Ortho 1 Ra

Front 1

RA is what?

Back 1

an autoimmune disease that eat's away at the bones and joints

Front 2

Irreversible joint damage can occur with in how many years of the disease?

Back 2

2

Front 3

What are 3 main signs of RA

Back 3

-Chronic
-Systemic
-Inflammatory

Front 4

How is RA caused?

Back 4

-antigen forms abnormal IgG
-antibodies form RF
-IgG & RF deposit on synovial membrane and joint cartilage
-inflammation occurs attracting Neutrophils causing damage and synovial lining thickens
-Chronic inflammaton results

Front 5

Pannus is what?

Back 5

(highly vascular granulation tissue)
-occurs at the junction of synovial tissue and articular cartilage
- it will project into the joint cavity and cause necrosis

Front 6

The pannus occurs generaly where?

Back 6

all around the joint cartilage

Front 7

the inflammation leads to what?

Back 7

-destruction of connective tissue and synovial membrane within the joints
-weakens the joints leading to dislocation and deformity

Front 8

So in a nut shell RA happens and does what?

Back 8

-autoimmune in which the body attacks the joints
-swelling occurs
-synovitis occurs
-the synovial fluid thickens and forms pannus
-the pannus then destroys cartliage

Front 9

(T/F)
RA is symmetrically in occurance

Back 9

True,
wrists, hands, elbows, shoulders, knees, ankles common

Front 10

RA criteria are

Back 10

-am stiffness for an hour
-arthritis of 3 months
-hand joint involvement
-Rheumatoid nodules
-Rheumatoid Factor (RF) positive
-Radiographic changes

Front 11

RA S/S are

Back 11

-fatigue & weakness
-inflammation
-tenderness
-pain longer than 30 min
-joint deformity
-decrease ROM
-anoxrexia, Wt loss, anemia
-high ESR, anti-CCP
-X-rays showing joint destruction
-WBC >2000

Front 12

Joint symptoms

Back 12

-Pain
-stiffness after inactivity
-limited motion
-inflammation
-symmetrical
-joint deformity

Front 13

RA can have what 3 types of extra articular manifistations?

Back 13

-Rheumatoid nodules (firm non-tender nodules over joints)
-Sjogren syndrome (decreased lacrimal & salivary gland secretions)
-Felty syndrome (inflammatory disease of the eyes, plenomegaly, lymphadenopathy, pulmonary disease and blood dyscrasias)

Front 14

Nodules can also spread where else?

Back 14

to the lungs, heart, and eyes

Front 15

What is commonly given to somebody with Sjogrens, or maybe Felty?

Back 15

artifical tears

Front 16

What can happen to these nodules?

Back 16

They can open up and become a portal for infection

Front 17

What are some "names" for the hands of RA Pt's?

Back 17

-swan neck
-ulnar deviation
-Boutonniere demority (the thumb curves outward)

Front 18

Rheumatoid factor (RF) is what?

Back 18

-an antibody that activates the inflammatory processes within the body
-titers increase during active disease
-can be misleading since it also rises with bacterial, viral and parasitic disease

Front 19

What is thought be replacing RF?

Back 19

Anti-CCP (Cyclic citrullinated peptide antibody)

Front 20

% of RA Pts with RF vs. Anti-CCP

Back 20

RF 80%
Anti-CCP 98%

Front 21

Anti-CCP is useful how?

Back 21

-Useful in evaluating early inflammatory arthritis
-if positive, can lead to more rapid initiation of more advanced RA Therapies

Front 22

TNF (tumor necrosis factor) does what during RA?

Back 22

increases in their synovial fluid, blocking TNF decreases effects of RA

Front 23

ESR
Erythrocyte Sedimentation Rate shows what?

Back 23

It measures the distance the RBC settle in 1 hr.
-ESR of 30 or less is normal
-40-70 is moderate inflammation
-70-140 is severe inflammation

Front 24

ESR in RA means what?

Back 24

supports RA as a diagnosis and shows severity of inflammation

Front 25

What is our Goal for RA?

Back 25

-satisfactory pain relief
-minimal loss of functional ability
-Pt participation in therapeutic regimen
-maintenance of a postive attitude

Front 26

Drug therapy for RA consists of what drug groups?

Back 26

-NSAIDS
-Corticosteroids
-DMARDS
-Biologics

Front 27

NSAIDS are what?

Back 27

non-steroidal anti-inflammatory drugs
(they aren't selective)

Front 28

S/E from NSAIDS are what?

Back 28

-GI upset
-Esophagitis
-Gastritis
-CNS problems (dizzyness)
-Skin rash

Front 29

NSAIDS meds

Back 29

-Ibuprofen
-Naproxen
-Indomethacin

Front 30

What are the reasons for NSAIDS?

Back 30

-decrease joint pain and swelling

Front 31

What drug is commonly given with NSAIDS?

Back 31

misoprostol (Cytotec) to cover GI problems

Front 32

What is the selective NSAID?

Back 32

Cox 2 inhibitor (Celebrex)
-blocks pain, edema, inflammation
-shouldn't cause GI irritation

Front 33

What is going on with Cox 2 inhibitors?

Back 33

Celebrex is one of the only ones not to be taken off the shelves due to increased CVA problems

Front 34

DMARDS are what?

Back 34

disease-modifying anti-rheumatic drugs

Front 35

What general info is with DMARDS?

Back 35

-slow acting
-maybe used alone or in combo with other drugs
-can deminish progression of disease

Front 36

What are the 2 problems with DMARDS?

Back 36

-Liver damage (CBC)
-Birth defects

Front 37

What are some DMARDS?

Back 37

-Arava
-Plaquenil
-Methotrexate

Front 38

Which DMARD is used first and also a melaria drug?

Back 38

Plaquenil
(vision problems see dr. Q6 months, N/V)

Front 39

Which DMARD is drug of choice for mod-severe RA?

Back 39

Mehotrexate

Front 40

Biologics are considered what?

Back 40

The Big guns in treating RA

Front 41

They are often combined with what?

Back 41

DMARDS to improve efficacy

Front 42

What are some Biologics?

Back 42

-Enbrel
-Humira
-Remicade
-Kineret
-Orenica
-Rituxan

Front 43

What can't be given to somebody taking Biologics?

Back 43

live vaccine

Front 44

Biologics do what?

Back 44

-sup. inflammatory process
CAUSES
-anemia
-thrombocytopenia
-neutropenia
-can reactivate TB
-lymphoma

Front 45

methotrexate and biologics does what?

Back 45

-works better than using each alone
-using together increases the risk of infection and recur. of TB

Front 46

What two groups of drugs slow the progression of the disease?

Back 46

-DMARDS
-Biologic

Front 47

one of our main goals is what?

Back 47

preserve joint function

Front 48

what can we do to preserve joint function?

Back 48

-ROM exercise
-Alternate rest & activity
-may splint joints during acute inflammation
-apply heat or cold as prescribed
-paraffin baths/massage
-relaxation tech

Front 49

Why aren't we focused on preventing RA like we are in OA?

Back 49

Because RA is autoimmune, we can only slow it down, not prevent it

Front 50

What are some complications of RA?

Back 50

-contractures
-cataracts
-nod ulceration leading to open wounds
-fatigue

Front 51

What should we check for if fatigue is present?

Back 51

-S/S of anemia
-adminster Ir. F.Acid, Vit's

Front 52

What could make RA worst?

Back 52

-physical/emotional stress
-Risk Factors are exposure to infectious agents, fatigue, stress

Front 53

what should we teach our Pt with RA?

Back 53

-educate
-safety
-energy conservation
-assistive devices
-exercise
-joint protection
-good body alignment
-no pillows under knees
-medication
-nutrition
-emotional support

Front 54

Surgical interventions are what?

Back 54

-Snyovectomy
-arthrodesis
-arthroplasty

Front 55

Snyovectomy is what?

Back 55

removal of synovia to maintain joint function

Front 56

Arthrodesis is what?

Back 56

surgical fusion of a joint to attempt to relieve pain & stabilize the joint

Front 57

Arthroplasty is what?

Back 57

(joint replacement) replacement of a diseased joint in order to restore function