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24 Cards in this Set
- Front
- Back
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Pannus
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inflammed, new synovial tissue
grows irregularly and invades other tissue - destroying cartilage and bone releases cytokines, interleukins, proteinases, growth factor (TNF - tumor necrotizing factor) that further destroy the joint and cause systemic problems |
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Subluxation
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partial dislocation - one bone slips over another and eliminates the joint space
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Pathophysiology of Rheumatoid Arthritis
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1. Phagocytosis produces enzymes
2. Enzymes break down collagen 3. Causes edema, proliferation of the synovial membrane, and pannus formation 4. Pannus destroys cartilage and erodes bone 5. Loss of articular surgaces and joint motion 6. Muscle fibers degenerate, tendon and ligament elasticity and contractile power are lost |
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Swan Neck vs. Boutonniere Deformity
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Swan Neck: PIP extension, DIP flexion
Boutonniere: PIP flexion, DIP extension |
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How quickly does joint destruction occur with RA?
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Within weeks of onset of symptoms
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How is RA diagnosed?
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Clinical Diagnosis - labs done to confirm and track the disease process, but not diagnose
CBC w/ diff. = ACD (Anemia of Chronic Disease) Rheumatoid Factor = not specific or sensitive (positive in 3/4 of paitents) Anti CCP = anti-cyclic citrullinated peptide antibody High ESR and CRP (C-Reactive Protein) Baseline renal and hepatic tests |
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Criteria for Diagnosis of RA
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4 of 7 present for 6 weeks
1. morning stiffness (>1 hour) 2. arthritis of 3 or more joints 3. arthritis of hand joints 4. symmetric arthritis 5. rheumatoid nodules 6. + serum rheumatoid factors 7. radiographic changes |
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What diseases does RA put one at risk for developing?
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stroke (70% more likely)
serious infection (70%) non-hodgkin lymphoma (44%) cardiovascular (50%) 2 times more likely to have an MI lung cancer and pulmonary problems (40%) osteoporosis (increased) |
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DMARDS
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Disease Modifying Anti-Rheumatic Drugs
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Risk factors for Colorectal Cancer
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1. Increased Age
2. Family History (colon cancer or polyps) 3. Previous colon cancer or adenomatous polyps 4. High alcohol consumption 5. Cigarette smoking 6. Obesity 7. History of gastrectomy 8. History of IBD (Inflammatory Bowel Disease) 9. Diet: high fat, high protein (high beef), and low fiber 10. Genital or Breast Cancer in Women |
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Tenesmus
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Ineffective or painful straining during bowel movements
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Systemic Effects of RA
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Low Grade Fever
Anorexia Fatigue and Malaise Weight Loss Myalgia Actual Weakness |
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ACD
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Anemia of Chronic Disease
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CRP
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C-Reactive Protein: sign of inflammation
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Arthroplasty
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Joint Replacement
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Examples of Tradition DMARDs
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1. Antimalarials: Hydroxychlroquine (Plaquenil)
2. Sulfasalzine (Azulfidine) 3. Cyclosporin (Neoral) 4. Methotrexate (MTX) |
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What is the gold standard medication for RA treatment?
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Methotrexate (MTX)
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How long is the onset of action for Methotrexate?
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6-12 weeks
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Side Effects of Methotrexate
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nausea, fatigue, mucosal ulcers, hepatotoxicity, teratogenic
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What must Methotrexate be given with when treating RA?
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1mg/day folic acid
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Other names for the newer generation of DMARDs for RA
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Immunomodulators,
“Biologic Response Modifiers” |
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Major side effects of the newer generation of DMARDs
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increase infection, reactivate TB, increase malignancies
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Types of new generation DMARDs
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1. TNF-α Blockers (proinflammatory cytokine): etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira)
2. Interleukin-1 Receptor Antagonist: anakinra (Kineret) Very expensive > $15,000 year per pt Combined with MTX |
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How often do patients on newer DMARDs need lab work?
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Every 4-8 weeks
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