Rheumatoid Diseases

Question 1

Complex Regional Pain Syndrome

• key symptoms
• etiology

Answer 1

1 - Continuous, severe pain out of proportion and which worsens over time

Other symptoms: intense burning or hot pain, joint stiffness/inflammation, motor dysfunction, skin hypersensitivity, altered skin temperature, changes in skin color, texture or hair/nail growth

Etiology: CNS or PNS dysfunction
CRPS I - no underlying nerve injury
CRPS II - known nerve injury

Question 2

Stages of CRPS

Answer 2

Stage I - 1-3 months: severe pain, muscle spasm, joint stiffness, EXCESSIVE hair growth, skin color & temperature change

Stage II - 3-6months: pain intensifies, swelling, DECREASED hair growth, nail changes, osteomalacia, hypotonia

Stage III - >6 months: changes to skin and bone become IRREVERSIBLE, intractable pain, atrophy, joint deformity

Question 3

Juvenile Rheumatoid Arthritis

• age of onset
• etiology
• 3 types
• diagnosis & symptoms

Answer 3

RA onset at or prior to age 16

Unknown etiology

3 types:

1. Pauciarticular - 4 or fewer joints affected
2. Polyarticular - 5+ joints affected
3. Systemic or Stills disease - inflammation outside the joints, usually accompanied by fever or rash

Diagnosis: no single test
Symptoms: arthritis, fever, rash, fatigue, anemia, loss of apetite, irritability, reduced mobility

Question 4

Ankylosing Spondylitis

• what is it
• etiology
• symptoms
• treatment focus

Answer 4

Inflammatory disease of axial skeleton w/ flares & remission:
Inflammation –> erosion –> healing = bony fusion

Unknown etiology, males > females

Symptoms: back pain & morning stiffness >60min

• onset at SI joint w/ ascending pattern
• fever, fatigue, anemia, weight loss

Treatment focus: pain relief, preservation of ROM & correction/prevention of deformities

Question 5

Systemic Lupus Erythematosus

• what is it
• diagnosis/symptoms
• treatment focus

Answer 5

Autoimmune connective tissue disorder (body’s immune cells attacks the bodies tissues - heart, lungs, kidneys, etc) that is most common in women of childbearing age; this disease is chronic w/ cycling of exacerbations/remission

Diagnosed based on clinical findings and ANA+
Symptoms:
- photosensitive malar rash
-arthritis
- anemia, leukopenia, thrombocytopenia
- cardiopulmonary manisfestations

Treatment focus: early ID of flares and reversal of inflammation, prevention of organ complications
**RENAL failure most concerning so aggressive treatment of HTN and renal dysfunction

Question 6

Scleroderma

• what is it
• symptoms
• treatment focus

Answer 6

Inflammation, degeneration and fibrosis of the skin, vasculature, joints and tendons, muscle GI tract, lung, heart & kidneys

Symptoms: swelling and cyanosis of fingers, Raynauds, heartburn, myositis, and arthritis

Treatment focus: treat the symptoms b/c no cure
- NSAIDS, immunosuppressants, corticosteroids, anticoagulants, anti-hypertensives

Question 7

Reactive/Infectious Arthritis

• what is it
• risk factors
• diagnosis
• treatment

Answer 7

Infection of a joint by bacterial (gram +), fungal or viral agents; usually monoarticular
- major concern w/ joint replacements

Risk factors:
- known infection, very old or young age, another systemic disease, recent invasive procedure, prosthetic joint, immunosuppression, IV drug use

Early diagnosis is imperative!
- arthrocentesis, blood culture or bone scan

Treatment: joint aspiration or surgical drainage, antibiotic coverage, maintain/preserve ROM and strength

Question 8

Gout

• what is it
• what does it generally affect
• results from?
• treatment

Answer 8

Elevated uric acid levels that result in deposition of monosodium urate crystals (the crystals must be present for diagnosis)

Affects MTP of great toe

May result from: diuretic, aspirin, cyclosporine, renal insufficiency, enzymatic abnormalities, alcoholism

Treatment: rest, NSAIDS, corticosteroids

Question 9

Polymyalgia Rheumatica

• what is it
• characterized by
• diagnosis
• treatment

Answer 9

Systemic inflammatory disease in those > 50y/o

Characterized by:
-malaise and fatigue, fever, anorexia, weight loss, chronic and symmetrical aching of proximal muscles and joints, prominent neck shoulder and pelvis (worse in morning)

Diagnosis: elevation in ESR and exclusion of neoplasm, infection, muscle disease

Treatment: corticosteroid will provide IMMEDIATE relief….. if not then its something else