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Med/Surg III Test 2 > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

Common effects of inflammatory arthritis at the joint level:

A
  • SWaR
  • PaMoWo
  • can have systemic components
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2
Q

I made up SWaR to stand for

A
  • Swelling
  • Warmth
  • Redness
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3
Q

I made up PaMoWo to stand for

A
  • Pain and stiffness
  • Morning > afternoon symptoms
  • Worse with rest, better with use
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4
Q

Rheumatoid arthritis is a _____________________ disease, primarily involving the ______________ membrane of ________________ joints.

A

systemic inflammatory; synovial; diarthrodial

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5
Q

Rheumatoid arthritis is most prevalent in

A

women of child-bearing age

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6
Q

True/False: Rheumatoid arthritis can occur in any person at any age.

A

True

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7
Q

True/False: Rheumatoid arthritis can only occur after puberty.

A

False

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8
Q

In order to be diagnosed with RA, one must be diagnosed with ____ of _____ criteria.

A

4; 7

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9
Q

The 7 criteria for diagnosis of RA

A
  • MArASy

- RheSeRad

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10
Q

I made up MArASy to stand for

A
  • Morning stiffness > 1 hr duration
  • Arthritis of 3 or more joints
  • Arthritis of the hand joints
  • Symmetrical arthritis
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11
Q

I made up RheSeRad to stand for

A
  • Rheumatoid nodules
  • Serum rheumatoid factor (85%)
  • Radiographic changes
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12
Q

RA can cause

A
  • Rheumatoid nodules
  • Interstitial lung disease
  • Vasculitis
  • Felty’s Syndrome
  • Ocular disease
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13
Q

True/False: Rheumatoid nodules are typically very painful.

A

False

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14
Q

True/False: Rheumatoid nodules are painless.

A

True

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15
Q

Vasculitis is

A

destruction of blood vessels by inflammation

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16
Q

What is Felty’s Syndrome?

A

Triad of RA, splenomegaly, and granulocytopenia

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17
Q

True/False: Everyone with RA has Felty’s Syndrome.

A

False

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18
Q

True/False: Everyone with Felty’s Syndrome has RA.

A

True

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19
Q

Late stage clinical features of RA

A
  • Boutonniere deformity of thumb
  • Ulnar deviation of metacarpophalangeal joints
  • Swan-neck deformity of fingers
  • Lateral deviation of great toe
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20
Q

Distribution of Rheumatoid Arthritis

A
  • symmetrical
  • hands most commonly affected
  • devoid in the axial skeleton
  • neck, TMJ
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21
Q

Would RA affect the hips? Why or why not?

A

No - hips are part of the axial skeleton

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22
Q

Concerning the etiology of RA, describe the general risk factors

A
  • multiple genes / risk factors
  • 15-30% identical twins
  • women > men
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23
Q

Concerning the etiology of RA, describe the environmental triggers

A

relatively unknown - could be many things

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24
Q

Concerning the etiology of RA, describe the genetic risk factors

A
  • family history
  • female sex
  • specific gene: HLA-DR4
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25
What MHC locus is associated with a higher susceptibility to develop RA?
HLA-DR4
26
Concerning the etiology of RA, describe the non-genetic risk factors
- Bacterial or viral agent | - Environmental triggers
27
Stages of RA
- early - intermediate - late
28
Which stage of RA is the "window of opportunity" to intervene?
Early
29
What can occur once the "window of opportunity" for treating RA closes?
permanent joint deformity, destruction, and disability
30
RA treatment guidelines
- DMARD tx within 3 months of diagnosis - control joint damage - control loss of function - decrease pain
31
What DMARD is typically used as the first line of tx for RA?
methotrexate - alone or in combination with other DMARDS
32
What should the therapist be aware of when treating a pt taking corticosteroids?
high risk for fracture
33
How does methotrexate work?
reduces proliferative potential of replicating immune cells
34
Benefits of methotrexate
- symptom improvement - retardation of joint damage - well tolerated over the long term - renally cleared
35
Adverse effects of methotrexate
- GI - Hematologic - Hepatic - Pulmonary - Infections - Neoplasia - Accelerated nodulosis and vasculitis
36
Adverse effects of methotrexate - GI
- mucositis - diarrhea - abdominal pain
37
Adverse effects of methotrexate - hematologic
- cytopenias | - macrocytosis
38
Adverse effects of methotrexate - hepatic
- fibrosis | - cirrhosis
39
Adverse effects of methotrexate - pulmonary
- hypersensitivity pneumonitis | - pulmonary fibrosis
40
Adverse effects of methotrexate - neoplasia
- reversible lymphoproliferative disorder - lymphoma - leukemia
41
What are biologic therapies?
involves use of organic compounds made by living cells, as opposed to products from a chemistry lab
42
How do biologic therapies work?
modify biologic responses
43
What sorts of biologic responses do biologic therapies modify?
- antibody-antigen interactions - cytokine-receptor interactions (both ends) - cell signaling proteins, inhibitors, or ligands
44
Families of biologic therapies
- Anti-Tnf medications - B-cell depleting agents (monoclonal antibody) - T-cell co-stimulation inhibitors (receptor-ligand)
45
Tnf stands for
tumor necrosis factor
46
Examples of anti-Tnf medications
- Etanercept - Infliximab - Adalimumab
47
Etanercept is
- Anti-Tnf medication | - cytokine receptor fusion protein
48
Methotrexate is
a DMARD
49
Infliximab is
- Anti-Tnf medication | - anti-cytokine antibody
50
Adalimumab is
- Anti-Tnf medication | - anti-cytokine antibody
51
Examples of B-cell depleting agents
Rituximab
52
B-cell depleting agents aka
monoclonal antibody
53
Monoclonal antibody aka
B-cell depleting agents
54
T-cell co-stimulation inhibitors aka
receptor-ligand
55
Receptor-ligand aka
T-cell co-stimulation inhibitors
56
Examples of T-cell co-stimulation inhibitors
Abatacept
57
Rituximab is
a B-cell depleting agent (monoclonal antibody)
58
Abatacept is
a T-cell co-stimulation inhibitor (receptor-ligand)
59
PT implications of RA
- Know S/S of early RA - Encourage aerobic activity - Low load strength training
60
Concerning knowing the S/S of early RA, early intervention =
joint preservation
61
What is a "flare-up" of RA
extreme exacerbation of symptoms
62
What should the PT do in the case of a "flare-up" in a pt with RA
go easy on the pt
63
Concerning knowing the S/S of early RA, joint preservation =
early intervention
64
Concerning low load strength training, when should it be monitored while working with a pt with RA?
with a flare-up
65
What should be monitored with a "flare-up" of RA?
low load strength training
66
PT implications of low load strength training
- monitor with flare-up | - AVOID OVERTRAINING

Med/Surg III Test 2 (5 decks)

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