosis

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11
Q

condition common to all metabolic bone diseases; not a diagnosis but term used to describe loss of bone density
refers to bone mineral density (BMD) that is lower than normal peak BMD; not as low as osteoporosis

A

osteopenia

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12
Q

stats on osteopenia and osteoporosis

A

Cause, generally unknown
As many as 10 million Americans have osteoporosis
34 million more have osteopenia (low bone density)
Bone density peaks at about age 30

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13
Q

women can lose up to __% of their bone density 5 years after menopasuce

A

20%

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14
Q

two types of osteoporosis

A

primary and secondary

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15
Q

age-related bone loss (called senile osteoporosis)

or cause is unknown (idiopathic osteoporosis – term used only for men younger than 70 years old)

A

primary osteoporsis

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16
Q

caused by certain lifestyle behaviors diseases, or medications
smoking, excessive alcohol, immunosuppressive drugs, COPD, immobilization, etc.

A

secondary osteoporsis

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17
Q

osteoporsis diagnostic work up

A

medical history, x-rays, and urine and blood tests
bone mineral density (BMD) test (dual-energy x-ray absorptiometry or Dexa)
other tests - includes ultrasound and QCT

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18
Q

Reading Dexa Results

T score numbers and Z score numbers

what is bone mineral density?

A

Bone mineral density (BMD) = the number of grams per centimeter of bone. Numbers 1.0 or above are good.
T score shows how your bone mineral density compares with women in their thirties
-1 through -2.5 indicate osteopenia
< -2.5 indicate osteoporosis
Z score compares your bone mineral density with others of your own age

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19
Q

osteoporosis risk factors

A

highest-risk groups include older women and those who have gone through menopause

estrogen levels decrease, bones lose calcium and other minerals at a faster rate
bone loss of approximately 2% per year occurs for several years after menopause
Men also lose bone as they age, however testosterone levels decline gradually so bone mass remains adequate longer

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20
Q

Uncontrollable osteoporsis risk factors:

A

Family history – bone health can be strongly inherited
Being female
Menopause
Low body weight (small/thin)
Coeliac disease, inflammatory bowel disease (malabsorption)

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21
Q

Controllable osteoporosis risk factors:

A 
Low calcium intake
Low vitamin D levels
Inactive, sedate lifestyle
Smoking, excessive alcohol 
Weight loss
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22
Q

Other Osteoporosis Risk Factors

A 
Vitamin D deficiency
Dark skin pigmentation
Environmental causes
Lead 
Housebound, frail elderly, malabsorption
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23
Q

Osteoporosis Prevention in kiddos

A

Children and adolescents should:
Ensure a nutritious diet with adequate calcium intake
Avoid protein malnutrition and under-nutrition
Maintain an adequate supply of vitamin D
Participate in regular physical activity, exercise regularly
Avoid the effects of second-hand smoking

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24
Q

Osteoporosis Prevention in adults

A

Ensure a nutritious diet and adequate calcium intake
Avoid under-nutrition, particularly the effects of severe weight-loss diets and eating disorders
Maintain an adequate supply of vitamin D
Participate in regular weight-bearing activity
Avoid smoking and second-hand smoking
Avoid heavy drinking

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25
Bone mineral density (BMD) tests recommended for
All women aged 65 years or older and men aged 70 years or older Younger postmenopausal women and men aged 50-70 years with clinical risk factors for fracture Women in menopausal transition with a risk factor for fractures (low body weight, prior low-trauma fracture, use of a high-risk medication) Adults with fragility fractures Adults who have a condition associated with low bone mass or bone loss (e.g., rheumatoid arthritis) Adults on medication associated with low bone mass or bone loss (glucocorticoids, ≥5 mg of prednisone daily for > 3 mo)
26
``` Hyperparathyroidism Paget’s diseases of the bone (osteitis deformans) Fragility Parathyroid disorders Vitamin D deficiency Osteomalacia Rickets Calcium and phosphorus disorders Renal osteodystrophy ```
Other metabolic bone disorders
27
means trouble w flow in patient's body
rheumaticus
28
rheumatic diseases are what kinda of disease?
autoimmune and inflammtory diseases | immune system attachs person's joints, muscles, bones, and organs
29
women are how many more times likely to develop RA?
2-3x
30
women are how many more times likely to develop lupus?
10x
31
when do inflammatory rheumatic diseases strike people in life?
prime of life RA 35-50 Lupus 14-44
32
Rheumatic diseases are often lumped under the term ____
arthritis
33
___ is used to describe over 100 diseases and conditions, 30 of which are inflammatory
arthritis
34
examples of inflammatory rheumatic diseases
RA, lupus, gout, scleroderma, juvenile idiopathic arthritis | Sjögren’s syndrome, spondylarthritides, polymyalgia rheumatica, etc.
35
rheumatic diseases cause severe deformities that limit _____
basic self care
36
rhematic diseases cause damage to ____
vital organs
37
30% of ppl w rhematic diseases experience ____
work limitations
38
what is a more frequency cause of activity limitation than heart disease, cancer, or diabetes?
rheumatic diseases and arthritis
39
example of ADLs and iADLS that may be difficult for ppl w rhematic diseases
getting out of bed, eating breakfast, getting dressed, and driving to work
40
Symptoms of rheumatic diseases are more than just aches and pains and cause They also develop
can cause inflammation and damage to the joints and organs of the body Develop co-existing diseases, disability, and even death
41
mortality for ppl w rheumatic diseases
have a potentially crippling disease the reality that they might die 10 to 15 years earlier than expected Mortality rates for people with diffuse scleroderma are 5 to 8 times greater than people of the same age and gender without the disease Life expectancy is also shorter among patients with RA than in the general population
42
Chronic, autoimmune disease that can damage (attack) any part of the body (skin, joints, and/or organs inside the body)
lupus
43
types of lupus
Systemic lupus erythematosus (SLE) is most common. Can be mild or severe, and can affect many parts of the body. Discoid lupus causes a red rash that doesn't go away Subacute cutaneous lupus causes sores after being out in the sun Drug-induced lupus is caused by certain medicines Neonatal lupus, which is rare, affects newborns, probably caused by certain antibodies from the mother
44
Rheumatic Arthritis (RA) Characteristics
Tender, warm, swollen joints Symmetrical pattern of affected joints Joint inflammation often affecting the wrist and finger joints sometimes affecting other joints, fatigue, occasional fevers, a loss of energy Joint pain and stiffness lasting for more than 30 minutes in the morning or after a long rest Symptoms last many years Variability of symptoms
45
RA Etiology (what kinda disease, genes play a role?)
Autoimmune disease, cause unknown Certain genes are known to play a role in the immune system associated with a tendency to develop RA but individual genes themselves are a small risk
46
who is more likely to develop RA and when?
May improve during pregnancy and flare after pregnancy. Breastfeeding may also aggravate the disease
47
Contraceptive use may increase a person’s likelihood of developing ________
rheumatoid arthritis Suggests hormones (or possibly hormonal deficiencies) promote the development of RA in susceptible people
48
how do you diagnosis RA?
No single test for the disease Symptoms and severity vary from person to person Symptoms may mimic those of other types of arthritis and joint conditions and may take time to rule out Medical history, physical exam conducted, x-rays, lab tests
49
Lab tests for RA
Antinuclear antibody (ANA) Rheumatoid factor (RF) Erythrocyte sedimentation
50
can suggest the presence of lupus, polymyositis, scleroderma, Sjogren’s syndrome, mixed connective tissue disease or RA
Antinuclear antibody (ANA) test for RA
51
designed to detect and measure the level of an antibody that acts against the blood component gamma globulin, often positive in people with RA
Rheumatoid factor (RF) test for RA
52
measures how fast red blood cells cling, fall, and settle in the bottom of a glass tube. Elevated sed rate may indicate a greater amount of inflammation
Erythrocyte sedimentation rate called ESR or “sed rate,” test for RA
53
Swan-Neck deformity occurs due to what?
Can occur due to synovitis of MCP, PIP, DIP fairly common deformity from trauma in non-RA patient (MP synovitis is most common cause in RA) Swan-neck- 3 components: PIP hyperextension DIP flexion MCP flexion
54
Rheumatoid/Subcutaneous Nodules
Discrete tissue masses composed of fibrous and granulomatous tissue. Commonly found over bony prominences exposed to pressure. (i.e. found on elbow, hands- MP’s) They can be freely moveable or fixed- generally not painful May also arise over bony prominence created by a subluxed joint Associated with sero-positive RA - presence of proteins rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) indicate a more severe disease course
55
RA Treatment
No known cure Goal of medical Tx achieve lowest possible level of disease activity and remission, if possible minimize joint damage enhance physical function and quality of life Optimal treatment of RA requires a comprehensive program combines medical, social, and emotional support, patient and the family education Treatment options medications, joint protection, PT & OT, and surgical intervention
56
Pharmacological Tx
3 general classes of drugs commonly used: non-steroidal anti-inflammatory agents (NSAIDs) corticosteroids disease modifying anti-rheumatic drugs (DMARDs) NSAIDs and corticosteroids have a short onset of action while DMARDs can take several weeks or months to demonstrate a clinical effect Cartilage damage and bony erosions frequently occur within the first two years of disease Therefore, rheumatologists now move aggressively to initiate DMARD treatment
57
Medications for RA
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) inhibit generation of prostaglandins by blocking cyclooxygenase enzymes, COX-1 and COX-2 Prostaglandins are potent mediators of inflammation Cause pain, swelling and inflammation Aspirin, ibuprofen, indomethacin and COX-2 inhibitors Work by blocking production of prostaglandins Common side effect of NSAIDs Gastrointestinal disturbance These drugs alone do not change the course of the disease Analgesic Drugs –acetaminophen, propoxyphene, mepeidine, and morphine.
58
Glucocorticoids (Prednisone)
Is a corticosteroid (or steroid medication) that prevents release of substances in the body that cause inflammation. Have both anti-inflammatory and immunoregulatory activity Useful in early disease as temporary adjunctive therapy, while waiting for DMARDs to exert their anti inflammatory effects May be difficult to discontinue and even at low doses
59
Corticosteroids side effects
Constellation of signs and symptoms caused by an excess of cortisol hormone, or Cushing syndrome Weight gain, cushinoid appearance fat deposits around face, redness of cheeks, “buffalo hump” over neck High blood pressure & blood sugar, risk of cataracts, avascular necrosis of bones
60
Disease Modifying Anti-rheumatic Drugs (DMARDS)
Only DMARD agents have been shown to alter the disease course and improve radiographic outcomes Effect on RA may be slower When Dx of RA is confirmed, DMARD agents should be started ``` DMARDs: Methotrexate T-cell Costimulatory Blocking Agents B cell Depleting Agents Intramuscular Gold ```
61
Surgical Options
Prior to surgery, surgeons must consider a patients: motivation and goals ability to undergo rehabilitation general medical status Synovectomy is sometimes appropriate, though in many patients relief is only transient Total joint arthroplasties, particularly knee, hip, wrist, and elbow, are highly successful Arthroplasty of the hand MCP joints can reduce pain and improve function

human conditions (28 decks)

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