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73 Cards in this Set

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rheumatism
an acute or chronic condition characterized by inflammation, soreness, stiffness of muscles, and pain in joint and associated structures
rheumatoid arthritis
a chronic systemic inflammatory disorder typically characterized by symmetrical polyarthritis and extra-articular manifestations
genetic predispostion for RA illustrated by the association between RA and
histocompatability complexes (HLA) found on t-lymphocytes
children of parents that are rheumatoid factor positive are ___ times more liked to have RA
6
are women or men more likely to have RA?
women
pathology of RA
chronic inflammation of synovial tissue results in proliferation of synovium to form a pannus
synovium
a thin membrane in synovial (freely moving) joints that lines the point capsule and secretes synovial fluid
pannus
when tissue invades normal cartilage and bone surfaces resulting in erosion
destruction of joint
what are 2 sources of inflammation in RA?
infectious agents
immune system
name two immune system components that can cause inflammation in RA
humoral components
cellular components
humoral components
antibodies produced by plasma cells
70% of patients with IgM antibodies have + rheumatoid factor
cellular components
leukocytes and lymphocytes propagated from the antigen that results in cascade rxn leading to production of cytotoxins, oxygen radicals, & enz production, causing tissue damage
50 to 70% of patients with RA have what kind of onset
insidious (few or no symptoms)
slow (weeks to months)
generalized presentation of RA
fatigue
malaise
early morning stiffness (>30min)
malaise
A vague feeling of bodily discomfort; A general sense of depression or unease
early musculoskeletal presentation of RA
pain localized in joints bilaterally
joints that are red, warm, tender, swollen
early musculoskeletal presentation of RA is found in what joints (4)
hands
wrists
feet
ankles
result of early RA
decr self care
inability to clasp, grasp, or pinch
late musculoskeletal presentation of RA - locations
elbows
knees
shoulders
ankles
cervical spine
result of latent RA
difficulty walking, moving neck and chewing
other signs and symptoms of RA
subcutaneous nodes
pleuropulmonary manifestation
rheumatoid vasculitis
how long does it usually take to diagnose RA?
1 to 2 years after onset of signs
patients must have 4 of these 7 symptoms for RA diagnosis
morning stiffness
arthritis of 3 or more joints
arthritis of hand joints
symmetric arthritis
rheumatoid nodules
serum rheumatoid factor
radiographic changes
what is the rheumatoid factor?
altered, abnormal IgG produced & not recogized by the body, treated like an antigen, attacked by normal IgM or IgG
radiographic evaluation determines (RA)
extent of cartiledge destruction and bone erosion
anemia associated with RA
mild to moderate
normocytic, normochromic
osteoarthritis
degernative joint disease
affects weight bearing joints of peripheral & axial skeleton
risk factors for osteoarthritis
age
obesity
occupation
genetics
pathology of osteoarthritis
progressive breakdown of articular cartilage
exposure of underlying bone
formation of osteophytes
synovitis
generalized presentation of OA
early morning stiffness confined to affected joint (<30min)
musculoskeletal presentation of OA
pain upon use of affected joint
warm, tender, red joint
what joints does OA usually affect
hands
knee
hip
spine
feet
age of onset OA & RA
OA: 40-50
RA: 20-30
joints effected by OA & RA
OA: large weight bearing joints
RA: small peripheral joints & knee
is OA systemic or non-systemic? RA?
OA: non
RA: systemic
is the duration of morning stiffness longer for OA or RA
RA
while OA is a _________ disease, RA has _________ and ___________
progessive
remissions; exacerbations
for OA, is the cartilage or synovium involved? RA?
OA: cartilage
RA: synovium
SLE
systemic lupus erythematosis
SLE
multisystemic, chronic inflammatory disease
exacerbations & remissions
in latin, lupus means
wolf or wolf-bite
pathology of SLE
overproduction of antibodies directed at human tissue, unable to distinguish normal self tissue from foreign tissue
general presentation of SLE
fatigue and fever
musculoskeletal presentation of SLE
arthralgias
myalgias
arthritis
arthralgias
joint pain in absense of arthritis
myalgias
muscle pain
cutaneous manifestations of SLE
butterfly rash
photosensitivity
alopecia
alopecia
hair loss
pulmonary presentation of SLE
pleural effusions
pleurisy
pleurisy
inflammation of the pleura
pleural effusions
accumulation of fluid in the pleural space
cardiac presentation of SLE
pericarditis
murmurs
EKG changes
renal presentation of SLE
proteinuria
SCr changes
CNS symptoms of SLE
very diverse
functional - depression & anxiety
organic - psychosis, seizures, neuropathies
GI manifestations of SLE
dyspepsia (indigestion)
Peptic ulcer disease
esophagitis
hematologic presentation of SLE
leukopenia - abnormally low number of leukocytes in the circulating blood
SLE patients are highly susceptible to what drug induced psychosis
corticosteroid psychosis
8 Lupus inducing drugs
hydralazine
procainamide
isonazid
chlorpropamide
methyldopa
phenatoin
carbamazepine
lithium
must meet 4 of these 10 criteria to diagnose SLE
malar rash
discoid rash
oral ulcers
arthritis
serositis
renal disorder
neurologic disorder
hematologic disorder
immunologic disorder
antinuclear antibody
antinuclear antibody test
indicates presence of antibodies to nospecific nuclear material
activated protein C
nonspecific test for inflammation
gout
chronic metabolic disease due to a disorder of uric acid metabolism
manifestation of gout
hyperuricemia
acute or chronic recurrent arthritis
deposits of urate crystals in body tissues
hyperuricemia
serum urate >8mg/dl in men & >7mg/dl in women
primary gout
basic metabolic defect is unknown
patients are overproducers or underexcretors
secondary gout
other dieases associated with errors in purine metabolism - polycythemia vera, myeloproliferative disorders, leukemiaa, anemias, drug-induced, chronic lead ingestion, fasting
6 of these 11 criteria must be present to diagnose gout
exquisite pain involving joint
more than 1 acute attack of arthritis
joint inflammation maximal within 1 day
oligoarthritis
erythrema over involved joint
podagra
unilateral podagra
tophi
hyperuricemia
termination of an acute attack
asymmetic swelling within a joint
podagra
gout, esp of the big toe
tophi
a deposit of crystallised monosodium urate in people with longstanding hyperuricemia
gouty arthritis
onset of acute unbearable pain usually in 1 joint of lower extremity
__% of first attacks of gouty arthritis affect the:
50
big toe
__% of gouty arthritis attacks occur within 2 years of first attack
75
gouty nephropathy
formation of urate crystals in ureter and collecting tubules, kidney stones