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62 Cards in this Set
- Front
- Back
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Osteoarthritis
Epidemiology |
Most common arthropathy in adults
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Rheumatoid Arthritis
Epidemiology |
0.8% of adult population with onset beginning between ages 30-80 years
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What is osteoarthritis
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Degenerative changes with progressive loss of cartilage and hypertrophic changes in surrounding bone
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What is Rheumatoid Arthritis
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Chronic, inflammatory, systemic autoimmune disease.
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Who usually get osteoarthritis
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Most common in older people, women>men; risk factors = obesity, family history, metabolic disorders, neuromuscular dysfunction
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Who usually gets Rheumatoid Arthritis
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Peak incidence in young adults; more common in women
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When are symptoms present with osteoarthritis
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Joint pain worsens with activity and improves with rest, worse in the evening; Stiffness is experienced more in the evening and after sitting for extended periods
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When are symptoms present with Rheumatoid Arthritis
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Morning stiffness greater than one hour.
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Where is the pain located
with osteoarthritis |
Variable; asymmetrical distribution, hands, knees, hips
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Where is the pain located
with Rheumatoid Arthritis |
Symmetrical, smaller joints affected first as disease progresses other joints affected. Deformity is common.
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What tests are used for osteoarthritis
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None; may see Herbeden nodules on exam, bony enlargement, joint instability, restricted movement. Osteophytes on x-ray.
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What test are used for rheumatoid arthritis
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Rheumatoid Factor (pos in about 80-85% in RA), enzyme assays, CRP, ESR, CBC, and x-rays used to stage disease. See 1,000 of WBC within joint fluid from aspiration
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Goal of therapy Osteoarthritis
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Pain relief and maintain functioning
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Goal of therapy Rheumatoid Arthritis
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Minimize joint pain and damage, control systemic involvement, prevent disease progression and avoid side effects of medications
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How to treat Osteoarthritis
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NSAIDS, yoga, muscle stretching, lidocaine patch,
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How to treat Rheumatoid Arthritis
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Acetaminophen, NSAIDS, PPI, prednisone, anti-rheumatic drugs biologic response modifiers, PT/OT. hydroxychloroquine (antimalaria drug), sulfasalzine, methotrexate (preferred choice)
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Morbidity of Osteoarthritis
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Secondary diagnoses are bigger issue, as well as immobility!
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Morbidity of Rheumatoid Arthritis
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If not treated, severe disability can occur within 10 years of diagnosis.
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What chronoic disease is rheumatoid factor seen in
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Hepatitis C (blood transfusion and tattoos can get Hep C from) just because has pos RA factor does not say has RA
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RA s/s can seen dry eye, dry mouth, dental carries
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true
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How to diagnose RA
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morning stiffness in & around joints at least 1 hour before improvement 2) arthritis of 3 or more j oints, swollen, PIP joints in hands, MCP (joint where fingers attach to hands), wrist, knee, ankle MTP (joints where toes attach to feet) or elbow 3) rheumatoid nodules, 4) arthritis of hand 5) serum Rheumatoid factor 6) radiographic changes erosion or bondy decalcification (need 4 of 7 criteria)
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What deformatities se ein RA
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swanneck deformaties, ulnar deviation
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Criteara classifcation for Lupus
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malar rash (butterfly facial rash), rash all over body, photosensitivity - rash gets worse in sun or light, arthritis - tender joints, pleuritis or pericarditis, renal disorders - protienuria, hemolytic anemia & other hemotologic disorders, neurologic disorders,
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Clinical manisfestation for lupus
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Flares & remits: skin rash, alopecia, mucosal lesions, uritcaria, purpura, nail changes, painful joints, mood changes, anxiety, psychosis, pericarditis, raynauds syndrome
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Treatment for lupus
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avoid sun exposure, treat infections quickly, high risk pregnancies, increased risk kof malignancy, NSAIDS, steroids, methotrexate, cyclosporine
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What is Gout
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monosodium urate cyrstal deposit in tissues. Kidneys don't filter out uric acid and then deposit in joints (most seen in older men) if in younger men then genetic makes too much uric acid, usually occurs first in big toe, uniarthuclar, very painful
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How long to tophi take to grow
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years and years, found in fingers, writs, ears, knees, elbows,
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Fibromyalgia
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diffuse pain, sleep disturbane, IBS, fatigue, memory problems, pain all over body
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What is ankylosing spondylitis
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Chronic inflammatory disease, found in young males, progressive stiffness with fusion of some joints - especialy fusion of spine, genetic,
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Treatment fo rsnkylosing spondylitis
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NSAIDS, exercise, intrarticulart and systemic corticosteroids, sulfasalazine, methrotrexate, Enbrel
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What is primary prevention for osteoarthritis?
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weight control and injury prevention
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What is secondary prevention for osteoarthritis?
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early diagnosis and skilled management
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Who usually gets lupus?
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women, ages 20-45, more blacks, asians
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What see a lot in lupus?
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skin disorders, and lots of ititis (pleuritis, pericarditis, uvetitis), c/o fatigue - very hard to diagnosis
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What tests to order for lupus?
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ESR (long-term inlflamation), CRP (short term inflammation), (measures inflamation), ANA, CBC (anemia)
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What see with osteoarthritis
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disease of age, worse with activity, improves iwth rest, asymmetrical, not present at night, morning stiffness, know about nodules Bouchard nodules (middle joints of fingers, & Herbedon nodules (distal joints of fingers) NSAIDS, normal labs, swimming best exercise
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What is RA
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autoimmune disease - will see abnormal labs, see anemia of chronic disease, first line drugs DMARDS refer
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How to diagnose gout
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joint aspiration gold standard, draw uric acid needs to be below 6, need to reduce inflammation first (indocin or prednisone) then treat uric acid level second otherwise gout ith flare allopurinal for decreasing gout - disease of diet reduce diet high in purines - meat, liver
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What does ESR test?
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acute inflammation - h igh in lupus, RA
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What does rheumatoid factor test for?
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Immunoglobulin antibody directed against IgG
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What doe antinuclear antibodies test for?
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autoantibodies directed agains cell nuclei. Pos in SLE, seen in RA
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What does uric acid test for?
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by product of purine metabolism
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What is HLA-B27 test?
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imunogenetic marker associated with ankylosing sponkylitis
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What is ankylosing spondylitis?
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familial, more in men, begins in 30-40, low back pain that is inflammatory. indisous onset, chronic - last over 3 months, below waist, in buttocks and hips, worsens with bed rest & improves iwth exercise, sleep disturbance, worse in morning, causes joint sin back to fuse together,
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Physical exam with ankylosing spondylitis
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loss of normal lumbar lordosis, measure spine mobility with Schobers flexion test.
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How to diagnose someone with snkylosing spondylitis?
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need 3 critera: low back apin adn stiffness for > 3 months tha tis improved by exercise and worsens with rest, 2) limited ROM of lumbar spine 3) limited chest expansion. Presence of sacroilitis
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How to treat ankylosing spondylitis?
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NSAIDS, COX-2 inhibitors, if that does nto work then can use sulfsalazine or methotrexate, if they fail then anti-TNF (biologic anti-tumor necrosis factor agents) - very expensive (cannot use in pregnancy, active infection or heart failure). Need to control pain, pt stoop to control pain and then spine fuses in stooped posistion, use heat, massage, muscle relaxants, low-dose steroids
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What are some complications of ankylosing Spondylitis?
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visual loss r/t inflammatory eye disease, spinal cord problems r/t spine fusion - sensory loss, spinal cord compression, weakness,
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Pt Education with ankylosing spondylits
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swimming great exercise, don't sleep with pillow under head or under knees,, back stroke hleps straighten back
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What is reactive arthritis or Reiters syndrome
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acute sterile inflammatory arthrophay following an infection where there are no microbes in synovium. See triad in reiters syndrome - conjunctivisit, urethrisit and arthritis. Usually pt does not present with all 3 use reacive artithis instead. Most prevelant in 30's, affectds men more,
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What is clinical presentation of REactive arthritis
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after infection s/s occur 10-20 days later, distinctive s/s seen in lower extremeity, asymmetrice joints, sausage digits (classic manifestation), heel pain, achilles tendonitis, plantar fascitiis & sacroilities, hip involvement common. Can have dermatologic manifestations, disease last 2-3 mnths & can reoccur
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How to treat reactive arthritis
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same as ankylosing spondylitis. sulfasalazine 2g/day, NSaids, Methrotrexate
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What is Psoriatic arthristis
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inflammatory arthrisit assoc with psoriasis
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Clinical presentation fo psoriatic arthritis
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can occur with onset of disease or afterwards. Often see nail pitting - classic of psorasis, can also see sausage digits like reactive arthritis - very similar to reactive arthritis except nail pitting only seen in psoriatic
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How to treat psoriatic arthritis
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NSAIDS, sulfasalazine, methortrexate, anti-TNF drugs (etanercept infliximab)
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What is RA?
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autoimmune disorder charcterized by symmetric inflammaotry poly arthritis, may result in joint destruction, more women than men, onset over 2-3 months, general inflammation, weakness, weight loss, malaise, fatigue, anorexia, aching, stiffness, painful tender, swollen joints, morning stiffness. First joints affected are hands and feet and wrists. Joint involvement is bilateral and symmetrical
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What do you see on an exam of RA?
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inflammed joint feels warm, tender, boggy skin look thin and shiny and may be ruddy. May find subcuteanous nodules. See inflammation in eyes, lungs, heart & nerve entrapments - can affect many organs. Bone erosions seen on x-ray w/i 2 years
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Tests for RA
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ESR, CRP, CBC, radiographs, synovial fluid analysis ( hgih WBC count of over 10,000 predominance of neutrophils
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How to treat RA
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strenghtening exercises, NSAids, DMARD therapy (disease modifying antirheumatic drugs - methotrexate, sulfasaliazine, gold salts, infliximab,
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What is SLE
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chronic, multi system, inflammatory rheumatic disease. More women see most in 15-35 yo Damages heart, kidnesy, lungs, an d brain. More common in blacks. Cause unknown
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What s/s are seen with SLE?
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varied presentation, relapes and remissions. arthritis, nephritiis, serositis, or vasculitis or mild s/s like fatigue, arthralgia, skin rashes., oral ulcers, joint pain, weigth loss. Often misdiagnosed. See butterfly rash on face in some. Discoid rash on body, photosensitivity, oral ulces, arthritis, serositis, renal disorder, neurologi disorder, hematoloic disorder, immunologis disorder, antinuclear antibody. See raynauds symdrome. Inc risk of heart disease, mood changes, migraine HA, impaired concentration
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Treatment of SLE
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avoid sun, exercise, avoid fatty diet, dental and health checkups, NSAIDS for pain, corticosteriods mainstay of tretment for flair ups then immunosuppresive drugs to control disease like hydooxycholoroquine, azathioprine, methotrexate, at risk for bone disease d/t steroid use.OCPs with estrogen not good, best to use ;progesterone only
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