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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
Q

What MHC locus is associated with a higher susceptibility to develop RA?

A

HLA-DR4

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26
Q

Concerning the etiology of RA, describe the non-genetic risk factors

A
  • Bacterial or viral agent

- Environmental triggers

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27
Q

Stages of RA

A
  • early
  • intermediate
  • late
28
Q

Which stage of RA is the “window of opportunity” to intervene?

A

Early

29
Q

What can occur once the “window of opportunity” for treating RA closes?

A

permanent joint deformity, destruction, and disability

30
Q

RA treatment guidelines

A
  • DMARD tx within 3 months of diagnosis
  • control joint damage
  • control loss of function
  • decrease pain
31
Q

What DMARD is typically used as the first line of tx for RA?

A

methotrexate - alone or in combination with other DMARDS

32
Q

What should the therapist be aware of when treating a pt taking corticosteroids?

A

high risk for fracture

33
Q

How does methotrexate work?

A

reduces proliferative potential of replicating immune cells

34
Q

Benefits of methotrexate

A
  • symptom improvement
  • retardation of joint damage
  • well tolerated over the long term
  • renally cleared
35
Q

Adverse effects of methotrexate

A
  • GI
  • Hematologic
  • Hepatic
  • Pulmonary
  • Infections
  • Neoplasia
  • Accelerated nodulosis and vasculitis
36
Q

Adverse effects of methotrexate - GI

A
  • mucositis
  • diarrhea
  • abdominal pain
37
Q

Adverse effects of methotrexate - hematologic

A
  • cytopenias

- macrocytosis

38
Q

Adverse effects of methotrexate - hepatic

A
  • fibrosis

- cirrhosis

39
Q

Adverse effects of methotrexate - pulmonary

A
  • hypersensitivity pneumonitis

- pulmonary fibrosis

40
Q

Adverse effects of methotrexate - neoplasia

A
  • reversible lymphoproliferative disorder
  • lymphoma
  • leukemia
41
Q

What are biologic therapies?

A

involves use of organic compounds made by living cells, as opposed to products from a chemistry lab

42
Q

How do biologic therapies work?

A

modify biologic responses

43
Q

What sorts of biologic responses do biologic therapies modify?

A
  • antibody-antigen interactions
  • cytokine-receptor interactions (both ends)
  • cell signaling proteins, inhibitors, or ligands
44
Q

Families of biologic therapies

A
  • Anti-Tnf medications
  • B-cell depleting agents (monoclonal antibody)
  • T-cell co-stimulation inhibitors (receptor-ligand)
45
Q

Tnf stands for

A

tumor necrosis factor

46
Q

Examples of anti-Tnf medications

A
  • Etanercept
  • Infliximab
  • Adalimumab
47
Q

Etanercept is

A
  • Anti-Tnf medication

- cytokine receptor fusion protein

48
Q

Methotrexate is

A

a DMARD

49
Q

Infliximab is

A
  • Anti-Tnf medication

- anti-cytokine antibody

50
Q

Adalimumab is

A
  • Anti-Tnf medication

- anti-cytokine antibody

51
Q

Examples of B-cell depleting agents

A

Rituximab

52
Q

B-cell depleting agents aka

A

monoclonal antibody

53
Q

Monoclonal antibody aka

A

B-cell depleting agents

54
Q

T-cell co-stimulation inhibitors aka

A

receptor-ligand

55
Q

Receptor-ligand aka

A

T-cell co-stimulation inhibitors

56
Q

Examples of T-cell co-stimulation inhibitors

A

Abatacept

57
Q

Rituximab is

A

a B-cell depleting agent (monoclonal antibody)

58
Q

Abatacept is

A

a T-cell co-stimulation inhibitor (receptor-ligand)

59
Q

PT implications of RA

A
  • Know S/S of early RA
  • Encourage aerobic activity
  • Low load strength training
60
Q

Concerning knowing the S/S of early RA, early intervention =

A

joint preservation

61
Q

What is a “flare-up” of RA

A

extreme exacerbation of symptoms

62
Q

What should the PT do in the case of a “flare-up” in a pt with RA

A

go easy on the pt

63
Q

Concerning knowing the S/S of early RA, joint preservation =

A

early intervention

64
Q

Concerning low load strength training, when should it be monitored while working with a pt with RA?

A

with a flare-up

65
Q

What should be monitored with a “flare-up” of RA?

A

low load strength training

66
Q

PT implications of low load strength training

A
  • monitor with flare-up

- AVOID OVERTRAINING

Med/Surg III Test 2 (5 decks)

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