Rhuematoid Athritis

Question 1

What is it

Answer 1

chronic systemic imflammed joints (synovial joint) autoimmune
remission and exacerbation
usually small joints then progress
rapidly progress

Question 2

Who is at risk 5

Answer 2

women more than men
20-50 years
genetic
Epstein BARR 
Stress

Question 3

Clinical manifestations 6

Answer 3

pain- Early AM pain last 30-40 min
swelling
erythema
warmth (spongy tissue)
immolized in active inflamm (extended time lead to contractr)
Raynauds phenom- white red blanching of hands

Question 4

How onset of sympt occur 3

Answer 4

usually acute bilateral and symetrical

Question 5

How would rheumatoid nodule RA

Answer 5

non tender
movable in SQ tissue
dissapear spontaneously

Question 6

SS in articular systemic disease 4

Answer 6

fever
wt loss
anemia
lymph node enlargemnt

Question 7

SS articular disease 5

Answer 7

neuropathy 
scelritis
pericarditis
splenomegaly (lungs heart skin)
Sjorgrens syndrome (dry eyes dry mm )

Question 8

Lab finding RA 4 and result meaning

Answer 8

Rhuematoif functn- (not diagnostic/ not r/o) higher titers can correlate c disease
ESR- significanly elevated
ANA- antinucl- positive (produced against own DNA)
Athrocentesis- cloudy milky yellow leukocytes synovial fluid
Minocycline- atbx-

Question 9

EARLY Managemnt RA 5

goal relieve pain perserve joint fxn

Answer 9

education and sppt- arthritis found.
alternate rest activity
ASA or NSAID- inflamm and pain
IM injectn GOLD 
DMARDS

Question 10

ASA implent 5
how to take it
adverse rx
watch for

Answer 10

take c milk or food
4-6 hrs apart maintain blood levels - may need 12 a day
Adverse Rx- tinnitus (toxic), GI upset and bleed,
may need enteric coating
watch for blood in stool

Question 11

NSAIDs implnt 3
med name
Se- 5
Contraindic.

Answer 11

cx-2 inhibitors celebrex
cannot take if allrgc to other NSAID
SE- GI bleed, abd pain, black tarry stool (upper bleed), sudden wt gain , edema
CAn affect kidney or liver

Question 12

DMARDS
meds 2
teachings
PC

Answer 12

antirheumatic drugs improve quality life and decr pain
IT IS STANDARD TREATMENT
methotrexate
Hydrochloroquine (safetest DMARD but rental damage )
take > 3mo of onset
eye checks q 6-12 mo
PC- more infect bc its immunosuppressant

Question 13

Moderate errosive disease RA moderate 6

4 additional meds

Answer 13

in adittion to early tx 
PT
Other DMARDS- cyclosporine (imune modulat)added to methotr. 
Sulfasalazine, luflunomide, azathiopride
Biological response modifiers

Question 14

Sulfasal, luflunomide, azathiopride
PC
4 side effects

Answer 14

PC immunosupp incr risk for infection

SE- N/V/D anorexia headache

Question 15

Azothioprine (imuran)

PC 3

Answer 15

hepatoxic and hematoxic
thrombocytopenia- platelet low
anemia
leukopenia low wbc

Question 16

Biological Response Modif. 
meds 3 how to give
function
SE
Contraindication
good for

Answer 16

adalimamab and etanerecpt (sq inj x wk),
, infliximab (weekly at first then q 6-8 wks)
blocks protein (TNF) they have too much
slows damage and progression RA pts poor response to DMARDS
Se- serious infn
Contraindicated c hx of TB or LUPUS
expensive

Question 17

Persistant erosive RA

5

Answer 17

Steriods- unrelieved inflammation or bridge until other meds work- may have to give inj in joint if PO not wrk
steriods also incr risk of osteporosis and fxr (2-5x)
not give for immun systm

Question 18

Surgery for persistant erosive 4

Answer 18

synovectomy
arthridesis- fusion of joint element joint all togethr
arthroplasty- repair
Tennorrhaphy- suture tendon if ruptures

Question 19

Advnace unremiting disease

PC

Answer 19

Immunosuppres meds
hi dose for DMARD- other methitrexate cyclosporin
(watch for bone marrow suppr anermia GI rash)
prosbra
apheresis
Rixutan

Question 20

Most common problems for RA pts 6 and how to fx them

Answer 20

pain- analgesics hot wax or cold. meds before get up in am
morningn stiffness hot shower
sleep disturbance- short term low dose Evil paxil ZOLoft, dont sleep in recliner
altered mood
limited mobility- exercise EXTENSION
nutritional- anorexia wt loss anemia
fatique- rest period

Question 21

Diet for RA pts 2

Answer 21

fish oil , flaxseed - may need to decrease doses for these

Question 22

Avoid contractions 3

Answer 22

no pillows under knees or large pill on head bc get still too wuck
prone position at times