Rheumatoid Arthritis Flashcards
1
Q
What is rheumatoid arthritis?
A
A chronic systemic autoimmune disorder.
2
Q
What is the most prevalent inflammatory arthritis?
A
Rheumatoid arthritis.
3
Q
Where does the inflammation show up in RA?
A
In connective tissues, primarily in joints.
4
Q
How does the course and severity vary in RA?
A
May have small symptoms, oral symptoms.
5
Q
What is an autoimmune disorder?
A
The body attacks itself.
6
Q
When does RA typically begin?
A
Third decade.
7
Q
When dos RA typically peak?
A
70 yrs old.
8
Q
What type of pain typically accompanies RA?
A
Chronic pain.
9
Q
True or False.
RA contributes to disability factors.
A
True.
10
Q
True or False.
RA does not shorten life expectancy.
A
False. RA DOES shorten life expectancy.
11
Q
What type of alterations accompany RA?
A
Alterations in body image; deformed joints, stiffness, pain.
12
Q
RA is typically an aberrant immune response in what type of host?
A
A genetically susceptible host.
13
Q
What are rheumatoid factors?
A
Normal antibodies become autoantibodies, These transformed antibodies are known as rheumatoid factors.
14
Q
What are leukocytes attracted to during RA?
A
The synovial membrane. (Membranes that surrounds joints)
15
Q
What of patients with RA have rheumatoid factors?
A
80%
16
Q
What does inflammation cause in RA?
A
Hemorrhage, coagulation, and fibrin deposits on synovial membrane.
17
Q
What is Pannus tissue?
A
Abnormal tissue layer within synovial membrane.
18
Q
What does the presence of pannus tissue lead to?
A
Greater loss of bone and cartiledge, and scar formation.
19
Q
What does atrophy mean?
A
Waste away due to lack of use
20
Q
What is the most common form of arthritis in older adults?
A
Osteoarthritis
21
Q
Which gender does RA typically affect more?
A
Women
22
Q
When will RA occur?
A
At any age.
Kids could go into remission and never get it again, adults will always have it, but can have “clinical remission”
23
Q
What is the age of typical onset of RA?
A
Between 40-60 years of old.
24
Q
When is RA remission most likely?
A
In the first year after DX
25
True or False.
| The cause of RA is unknown,
True
26
Which is more rehabilitating? Regular arthritis or RA?
RA
27
What are the risk factors of RA?
-FAmily history of RA
-Femal gender
-Obesity
-Heavy smokers
-Risk can be reduced IF smoking stops
(Just because you lower risk factors it doesn’t mean you will not get RA)
28
What are the clinical manifestations of RA?
- Joint deformity
| - Redness, warmth, pain, swelling of affected sites
29
What are the clinical manifestations of RA during the ACTIVE phase (when joint inflammation is active)?
- Fever
- Anorexia
- Fatigue
30
Why is RA described as a cyclical disease?
It has cycles of getting better and then worse,
31
How will the clinical manifestations of RA always present?
Bilaterally and symmetrical. (Although they may be in different stages)
32
What are signs of onset joint manifestations in RA?
- Usually insidious
- Possibly acute, following a stressor
- Possibly following systemic manifestations of inflammation
- Polyarticular, symmetrical
- The development rate can fluctuate
- Stiffness
- Skin over affected joint may be red and shiny.
33
What does polyarticular mean?
Affects many joints.
34
How is stiffness in the onset of joint manifestations described?
More stiff in morning, lasting more than 1 hour.
May occur with prolonged rest during the day.
May get worse after strenuous activity.
35
What are the joint manifestations of RA in the hands and fingers?
- Ulnar deviation (any change in the wrist)
- Boutonnière deformity (large nodules)
- Swan neck deformity (one hyperextended joint and one flexed joint)
36
Wrist involvement in RA is nearly what?
Universal. (Wrist is almost always involved)
37
What are the joint manifestations in knees?
Visible swelling, instability, atrophy in the quads (not bending knees anymore)
38
What can you test for to check for RA?
An significantly elevated erythocyte sendimentation rate (ESR) and elevated amount of C-reactive proteins (CRP) on blood test.
39
What are the joint manifestations in the ankles and feet?
Ambulation is limited due to pain and deformities.
- subluxation (incomplete or partial dislocation of joint)
- hallux valgas (bunion)
- lateral deviation of the toes
40
What are the joint manifestations of the spine?
Usually limited to the cervical vertebrae and neurological complications.
41
What are the extra articular manifestations of RA?
- Systemic disease
- Anemia of chronic disease (resistance to IRON therapy)
- skeletal muscle atrophy (from disuse)
- rheumatoid nodules
- not an exhaustiive list
42
What is resistance to iron therapy?
Bone marrow not taking in iron, therefore wont be making RBCs
43
What are systemic affects of rheumatoid arthritis?
- fever, weight loss, fatigue
- enlargement of lymph nodes
- arteritis (inflammation of blood vessels)
- neuropathy
- scleritis (inflammation affecting white outer coating of the eye
- pericarditis (inflammation around heart muscle)
- splenomegaly (enlarged spleen)
- sjogren’s syndrome (DRY eyes, mouth, vagina)
- raynauds syndrome (narrowing of small arteries, limiting blood flow to fingers and toes)
44
How does RA increase risk of coronary heart disease?
- RA has direct affects on blood vessels.
- increased risk for Low LDLs, High cholesterol and triglycerides, HTN, High homocysteine levels
- many RA drugs have damaging side effects: methotrexaide is a cancer drug (kills good and bad cells)
45
How is juvenile idopathic arthritis described?
- Chronic inflammatory autoimmune disorder
- similar to RA but diagnosed in children
- a little more prevelant in girls then boys
- characterized by pain and joint inflammation
- treatment similar to RA in adults
- may be chronic OR may involve remission
46
What percentage of those diagnosed with juvenile idiopathic arthritis will go into remission?
70%
47
How many of 1000 children will develop juvenile idiopathic arthritis?
One.
48
What are the complications for juvenile idiopathic arthritis?
- eye chronic uveitis (inflammation of the middle layer of the eye)
- interference with normal growth
- bone growth disturbances
49
When could juvenile idiopathic arthritis begin in children?
In preschool or puberty
50
What can be used to help treat pain and inflammation in children as long as there is no evidence of the flu or chicken pox?
Aspirin. (Per MD order)
51
What are the goals for RA treatment?
Relieve manifestations, interdisciplinary approach that includes a balance of rest and exercise, PT, and suppression of inflammation, joint replacement or joint infusion.
52
What is Anti-CCP?
An autoantibody produced by the body’s immune system that attacks the body
53
What are the dx tests for RA?
- CBC
- rheumatoid factor
- ESR
- CRP
- Anti-CCP
- synovial fluid examination
- antinuclear antibody (ANA)
- complement levels
- X-rays of joints affected
54
What are the results of a synovial fluid examination of a healthy person?
Yellow, clear.
55
What are the results of a synovial fluid examination of a RA patient?
Yellow, cloudy.
56
American college of Rheumatology: 4 of 7.
If patient has 4 of these 7 they have RA.
57
What are the 7 things on the 4 for 7 test?
- morning stiffness greater then one hr
- arthritis of >three joint areas
- arthritis of hand joints
- rheumatoid nodules (on body prominence)
- symmetric arthritis
- Positive rheumatoid factor
- radiographic changes
58
What is a DMARD?
Disease modifying antirheumatic drugs
59
What does a DMARD do?
Blocks inflammation and slows progression of disease. Reduces damage to bone and cartiledge.
60
When should you use DMARDS?
Within first 2 yrs of diagnosis.
61
What are the 4 types of meds for RA?
- DMARDS
- NSAIDs, ASA, COX-2 inhibitors
- Corticosteroids
- Antidepressants
62
What are the 3 types of DMARD drugs?
- Antimalarials, gold
- Immunosuppressors
- Bilogic response modifiers
63
Other than RA, what is methotraxaide given for?
Abortion. :(
64
When you discontinue DMARDS what will happen?
Rebound flare-ups.
65
DMARD antimalarial MOA?
Relieves severe inflammation
66
DMARD antimalarial Contraindications?
Hepatic or renal disease, alcoholism
67
DMARD antimalarial AE?
- retinopathy
- anorexia
- GI disturbances
- loss of hair
- agranulocytes
- unusual skin pigmentation
- thrombocytopenia
68
When will the benefits to taking antimalarials finally show up?
By 6 months.
69
How often do you take an antimalarial?
Weekly
70
DMARD - immunosuppressor: Methotrexate MOA?
Immunosuppressor and antimitotic (prevents breakdown of cells)
71
DMARD - immunosuppressor: methotrexate Contraindications?
- hepatic and renal disease
- infections
- Blood dyscrasias
- very young
- very old
72
DMARD - immunosuppressor: methotrexate AE?
- hepatotoxicity
- bone marrow suppression
- malaise
- fetal defects (X)
- infections
- sudden death
73
What should you not take with methotrexate?
Vitamins with folic acid, PPI
| Decreases clearance, causes build up of drug, Folic acid - reduces effectiveness
74
What is important to get and monitor with methotrexate?
CBC, Liver and kidney function tests
75
True or false.
| It is important to stay well hydrated when on methotrexate.
True.
76
DMARD - Bilogic response modifier drug?
Adalimumab
77
DMARD - Adalimumab MOA?
Inhibits tumor necrosis factor which is a cytokine, thereby blocking the normal inflammatory and immune response controlled by TNF
78
DMARD - Adalimumab Contraindications?
Active infection, neoplasticism disease,
| CV disease, neuro disease, active or latent TB
79
DMARD - Adalimumab AE?
Infections, fatigue, HTN, injection site irritation
80
What should you NEVER give with Adalimumab?
LIve vaccines.
81
How often do you take Adalimumab?
Weekly.
82
How long until you see effects of taking Adalimumab?
12 weeks.
83
COX - 2 (celecoxib) MOA?
No inhibition of COX-1; inhibits prostglandin synthesis by inhibiting COX-2.
84
Celecoxib Contraindications?
Advanced renal disease, hepatic failure, anemia, GI bleed
85
Celecoxib AE?
CV events, dizziness, sinusitis, edema, nausea, flatulence, diarrhea, rash
86
Celecoxib special considerations include?
Monitoring for fluid retention(HTN and CHF); black tarry stools
Monitor CBC, LFT, BUN, creatinine
87
Systemic Corticosteroid - prednisone MOA?
Suppress histamine and prostglandins; immunosuppressant and anti inflammatory
88
Systemic corticosteroid - Prednisone contraindications?
Systemic infections, cataracts, peptic ulcer disease, osteoporosis, HTN, Renal disease.
89
Should prednisone be given with food?
Yes.
90
Why should you never abruptly withdraw corticosteroids?
While on the steroid, the adrenal gland has basically gone to sleep, you need to give them time to “wake up” and recover
91
Do steroids raise or lower blood sugar?
Raise
92
COX - 2 inhibitors increase risk of?
Heart attack or stroke.
93
Systemic corticosteroids - prednisone serious AE?
Suppression of adrenal gland function, hyperglycemia, Cushing syndrome, mood changes, cataracts, peptic ulcers, hypokalemia, osteoporosis
94
What can systemic corticosteroids like prednisone mask?
Infections. (Creates potential for existing infections to grow rapidly and undetected)
95
What are some nonpharmacologic therapies for RA?
- rest and exercise
- physical and occupational therapy
- heat and cold therapy
- orthotic and assistive devices
- nutrition
- plasmapheresis and irradiation
96
What is plasmapheresis?
A process that filters the blood and removes harmful antibodies.
97
What are some complementary and Alternative therapies for RA?
- Acupuncture
- hydrotherapy
- nutritional supplements: like fish oils
- non traditional treatments such as diets, hormones, and plant extracts (costly and not shown to be effective.
98
Assessment for RA includes?
- healthy history, pain, stiffness, fatigue, joint problems, fever, sleep patterns, past illnessses, surgery, ability to carry out ADLs, physical assessment, height, weight, gait, joints, skin, respiratory, cardiovascular
99
DX for RA?
- Chronic Pain
- Fatigue
- Ineffective role performance
- Disturbed body image
- impaired physical mobility
- Anxiety
- Activity intolerance
- Knowledge deficit
