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