T2 - Arthritis, SLE, Gout (Josh) Flashcards
Rheumatology is the study of CTD. What is CTD?
Connective Tissue Disease (CTD)
Arthritis can be inflammatory and non-inflammatory. Name which is which.
Osteoarthritis (non-inflammatory)
Rheumatoid (inflammatory)
— — is any disease or condition that involves the musculoskeletal system.
Rheumatic Disease
— is the inflammation of one or more joints.
NOTE: there is a type that is NOT inflammatory. Name it.
Arthritis
osteoarthritis is NOT inflammatory
— is not systemic and not autoimmune.
— is an autoimmune disorder.
Osteoarthritis
Rheumatoid
What is the most common arthritis type?
Osteoarthritis (OA)
Features of OA:
- Progressive loss of —
- Bone spures (aka: —)
- Cartilage — and bone and cartilage float into joint causing —
cartilage
osteophytes
disentegrates, crepitus
What is another name of Osteoarthritis (OA)?
Degenerative Joint Disease (DJD)
OA:
What are Heberden’s Nodes and Bouchard’s Nodes?
Heberden’s Nodes:
- only at distal portion
Bouchard’s Nodes:
- more proximal
B is closer to the beginning than H
What are the Primary Risk Factors for OA?
Aging
Genetic Changes
FEMALE
What are the SECONDARY Risk Factors for OA?
Joint Trauma
Joint Sepsis
Smoking
Obesity
DM
Paget’s Disease
Sickle Cell Disease
Labs for OA:
What will ESR look like?
What will hsCRP look like?
ESR - slightly elevated when you have associated effusion of joint but majority of time NOT elevated
hsCRP - ibid
Meds for OA:
Why are Cox-2 Inhibitors NOT used?
they are associated with risk of cardiac death
Meds for OA:
What is DOC?
What labs should we monitor?
Acetaminophen
monitor liver function
Meds for OA:
If using NSAIDs, what do we monitor for?
GI bleeds
Meds for OA:
What are some topical meds?
Lidocaine Patches
Trolamine Salicylate
Capsaicin (made from peppers)
Buspirone
Meds for OA:
What are some injections?
Cortisone
Hyaluronic Acid (made from chicken comb)
Meds for OA:
What do we need to teach before injecting Hyaluronic Acid?
are they allergic to eggs, birds, or feathers?
Meds for OA:
What do we need to teach before applying a Capsaicin lotion?
wear gloves because it’s made from hot peppers
Meds for OA:
— does NOT provide anti-inflammatory benefits, so it’s only really good for OA.
Acetaminophen
Meds for OA:
What is Glucosamine
naturally occuring chemical involved in the makeup of cartilage and is believed to aid in the synthesis of synovial fluid and rebuild cartilage
May also decrease the cells that cause inflammation
Meds for OA:
What do we teach regarding Glucosamine?
causes mild GI upset (nausea, heartburn)
use with caution if allergic to SHELLFISH
question clients about use of chondroitin, NSAIDs, heparin and warfarin
Surgery for OA:
— is diagnostic joint examination and must be able to move the knee — degrees.
Antroscopy
45
Surgery for OA:
— is joint replacement
Arthoplasty
ex: TJA (Total Joint Arthoplasty) and THA (Total Hip Arthoplasty)
It is important to prevent infection before joint surgery because it’s a hard infection to treat.
What should we counsel client?
have dental procedures BEFORE surgery
take antisceptic shower night before
To prevent anemia from blood loss related to surgery, what options does client have?
Autologous blood banked
Epoetin Alfa for several weeks prior
Postoperative Care (OA):
What is CFNB?
Continuous Femoral Nerve Blockade (CFNB)
- involves a catheter in femoral vein with constant infusion of meds
Postoperative Care (OA):
What can we do to prevent hip dislocation (subluxation)?
an abduction pillow to prevent INTERNAL ROTATION of leg
RA:
In most cases, inflammation associated with RA will by —-, whereas OA is —
symmetrical (both sides)
non-symmetrical (on only one side)
RA:
What is the patho of RA?
Transformed anutoantibodies (rheumatoid factors) form, attacking healthy tissue, causing inflammation
RA:
What are the risk factors?
FEMALE (3:1 ratio)
ages 20 - 50
Epstein-Barr Virus
Stress
Environmental Factors
What is a reason that RA may go undiagnosed for a while?
early signs of RA (fatigue, joint discomfort) are vague and may be attributed to other disorders in older adult clients
RA:
What are the EARLY signs of RA?
LATE?
Early:
- joint stiffness
- swelling
- pain
- fatigue
- generalized weakness
Late:
- joints become progressively inflamed and painful
RA:
What are some systemic complications of RA?
Weight loss, fever, and extreme fatigue
Exacerbations of RA
Subq Nodules
Resp and Cardiac complications
Eye Problems
Vasculitis
Periungual Lesions
Parestesias
Lymph Node enlargement
RA:
What are the eye problems associated with RA?
Iritis
Scleritis
RA:
What are the Subq Nodules associated with RA?
nodules found on Ulnar surface of arm, fingers or Achilles Tendon
RA:
What are the Periungual Lesions associated with RA?
small brownish spots around the fingernails
RA:
What are some syndromes associated with RA?
Sjogren’s Syndrome
Secondary Osteoporosis
Felty’s Syndrome
Caplan’s Syndrome
RA:
Which RA-associated Syndromes are the following:
- Dry eyes, dry mouth, dry vagina
- RA, hepatosplenomegaly, leukopenia
- RA nodules in lungs and pneumoconiosis
Sjogren’s Syndrome
Felty’s Syndrome
Caplan’s Syndrome
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