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31 Cards in this Set
- Front
- Back
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Most common form of joint disease in North America; slowly progressive non-inflammatory disorder of the synovial joint. Occurs as Primary (Idiopathic) & Secondary, both unknown.
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Osteoarthritis (OA)
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3 Factors linked to Osteoarthritis
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Estrogen reduction
Genetics Obesity |
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Cartilage damage / changes resulting in Osteoarthritis
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Dull, yellow and granular
Soft and less elastic Decreased ability to resist wear with heavy use. |
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Progressing Osteoarthritis
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Body cannot repair cartilage because of ongoing destruction.
Changes in collagen structure = fissuring & erosion of articular surfaces. Central cartilage thins while increasing at margins along with bony growth. Secondary synovitis Bone on bone pain. |
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Inflammation, causing pain and stiffness, as phagocytic cells try to rid a joint of small pieces of cartilage torn from the surface ,
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Synovitis
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Clinical Manifestations of Osteoarthritis
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Asymmetrical
Joint pain Joint stiffness Deformity |
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Osteoarthritis: Joint Pain
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Worsens with use
Worsens with drop in barometric pressure. Early stages: Rest relieves Late stages: Pain with rest & sleep disturbed. |
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Osteoarthritis: Joint Stiffness
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After periods of rest or static position
Early morning resolves in 30mins Over-activity = mild effusion = temporary increased stiffness. Crepitation. |
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Grating sensation caused by loose particles of cartilage; indicates loss of cartilage integrity.
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Crepitation
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Osteoarthritis: Deformity
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Heberden's & Bouchard's nodes
Red, swollen and tender Visible disfigurement No significant loss of function Osteophyte formation and loss of joint space. |
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Osteoarthritis: Care
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Manage pain and inflammation
Prevent disability Maintain and improve joint function Acute = cold; Chronic = heat Rest no longer than a week = atrophy, contractures Appliances: stools, LRG handles Accupuncture |
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Osteoarthritis: Drug Therapy
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Based on severity
Mild = 1g q6h Tylonol, Topical Zostrix or Aspercreme, Hyaluronic acid (HA) Moderate or Severe = NSAID |
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Chronic, systemic, autoimmune disease; inflammation of connective tissue in synovial (diathrodial) joints; periods of remission and exacerbation; accompanied by extra-articular manifestations. Unknown cause.
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Rheumatoid Arthritis (RA)
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Two Etiologies of Rheumatoid Arthritis
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Autoimmune (most accepted)
Genetic factor |
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Rheumatoid Arthritis: Inflammatory Process
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Stage 1 = Synovitis; local inflammatory response cells; enzymes degrade bone and cartilage.
Stage 2 = Pannus (grannulation tissue) covers and invades cartilage; eventually destroying joint capsule and bone Stage 3 = Fibrous invasion of pannus; bone atrophy and misalignment Stage 4 = Fibrous tissue calcifies. Bony ankylosis (fixation of joint) & immobility |
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Rheumatoid Arthritis: Clinical Manidestations
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Onset is insidious
Non-specific - Fatigue, weight loss, stiffness Specific articular - pain, stiffness, limited ROM, inflammation Symptoms are symmetric Usually small joints of hands and feet Morning stiffness 60mins - several hours Increased pain with motion. Atrophy of muscle and tendon damage lead to subluxation. |
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Rheumatoid Arthritis: Extra-articular Manifestations
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Rheumatoid nodules
Sjorgen's syndrom (eye drops and biotene (tears) Felty Syndrome - enlarged spleen and lymph nodes |
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Osteoarthritis: Diagnostic Studies
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Early = Bone Scan, CT, MRI
Late = Detect joint space narrowing, bony sclerosis, osteophyte formation, X-ray |
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Rheumatoid Arthritis: Complications
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Joint destruction
Flexion contractures & deformities Cataracts Rheumatoid nodules Cardiopulmonary effects Carpal Tunnel Syndrome |
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Rheumatoid Arthritis: Lab Tests
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Positive RF in 80% adults
ESR & C-reactive protein = active inflammation Antinuclear antibody (ANA) titer Antibodies to cyclic citrulline protein (anti-CCP) = early detection of RA |
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Rheumatoid Arthritis: Diagnostic Studies
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Bone Scan
X-Ray |
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Rheumatoid Arthritis = 4 of 7 for at least 6 weeks
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Morning stiffness over an hour
Swelling in 3+ joints Swelling in hand joints Symmetrical joint swelling Erosions or decalcification on X-ray Rheumatoid nodules Serum RF |
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Rheumatoid Arthritis: Collaborative Care
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Physical and Occupational Therapy
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Rheumatoid Arthritis: Drug Therapy
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Cornerstone of treatment
Choice depends: Disease activity, pt level of function, lifestyle Methotrexate (Rheumatrex) - drug of choice DMARDs - sulfasalazine (Azulfidine), hydroxychloroquine (Plaquenil) [anti-malarial; eye exams] Combination therapy with NSAID and corticosteroid |
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Rheumatoid Arthritis: Treatment
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Drugs
Rest - 8 to 10 hrs sleep Pillows under knees Firm mattress Splints Acute = cold 10-15mins Chronic = heat 20 - 30 mins |
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Chronic Multi-system Inflammatory Disease; autoimmune origin, effects skin, joins, serous membranes (pleura, pericardium, renal, hematologic, and neurologic systems); women in child bearing years; exacerbations and remissions
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Systemic Lupus Erythematosus
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Systemic Lupus Erythematosus: Pathophysiology
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B-cell hyperactivity - antibodies against own body cells
Widespread degeneration of connective tissue Possible CV, renal and neurologic complications |
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Systemic Lupus Erythematosus: Clinical Manifestations
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Mild to rapidly progressing, affecting many body systems.
Most common skin/muscle, lining of lungs, heart, nervous tissue & kidneys Butterfly rash |
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Systemic Lupus Erythematosus: Diagnostic Studies
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No specific test
Pt history, PE, labs Anti-double-stranded DNA Anti-Smith |
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Systemic Lupus Erythematosus: Drug Therapy
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NSAIDs
Amti-malarial drugs - hydroxychloroquine (Plaquenil) Corticosteroids Immunosuppressive drugs |
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Systemic Lupus Erythematosus: Patient Education
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Sunlight worsens
Long sleeves, hats, sun block Mild soaps and shampoos Reduce stress and infections |
