Ch 65: Osteoarthritis And Rheumatoid Arthritis

Front 1

OA is a disorder of the?

Back 1

Diarthrodial (synovial) joints

Front 2

True or False
OA is slowly progressive, non- inflammatory, and not systemic.

Back 2

True

Front 3

What was OA previously known as? why was it changed?

Back 3

- Degenerative joint disease
- Now known to involve the formation of new joint tissue in response to cartilage destruction

Front 4

What are the 2 types of OA? cause of each?

Back 4

- Idiopathic OA: cause unknown
- Secondary: caused by a known event or condition

Front 5

What are the risk factors of OA?

Back 5

- Growing older
- Gender
- Genetics
- Obesity
- Trauma
- Mechanical stress
- Joint instability
- Inflammation
- Skeletal deformaities
- Medications

Front 6

Relating to age and gender who is at risk for OA?

Back 6

- < 50 years: more common in men
- > 50 years: more common in women

Front 7

Why is it more common in women over 50?

Back 7

Estrogen production

Front 8

Essentially OA is?

Back 8

The progressive degeneration of joints that causes the formation of bony bulidup and the loss of articular cartilage

Front 9

What kind of joints does OA affect?

Back 9

Supporting

Front 10

Clinical manifestation of OA are?

Back 10

- Joint pain
- Increasing disability and loss of function
- Stiffness after rest periods that resolves in 30 mins
- Crepitus
- ASYMMETRICAL joint involvement
- Deformity
- Bony enlargement of some joints

Front 11

What is crepitus?

Back 11

Grating sensation caused by irregular and loose particles of cartilage in the joint

Front 12

OA joint pain increases with?

Back 12

- May increase with weather changes
- With joint use
- In advanced disease, pain is present at rest

Front 13

Joint deformities associated with OA?

Back 13

- Heberden's nodes
- Bouchard's nodes
- Knee malalignment due to cartilage loss

Front 14

True or False
Patient with OA can have serious deformities but not be in too much pain and vice versa.

Back 14

True

Front 15

Heberden's nodes are located?

Back 15

Distal finger joints

Front 16

Bouchard's nodes are located?

Back 16

Proximal finger joints

Front 17

What kinds of diagnostics are used to dx OA?

Back 17

- Bone scan
- CT scan
- MRI
- X ray ( used to confirm disease and monitor progression)

Front 18

What does the care of OA focus on?

Back 18

- Pain management
- Maintaining/ improving joint junction
- Prevention of disability

Front 19

What are some nursing interventions for a patient with OA?

Back 19

- Rest
- Joint immobilization
- Moderate exercise
- Nutritional support
- Application of heat or cold
- Acupuncture, yoga, massage
- Assistive devices

Front 20

What are the meds used for OA?

Back 20

- Acetaminophen (1000 mg q6hr, do not exceed 4 g/ day)
- Topical agents (Capsaicin)
- ASA
- NSAIDS
- Intraarticular injections of corticosteriods
- Intraarticular injections of Hyaluronic acid

Front 21

Hyaluronic acid is also called?

Back 21

Viscosupplemenation

Front 22

3 names of hyaluronic acid meds are?

Back 22

- Orthovisc
- Synvisc
- Hyalgan

Front 23

What are the nursing goals for a patient with OA?

Back 23

- Successful pain management through use of pharmacologic and non- pharmacologic ways
- Maintentance/ improvement of joint function
- Use of joint protection measures to improve activity
- Independence in self care activities

Front 24

True or False
RA is chronic, systemic, and inflammatory.

Back 24

True

Front 25

What is the cause of RA?

Back 25

Cause is unknown but autoimmune is the most widely accepted at the present

Front 26

In simple terms, what is the pathophysiology of RA?

Back 26

- The body' immune system attacks cells at the joint.
- Swelling occurs in the joint due to the inflammatory response.
- Synovitis occurs
- The synovial fluid thickens and forms an invasive pannus.
- The pannus then destroys cartilage and bone.

Front 27

What is a pannus?

Back 27

Highly vascular granulation tissue

Front 28

True or False
RA occurs symmetrically.

Back 28

True

Front 29

What are the criteria for classification of RA?

Back 29

- Morning stiffness lasting for at least one hour
- Swelling of 3 or more joints
- Hand joint involvment
- Symmetric swelling
- Rheumatoid nodules
- Serum rheumatoid factor positive
- Radiographic changes

Front 30

What 4 criteria for RA have to be present for 6 weeks before dx can be given?

Back 30

- Morning stiffness lasting for at least one hour
- Swelling of 3 or more joints
- Hand joint involvement
- Symmetric swelling

Front 31

RA S/S?

Back 31

- Fatigue and weakness
- Inflammation
- Joint stiffness after inactivity
- Pain and morning stiffness lasting longer than 60 minutes
- Joint deformities
- Decrease ROM

Front 32

What are the 3 extraarticular manifestations of RA?

Back 32

- Rheumatoid nodules
- Sjogren syndrome
- Felty syndrome

Front 33

Define Rheumatoid nodules

Back 33

- Firm, non tender nodules
- Usually over extensor surfaces of joints
- Can be anywhere, lungs, eyes, etc.

Front 34

Define Sjogren syndrome

Back 34

- Decreased lacrimal and salivary gland secretion
- 10- 15 % of patients

Front 35

Define Felty syndrome

Back 35

- Inflammatory eye disorders, splenomegaly, lymphadenopathy, pulmonary disease, and blood dyscrasias

Front 36

What are 3 lab tests used to dx RA?

Back 36

- Positive Rheumatoid Factor
- Anti- CCP Antibody
- ESR

Front 37

What is a Rheumatoid factor test? what does it show?

Back 37

- An antibody that activates the inflammatory processes within the body
- Titers generally rise during active disease
- May be misleading as other conditions also commonly present RF positive

Front 38

What is Anti- CCP Antibody test? what does it show?

Back 38

- New test, improvement over RF for the dx of RA
- Anti- cyclic citrullinated peptide antibody
- Particularly useful in evaluating early inflammatory arthritis

Front 39

What are the main therapeutic goals of RA?

Back 39

- Satisfactory pain relief
- Minimal loss of functional ability
- Patient participation in therapeutic regimen
- Maintenance of positive attitude

Front 40

True or False
Early dx of RA and treatment are imperative because irreversible joint damage can occur within the first year.

Back 40

False, occurs within the first 2 years

Front 41

What 5 types of meds are used for RA?

Back 41

- NSAIDS
- Salicylates (aspirin)
- Corticosteroids
- DMARDS
- Biologics

Front 42

True or False
For RA a combination of different types of drugs is most effective.

Back 42

True

Front 43

Why are NSAIDs used for RA?

Back 43

Antiinflammatory, analgesic, and antipyretic properties

Front 44

What is the difference with a selective NSAIDs?

Back 44

- Selectively blocks the COX- 2 pathway
- Does not block COX -1 so there should be no gastric irritation

Front 45

What is an example of a COX- 2 inhibitor used for RA?

Back 45

Celebrex

Front 46

What are DMRDs?

Back 46

- Disease modifying anti- rheumatic drugs
- slow acting
- Can diminsh progression of disease

Front 47

What are 3 examples of DMARDS?

Back 47

- Arava (leflunomide)
- Plaquenil (hydroxychloroquine)
- Rheumatrex (methotrexate)

Front 48

What was Plaquenil first used for?what can it cause?

Back 48

- Malaria
- Vision changes

Front 49

What DMARD is the initial one for most patients?

Back 49

Rheumatrex

Front 50

What are the side effects of Rheumatrex?

Back 50

- Depresses immune system
- Liver damage

Front 51

What are Biologics?

Back 51

- "Big guns"
- Biologic response modifiers
- Often combined with DMARDs to improve efficacy

Front 52

What are 2 examples of biologics?

Back 52

- Enbrel
- Humira

Front 53

What are some ways to preserve joint function in a patient with RA?

Back 53

- ROM exercises
- Alternate rest and activity
- May splint joints during acute inflammation
- Apply heat or cold
- Paraffin baths/ massage
- Relaxation techniques

Front 54

What are some complications associated with RA?

Back 54

- Contractures
- Cataracts
- Nodular ulceration leading to open wounds
- Fatigue: monitor for s/s of anemia
- Cardiopulmonary effects

Front 55

Exacerbations of RA are increased by?

Back 55

Physical and emotional stress

Front 56

What are some surgical interventions for RA? what do they do?

Back 56

- Synovectomy: surgical removal of the synovia to maintain joint function
- Arthrodesis: surgical fusion of a joint to attempt to relieve pain and stabilize the joint
- Arthroplasty: restores function

Front 57

OA or RA?
Involves only the joints

Back 57

OA

Front 58

OA or RA?
Stiffness lasts for 30 mins or less

Back 58

OA

Front 59

OA or RA?
Systemic disease

Back 59

RA

Front 60

OA or RA?
Pattern may be asymmetrical

Back 60

OA

Front 61

OA or RA?
Stiffness that lasts for 1 hr or more

Back 61

RA

Front 62

OA or RA?
Pattern is symmetrical

Back 62

RA

Front 63

OA or RA?
Metacarpal and proximal interphalanges joints

Back 63

RA

Front 64

OA or RA?
Heberden's and Bouchard's nodules

Back 64

OA

Front 65

OA or RA?
Bony enlargements of joints

Back 65

OA

Front 66

OA or RA?
Boutonniere and Swan neck deformities

Back 66

RA

Front 67

OA or RA?
Distal and proximal interphalanges joints

Back 67

OA

Front 68

OA or RA?
Treatment involves managing symptoms

Back 68

OA

Front 69

OA or RA?
Swollen joints

Back 69

RA

Front 70

OA or RA?
Treatment involves disease modifying drugs

Back 70

RA