Rheumatoid & Similar Diseases Flashcards
Q: How many rheumatoid diseases exist?
More than 100 have been identified
Q: What is the prevalence of rheumatoid disease in the US?
46 million
Defn: Complex Regional Pain Syndrome
Continuous severe pain out of proportion to injury and which worsens over time due to CNS/PNS dysfunction
Q: What is the difference between CRPS 1 and CRPS 2?
1 = no underlying nerve injury
2 = known nerve injury
Q: Who is CRPS more common in?
Young women
Symptoms: CRPS (6)
- Intense burning or hot pain
- Joint stiffness/inflammation
- Motor dysfunction
- Skin hypersenstivity
- Altered skin temp, color, texture
- Changes in nail/hair growth
Content: CRPS Stage 1 (5)
- 1-3 months
- Severe pain
- Muscle spasm and joint stiffness
- Excessive hair growth
- Skin color and temperature changes
Content: CRPS Stage 2 (6)
- 3-6 months
- Pain intensifies
- Swelling
- Decreased hair growth
- Nail Changes
- Osteomalacia and hypotonia
Content: CRPS Stage 3 (5)
- > 6 months
- Changes in skin and bone become irreversible
- Intractable pain
- Atrophy
- Joint Deformity
Content: Juvenile Rheumatoid Arthritis (3)
- Unusual but most common form of arthritis in children
- Onset prior to age 16
- Unknown etiology (genetic vs. environmental factors)
Content: 3 Types of JRA
- Pauciarticular (40-50%)
- Polyarticular (30%)
- Systemic or Still’s disease (20%)
Q: _________ and ___________ forms of JRA are commonly associated with ___________ which is asymptomatic but can cause permanent ________ loss if untreated.
Pauciarticular, polyarticular, iridocyclitis, visual
Q: How is the treatment course of JRA determined?
By disease activity in the first 6 months
Defn: Pauciarticular
Four or few joints affected, usually leg or jaw
Defn: Polyarticular
Five or more joints affected (can be as many as 40)
Defn: Systemic or Still’s Disease
Inflammation outside the joints (pericarditis, pleuritis, etc), usually accompanied by fever and rash
Content: Diagnosis of JRA (4)
- No single test, based on symptomology/clinical findings
- Symptoms can include arthritis, fever, rash, fatigue, anemia, loss appetite, irritability, reduced mobility
- RF and ANA may be negative or positive
- All forms can interfere with physical growth and cause joint deformity
T/F: Treatment and prognosis of JRA mirror adult disease.
True
Q: What percent of those JRA have complete remission.
50%
Defn: Ankylosing spondylitis
Inflammatory disease of the axial skeleton
Q: How does ankylosing spondylitis progress?
Onset at SI joint with ascending pattern
Inflammation > Erosion > Healing = bony fusion of fibrous ligaments
Q: What prevalence of ankylosing spondylitis?
1 in 1000, male > female
Symptoms: Ankylosing Spondylitis (4)
- Mild to Moderate flares and remissions
- Back pain and morning stiffness
- May be accompained by fever, fatigue, anemia, and/or weight loss
- Uveitis, valvular deficiencies, spinal cord compression are less common
Content: Treatment focus for Ankylosing Spondylitis (4)
- Pain relief
- Preservation of ROM
- Prevention
- Correction of deformity
Q: What other body system can ankylosing spondylitis effect?
Respiratory system
Defn: Systemic Lupus Erythematosus
Chronic autoimmune connective tissue disorder with cycling exacerbation and remission
Q: Who is Lupus most prevelant in?
Women of childbearing age
Symptoms: Lupus (6)
- Butterfly rash
- Arthritis
- Cortical and trabecular bone loss
- Anemia, leukopenia, thrombocytopenia
- Nephropathy
- Neuropsychiatric disorders
Content: Treatment of Lupus (3)
- Identify flares and reversal of inflammation
- Prevention of organ complications
- Aggressive treatment of HTN, renal dysfunction
Defn: Scleroderma
Inflammation, degernation, and fibrosis of skin, vasculature, joints and tendons, muscle, GI tract, lung, heart, and kidney
Q: Who is scleroderma more prevalent in?
females > males (4:1)
Symptoms: Scleroderma (5)
- Swelling and cyanosis of fingers
- Raynaud’s
- Heartburn
- Myositis
- Arthritis
T/F: Scleroderma and Lupus can be fatal
True
Q: What is the skin like in scleroderma? (3)
Fibrose, taut, and inflexible
T/F: Reactive or infectious arthritis is 80-90% polyarticular.
False, monoarticular
Q: What agents typically cause reactive/infection arthritis?
Gram positive aerobes
Content: Risk Factors for Reactive/Infectious Arthritis (6)
- Very old or young
- Presence of another systemic disease
- Recent invasive procedure
- Prosthetic joint
- Immunosuppression
- IV drug use
Q: How is reactive/infectious arthritis diagnosed (3)
- Arthrocentesis to rule out/in
- Blood culture
- Radiograph or joint scans
Content: Treatment of Reactive/Infectious Arthritis (4)
- Joint aspiration
- Antibiotic coverage
- Surgical drainage
- Maintain/preserve ROM and strength
Q: Who is gout more prevalent in?
Men (4:1)
Content: Causes of Gout (2)
- Elevated uric acid levels
- Depositions of monosodium urate (MSU) crystals
Content: Gout may result from… (5)
- Diuretic, aspirin, or cyclosporine use
- Renal insufficiency
- Enzymatic abnormalities
- Alcoholism
- Malnutrition
Q: What joint is most commonly affected by gout?
MTP of great toe
Content: Treatment of Gout (3)
Rest, NSAIDs, corticosteriods
Defn: Polymyalgia Rheumatica
Systemic inflammatory disease in those > 50 years
Symptoms: Polymyalgia Rheumatica (6)
- Malaise and fatigue
- Fever
- Anorexia
- Weight loss
- Chronic, symmetrical aching of proximal muscles and joints
- Prominent in neck, shoulders, and pelvis - worst in morning
Content: Diagnosis of Polymyalgia Rheumatica (4)
- Elevated ESR
- Exclusion of neoplasm
- Infection
- Muscle disease
