N304 Exam 1

Front 1

What is the classification of arthritis?

Back 1

Autoimmune connective tissue disorder

Front 2

How many types of arthritis are there?

Back 2

100

Front 3

What is an example of a non-inflammatory arthritis?

Back 3

Osteoarthritis (non-systemic)

Front 4

What is an example of an inflammatory arthritis?

Back 4

1. Rheumatoid arthritis
2. Systemic lupus erythematosus (SLE)

*both are systemic and autoimmune

Front 5

What is the most common connective tissue disorder?

Back 5

Rheumatoid arthritis

Front 6

What is rheumatoid arthritis?

Back 6

1. A chronic, progressive, systemic inflammatory autoimmune disease that affects synovial joints

2. Chronic pain & progressive joint deterioration = decreased function

Front 7

What are synovial joints?

Back 7

A freely movable joint in which contiguous bony surfaces are covered by articular cartilage and connected by a fibrous connective tissue capsule lined with synovial membrane.

Also called diathrosis.

Front 8

What are the types of synovial joints?

Back 8

1. Ball and socket joint
2. Condyloid joint
3. Gliding joint
4. Hinge joint
5. Pivot joint
6. Paddle joint
7. Uniaxial joint

Front 9

What is the physiology of rheumatoid arthritis?

Back 9

1. RF (rheumatic factors) are formed and attack healthy tissues, especially the synovium causing inflammation

2. Inflammation 1st in synvovial membrane which lines joint cavity then involves articular cavity, surrounding ligaments and tendons

3. Synovium thickens, becomes hyperemic fluid accumulation in the joint space; pannus
(vascular granulation) erodes articular cartilages and eventually destroys bone

4. Late—fibrous adhesions, bone ankylosis and calicifications, bone loses density and secondary osteoporosis

Front 10

What is systemic?

Back 10

Any body or organ system in which connective tissue is prevalent

Front 11

What is commonly seen in systemic arthritis?

Back 11

1. Vasculitis—vessel supplied to organ
2. Fibrotic lung disease
3. Pulmonary hypertension
4. Pericarditis

Front 12

What are the goals for treating RA?

Back 12

1. Prevent joint deformity if RA diagnosed early

2. Early aggressive treatment may suppress synovitis and cause suppression

Front 13

What are the characteristics of RA?

Back 13

Characterized by natural remissions and exacerbations

Front 14

What are the early clinical manifestations of RA?

Back 14

1. Joint inflammation

2. Systemic - Low-grade fever, fatigue, weakness, anorexia, paresthesia

3. Upper Extremity joints involved initially

4. Bilateral, symmetrical and increases as the disease progresses

5. Considered Migratory arthritis

**one hot swollen joint—may mean the joint is infected –Call MD

Front 15

What is paresthesia?

Back 15

Any subjective sensation, experienced as numbness, tingling, or a "pins and needles'' feeling

Front 16

What are the late clinical manifestations of RA?

Back 16

1. Joint deformities = moderate to severe pain & morning stiffness

2. Systemic - Osteoporosis, severe fatigue, anemia, weight loss, subcutaneous nodules, peripheral neuropathy, pericarditis, fibrotic lung disease, Sjogrens syndrome, renal disease

3. Increased disease = Increased progressively, increased inflammation + pain

4. Fingers are spindly, muscle atrophy sec. to pain, decreased range of motion in affected joints

Most or all synovial joints are eventually affected!

Front 17

What is Sjrogen's syndrome?

Back 17

1. Dry eyes (keratoconjunctivitis sicca KCS) or sicca syndrome

2. Dry mouth (xerostomia)

3. Dry vagina

4. Inflammatory cells obstruct or inhibit fluid production in glands

*Also seen in other autoimmune disorders

Front 18

What are the lab tests for diagnosing RA?

Back 18

1. **NO ONE LAB TEST**

2. Increased Rheumatoid Factor = possible CTD

3. Increased Rose Waaler Titer = indicative of RA

4. Positive ANA =indicate SLE, RA, or other CTD

5. Inflammation or infection: ESR (erythrocyte sedimentation rate) or sed rate, hsCRP (high sensitive C reactive protein), IgG –typically elevated

6. Other - anemia, leukocytosis, thrombocytosis

7. Labs r/t organ involvement

Front 19

What is the priority plan of care for RA?

Back 19

1. Physical mobility
2. Pain acute/chronic
3. Fatigue
4. Body image

Front 20

What is the pharmacological management of RA?

Back 20

1. Disease-modifying antirheumatic drugs (DMARDs) = Plaquenil (Antimalarial drug)

2. DMARDs = Sulfasalazine

3. Immunosuppressive Antineoplastic Folate antagonist = Methotrexate

4. Biological response modifiers = Etanercept (enbrel)

5. Glucocorticoids = Prednisone, solumedrol

Front 21

What is the action of DMARDs?

Back 21

Inhibiting the movement (neutrophils, monocytes, macrophages) into inflamed, damaged area, such as the joint

Front 22

What are the indications of DMARDs?

Back 22

1. Mild disease
2. Decrease joint/muscle pain

Front 23

What are the precautions of DMARDs?

Back 23

1. Give with food
2. Allergy to sulfa/aspirin*
3. Retinal damage*
4. Blurred vision/headache
5. Eye exam every 6-12 months
6. Monitor CBC
7. Increase dose slowly due to GI affects

Front 24

What is the action of immunosuppressive antineoplastic folate antagonist?

Back 24

Inhibit lymphocyte replication

Front 25

What are the indications of immunosuppressive antineoplastic folate antagonist?

Back 25

1. Advanced & sustaining RA
2. Low, once a week , slow acting

Front 26

What are the precautions of immunosuppressive antineoplastic folate antagonist?

Back 26

1. Bone marrow suppression
2. Liver/renal toxicity

Front 27

What is the action of biological response modifiers?

Back 27

Binding to and neutralizing tumor necrosis factor (TNF is a known proinflammatory cytokine)

Front 28

What are the indications of biological response modifiers?

Back 28

1. After or with methotrexate
2. Subcutaneous injection once/twice weekly

Front 29

What are the precautions of biological response modifiers?

Back 29

CBC, liver/renal toxicity

**great client outcomes

Front 30

What is the action of glucocorticoids?

Back 30

Inhibit or control inflammatory response by stabilizing cell membranes and dec migrating WBC

Front 31

What is the indications of glucocorticoids?

Back 31

1. Acute exacerbation
2. IV/PO
3. High dose--Short-term

Front 32

What is the precautions of glucocorticoids?

Back 32

Hyperglycemia, infection, osteoporosis

Front 33

What is another pharmacological treatment for RA?

Back 33

NSAIDs = ibuprofen, celebrex, etc.

Front 34

What are the non-pharmacological treatments for RA?

Back 34

1. Rest
2. Positioning
3. Ice & heat (ask pt preference)
4. PT
5. Warm bath in the am

Front 35

What are the other therapies for RA?

Back 35

1. Plasmapheresis (b/c it is an autoimmune disease)

2. Good nutrition

Front 36

What is plasmapheresis?

Back 36

Clients plasma is treated to remove antibodies causing disease

Front 37

What nutritional supplements help with RA?

Back 37

1. Omega 3 fatty acids
2. Fish oil capsules
3. Antioxidant vitamins (A,C,E)
4. Trace elements for joint health

Front 38

What is primary gout arthritis?

Back 38

1. Most common type and results from error in purine metabolism

2. Uric acid production exceeds the excretion

3. Sodium urate deposited in synovium and other tissues = inflammation

4. X-linked trait

5. Middle-aged and older men and post menopausal woman

Front 39

What is a significant characteristic of primary gout arthritis?

Back 39

X-linked trait

Front 40

What is secondary gout arthritis?

Back 40

1. Hyperuricemia (excessive uric acid in the blood)

2. All ages

3. Caused by another disease - renal insufficiency, diuretic therapy

4. CA - chemotherapeutic agents, multiple myeloma, and other cancers

5. Greater turnover of cellular nucleic acids

6. Crash diets

Front 41

What are the 3 clinical stages of primary gout arthritis?

Back 41

1) Asymptomatic hyperuricemic = increased uric acid in blood no s/sx
2) Acute gouty arthritis
3) Chronic or tophaceous gout

Front 42

What are the initial clinical manifestations of primary gout arthritis (1st attack)?

Back 42

1. Pt experiences excruciating pain/inflammatory in one or two small joints

2. Usually metatarsophalangeal joint of great toe

3. Increased ESR 2 to inflammation

4. Months or years pass before another attack

5. Pt asymptomatic, no change in joints

Front 43

What is the acute care setting for primary gout arthritis?

Back 43

1. Flare ups/attacks 2 to surgery/acute illness = MI, etc.

2. Excessive physical/Emotional stress can exacerbate disease

3. Aspirin & diuretics can precipitate an attack

4. Low purine diet (see nutrition)

5. Medication for pain/inflammation

6. Avoid Aspirin & diuretics

7. Plenty of fluids--decrease pH of urine ==> Prevention of formation or urinary stone

Front 44

What is chronic gout arthritis?

Back 44

1. Repeated episodes of acute gout

2. Urate crystals develop under skin (tophi)& within organs (renal!)

3. Urate kidney stone formation more common than insufficiency

Front 45

What is the pharmacological treatment of chronic gout arthritis?

Back 45

1. Allopurinol
**Excess production of uric acid

2. Colcichine

3. Indomethacin (indocin)

Front 46

What is the action of allopurinol?

Back 46

Xanthine oxidase inhibitor

Front 47

What are the indications of allopurinol?

Back 47

Maintenance

Front 48

What are the precautions of allopurinol?

Back 48

1. Aplastic anemia, agranulocytosis

2. Potentially fatal skin conditions—Steven Johnson syndrome; toxic epidermal necrolysis

Front 49

What are the actions of colcichine?

Back 49

Reduces the inflammatory response to the urate crystals in the tissue

Front 50

What are the indications of colcichine?

Back 50

1. Acute attack

2. PO or IV = 0.5 mg tabs Q 2 hours for relief or n/v/diarrhea

Front 51

What are the precautions of colcichine?

Back 51

1. Leukopenia

2. GI & urinary bleeding,

3. RENAL failure

Front 52

What are the actions of indomethacin?

Back 52

Analgesic, antiinflammatory, antirheumatic, and antipyretic properties

Front 53

What are the indications of indomethacin?

Back 53

1. PO, IV, rectally

2. PO 50 mg BID w/ food

Front 54

What are the precautions of indomethacin?

Back 54

1. Renal, liver, pregnancy, nursing moms

2. GI bleed!

Front 55

What is the low purine diet for primary gout arthritis?

Back 55

1. Low purine

2. Organ meats, oily fish (anchovies, sardines, etc)

3. Limit alcohol

4. Lose weight

5. No low carb diet - Diets high in protein fat, Increase uric acid levels

6. Drink plenty of fluids—limit sugar-sweetened soft drinks