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human conditions > rheumatic & metabolic > Flashcards

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
Q

Bone mineral density (BMD) tests recommended for

A

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
Q 
Hyperparathyroidism
Paget’s diseases of the bone (osteitis deformans)
Fragility
Parathyroid disorders
Vitamin D deficiency 
Osteomalacia
Rickets
Calcium and phosphorus disorders
Renal osteodystrophy
A

Other metabolic bone disorders

27
Q

means trouble w flow in patient’s body

A

rheumaticus

28
Q

rheumatic diseases are what kinda of disease?

A

autoimmune and inflammtory diseases

immune system attachs person’s joints, muscles, bones, and organs

29
Q

women are how many more times likely to develop RA?

A

2-3x

30
Q

women are how many more times likely to develop lupus?

A

10x

31
Q

when do inflammatory rheumatic diseases strike people in life?

A

prime of life

RA 35-50
Lupus 14-44

32
Q

Rheumatic diseases are often lumped under the term ____

A

arthritis

33
Q

___ is used to describe over 100 diseases and conditions, 30 of which are inflammatory

A

arthritis

34
Q

examples of inflammatory rheumatic diseases

A

RA, lupus, gout, scleroderma, juvenile idiopathic arthritis

Sjögren’s syndrome, spondylarthritides, polymyalgia rheumatica, etc.

35
Q

rheumatic diseases cause severe deformities that limit _____

A

basic self care

36
Q

rhematic diseases cause damage to ____

A

vital organs

37
Q

30% of ppl w rhematic diseases experience ____

A

work limitations

38
Q

what is a more frequency cause of activity limitation than heart disease, cancer, or diabetes?

A

rheumatic diseases and arthritis

39
Q

example of ADLs and iADLS that may be difficult for ppl w rhematic diseases

A

getting out of bed, eating breakfast, getting dressed, and driving to work

40
Q

Symptoms of rheumatic diseases are more than just aches and pains and cause

They also develop

A

can cause inflammation and damage to the joints and organs of the body

Develop co-existing diseases, disability, and even death

41
Q

mortality for ppl w rheumatic diseases

A

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
Q

Chronic, autoimmune disease that can damage (attack) any part of the body (skin, joints, and/or organs inside the body)

A

lupus

43
Q

types of lupus

A

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
Q

Rheumatic Arthritis (RA) Characteristics

A

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
Q

RA Etiology (what kinda disease, genes play a role?)

A

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
Q

who is more likely to develop RA and when?

A

May improve during pregnancy and flare after pregnancy. Breastfeeding may also aggravate the disease

47
Q

Contraceptive use may increase a person’s likelihood of developing ________

A

rheumatoid arthritis

Suggests hormones (or possibly hormonal deficiencies) promote the development of RA in susceptible people

48
Q

how do you diagnosis RA?

A

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
Q

Lab tests for RA

A

Antinuclear antibody (ANA)

Rheumatoid factor (RF)

Erythrocyte sedimentation

50
Q

can suggest the presence of lupus, polymyositis, scleroderma, Sjogren’s syndrome, mixed connective tissue disease or RA

A

Antinuclear antibody (ANA) test for RA

51
Q

designed to detect and measure the level of an antibody that acts against the blood component gamma globulin, often positive in people with RA

A

Rheumatoid factor (RF) test for RA

52
Q

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

A

Erythrocyte sedimentation rate called ESR or “sed rate,” test for RA

53
Q

Swan-Neck deformity occurs due to what?

A

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
Q

Rheumatoid/Subcutaneous Nodules

A

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
Q

RA Treatment

A

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
Q

Pharmacological Tx

A

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
Q

Medications for RA

A

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
Q

Glucocorticoids (Prednisone)

A

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
Q

Corticosteroids side effects

A

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
Q

Disease Modifying Anti-rheumatic Drugs (DMARDS)

A

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
Q

Surgical Options

A

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

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