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NURS 2514 > Week 10 - Rheumatoid Arthritis > Flashcards

Week 10 - Rheumatoid Arthritis Flashcards

1
Q

what is rheumatoid arthritis

A
  • chronic, systemic autoimmune disease

- characterized by inflammation of CT in synovial joints

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2
Q

what are risk factors of RA (6)

A
  • can occur at any age, but more common in 60+
  • female
  • genetic
  • smoking
  • obesity
  • stress
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3
Q

what types of stress might contribute to RA (5)

A
  • recent infection
  • surgery
  • childbirth
  • emotional upset
  • oevrwork
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4
Q

what is the cause of RA (2)

A
  • unknown

- genetic factors (most)

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5
Q

describe the genetic component of RA

A
  • most people w RA have a circulating antibody called “rheumatoid factor”
  • RF binds to other antibodies (IgG) and can form immune complexes which become trapped in the joints & removed by the inflammatory response
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6
Q

what is RA cause by RF called

A
  • seropositive arthritis
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7
Q

what 4 things does the inflammatory response during RA lead to

A
  • enzymatic breakdown of cartilage & subchondrial bone
  • synovial angiogenesis
  • synovial cell proliferation
  • pannus formation
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8
Q

what is synovial angiogenesis

A
  • new blood vessels growing into the synovium
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9
Q

what is pannus formation

A
  • abnormal tissue growth in the joints
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10
Q

what causes pannus formation

A
  • the synovial angiogenesis & proliferation makes the blood thick, rough, and irregular = pannus formation
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11
Q

what symptoms does RA begin with (4)

A

generalized symptoms

  • fever
  • fatigue
  • anorexia
  • weight loss
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12
Q

what happens as the disease progresses regarding symptoms

A
  • they become more localized to joints
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13
Q

what are the acute symptoms of RA that are localized to the joints (4)

A
  • bilateral inflammation
  • stiffness
  • pain/aching
  • limited ROM
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14
Q

what are signs of inflammation during RA (4)

A
  • redness
  • heat
  • swelling
  • tenderness
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15
Q

what makes the pain worse in RA

A
  • activity
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16
Q

where does RA commonly effect (5)

A
  • proximal interphalangeal joint (PIP) & metocarpalphalangeal joint (MCP) hands)
  • wrists
  • knees
  • feet
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17
Q

describe the stiffness in RA

A
  • morning stiffness can last anywhere from 1 hr - several hours
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18
Q

what are acute manifestations of RA characterized by

A
  • exacerbations & remission
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19
Q

what 2 other manifestations occur w acute RA

A
  • vasculitis

- rheumatic nodules

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20
Q

what are rheumatic nodules

A
  • lesions at pressure points
21
Q

what are chronic manifestations of RA (3)

A
  • subluxation of joints (dislocation)
  • muscle wasting
  • deterioration of tendons & ligaments
22
Q

what does the deterioration of tendons and ligaments lead to (2)

A
  • joint instability

- deformity

23
Q

what are 4 types of joint deformitys that can occur w RA

A
  • ulnar drift
  • boutonniere deformity
  • hallux valgus
  • swan-neck deformity
24
Q

what is ulnar drift

A
  • fingers drift towards the ulna
25
Q

what is boutonnier deformity

A
  • called “hitch hikers thumb” if it occurs in the thumb

- flexion of the fingers at the PIP joint, where they can not straighten out

26
Q

what is hallux valgus

A
  • drifting of the big toe laterally
27
Q

what is swan-neck deformity

A
  • binding at base of the finger, hyperextension of PIP joints, with flexion of the DIP
    (i recommend looking up a picture)
28
Q

what are ways to diagnose RA

A
  • history
  • physical findings
  • positive RF
  • elevations in ESR and c-reactive protein
29
Q

what do elevation in ESR and c-reactive protein indicate

A
  • inflammation
30
Q

what are complications of RA (6)

A
  • joint destruction
  • flexion contractures & hand deformities
  • nodular myositits
  • muscle fiber degeneration
  • cataracts & loss of vision
  • later, cardiopulmonary effects
31
Q

what are 4 types of treatments for RA

A
  • NSAIDs
  • glucocorticoids
  • DMARDS
  • TNF antagonists
32
Q

what are DMARDS

A
  • disease modifying antirheumatic drugs
33
Q

what is a type of non-biologic DMARD used for RA

A
  • methotrexate
34
Q

what is the MOA of methotrexate

A
  • causes immunosuppression

- reduced activity of B and T lymphocytes that are attacking the joints

35
Q

describe the effectiveness & onset of methotrextate

A
  • fastest acting DMARD (works in 3-6 weeks)

- 80% will improve w this drug

36
Q

what should be taken w methotrextae? why (2)

A
  • folic acid

- to reduce GI and liver toxity

37
Q

what is a contraindication for methotrexate

A
  • highly teratogenic
38
Q

what are s/e of methotrexate (5)

A

serious toxicities of the:

  • GI tract
  • bone marrow
  • liver
  • lungs
  • kidneys
39
Q

what should be monitored during treatment of RA with methotrexate

A
  • LFTs (liver fnxn test)
  • renal function test
  • CBC
40
Q

what are TNF antagonists

A

tumor necrotic factor antagonists

41
Q

what is one type of TNF antagonist used for RA

A
  • infliximab
42
Q

what is infliximab r/t DMARDs? what does this mean?

A

biologic DMARD

= targets specific cellular components of the inflammatory process

43
Q

what is the MOA of infliximab

A
  • antibody that binds to & neutralizes TNF
44
Q

what is infliximab often given with? how is it adminsitered?

A
  • often w methotreate but can be alone

- given IV

45
Q

what are 2 main side effects of infliximab

A
  • immune suppression

- infusion rxn

46
Q

what should you monitor regarding the s/e of immunosuppression w infliximab

A
  • increased risk of infection

- dose should be held iif acute infection is present

47
Q

what are signs of an infusion rxn (5)

A
  • flu-like symptom
  • headache
  • fever
  • GI disturbances
  • hypotension
48
Q

what can you use to treat the infusion rxn

A
  • tylenol

- antihistamine

NURS 2514 (75 decks)

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