Test 3 Part 1 Flashcards
________________ is an autoimmune mediate systemic inflammatory disease with primary presentation of pain and disability associated with destruction of synovial joints
RA
what sex is affected more by RA?
Female 3x
this disease is characterized by morning stiffness that improves over the course of the day
RA
RA disease progression leads to
- destruction of cartilage
- periarticular osteopenia with pull off of ligamentous insertions –> deformities and instability
how do B lymphocytes and cytokines play a role in rheumatoid arthritis?
- activated endothelial cells attract molecules that stimulate T and B cells
- B cells produce autoantibodies (rheumatoid factor) –> enhanced cytokine production
- cytokines (TNF, IL1, and IL6) are released and accelerate the inflammatory cascade
questions you want to ask if patient presents with RA
- age of onset?
- recent hospitalizations?
- location and severity of joint dysfunction?
- Exacerbation triggers
- Current meds?
when assessing pt with RA, you ask about location and severity of joint dysfunction, what are parts of this specific assessment that you should pay close attention to as an anesthesia provider?
neck stiffness
crepitus
hoarseness
with RA the joints of the ____________ and _______________ are affected first; however the _____________ is the most common joint involved in the lower extremity
hand; wrists; knee
supportive treatment of RA includes
physical therapy
exercise
analgesics
anti-inflammatories
steroids
________________ are drugs that are used with RA to slow the progression and prevent deformities
disease-modifying antirheumatic drugs (DMARDs)
based on pathology of RA, what airway issues should you expect?
- tempromandibular joint disease and limited mouth opening
- arytenoid disease with deformity obstructing the glottic opening
- sjogrens is common –> poor dentition
- cervical spine stiffness
- vocal cord dysfunction
what are the four main features of cervical spine involement you may see/anticipate in someone with RA?
- atlantoaxial instability
- pannus –> mass effect on spinal canal
- ondontoid of C1 going into foramen magnum
- ankylosis with fusion of entire cervical spine
if patient with RA has ankylosis with fusion of the entire cervical spine; how would you intubate them?
in a neutral position with video laryngoscopy or awake/asleep video bronchoscopy
T/F: a patient with RA does not have any symptoms of spinal cord compression, therefore there is probably not any secondary to their disease
false; degree of compression may not correlate with patients symptoms
you have a patient who has had RA for 25 years, the surgery they are having will require manipulation of the neck through positioning and intubation. What should you ensure is done preoperatively?
lateral flexion and extension cervical spine radiographs (x-ray)
what labs would you consider in someone with RA?
CBC with plt
Renal fx test
what specific renal fx test would you do for someone with RA with chronic NSAID use?
creatinine
DMARDs for RA may cause a patient to be ______________________
neutropenic
what pulmonary tests would you consider in a patient with RA
PFT have secondary restrictive disease
what cardiovascular tests would you perfrom on a pt with RA
EKG
possible echo
possible stress test
T/F: if pt with RA comes into preop for elective surgery, and they are telling you their RA is really flaring up this morning, it would be best to delay
true
anesthesia considerations for the patient with RA
- difficult airway
- positioning concerns/risk of fractures
- regional anesthesia: peripheral nerve blocks okay, but challanging to do neuraxial block
sx of RA
1.malaise, weight loss, fever, fatigue
symmetry
2.polyarthropathy: TMj, limited jaw mobility, hoarseness, multijoint inflammation with morning stiffness
3. peripheral neuropathy/nerve entrapment
4. renal vasculitis
5. pancytopenia
what disease is defined as a chronic progressive disease of the joints of the spine and thorax that starts in early adulthood with inflammation of the sacroiliac joints and progresses cephalad eventually involving entire spinal column and ribcage
ankylosing spondylitis