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113 Cards in this Set

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Connective tissue disease (CTD)

is the major focus of rheu-matology, the study of rheumatic disease

rheumatic disease

is any disease or condition involving the musculoskeletal system.

Arthritis

means inflammation of one or more joints. In clini- cal practice, however, arthritis is categorized as either nonin- flammatory or inflammatory.

Osteoarthritis

-Noninflammatory, localizedarthritis


- the progressive deterioration and lossof cartilage in one or more joints (articular cartilage)

osteophytes

(bone spurs)

crepitus

a grating sound caused by the loosened bone and cartilage.

primary OA

the disease may be triggered byaging, genetic changes, obesity, and/or smoking.

Secondary OA

occurs less often than primary disease and can result from other musculoskeletal conditions, such as rheumatoid arthritis.

OA pain assessment in detail.


Other questions to ask include:

-If joint stiffness has occurred, where and for how long?


-When and where has any joint swelling occurred?


-What do you do to control the pain or stiffness? -Do you have any loss of function or difficulty in per- forming ADLs?

Heberden’s nodes

(at the distal interphalangeal [DIP] joints)

Bouchard’s nodes

(at the proximal interphalangeal [PIP] joints)

Joint effusions

(excess joint fluid)


are common when the knees are involved.

infrapatellar notch

(the area directly below the knee)

suprapatellar area

(directly above the knee).

OA Disease pattern

-May be unilateral, single joint


-Affects weight-bearing joints and hands, spine ---Metacarpophalangeal joints spared


-Nonsystemic

OA Disease process

Degenerative

OA LAB FINDINGS

Normal or slightly elevated ESR

OA Common drug therapy

NSAIDs (short-term use)


Acetaminophen


Other analgesics

OA typical onset age

older than 60yrs

OA Risk Factors or cause

-Aging


-Genetic factor (possible)


-Obesity


-Trauma


-Occupation

OA- Local rest

involves immobilizing any unstable joint, most often the knee, with a brace or splint

OA Systemic rest

refers to immobilizing the entire body, such as during a nap.

OA Psychological rest

is equally important because it allows relief from the daily stresses that can enhance pain.

Glucosamine

may decrease inflammation

chondroitin

may play a role in strengthening cartilage.

totaljoint arthroplasty (TJA)

-surgical creation of a joint


-The most common surgical procedure performed for older adults with OA


-aka total joint replacement (TJR )

osteotomy

(bone resection) may be performed to correct joint deformity, but this procedure is done most commonly for younger adults

Osteonecrosis

is bony necrosis secondary to lack of blood flow, usually from trauma or chronic steroid therapy.

primary arthroplasty.





The first time a patient receives any total joint arthroplasty, it is referred to as

revision arthroplasty

If the implant loosens, _______may be performed.

neuroaxial

(epidural/spinal) anesthesia for LOWER EXTREMITY SURGERY

subluxation



-(partial dislocation) or total dislocation.


-A major complication of THA(total hip arthroplasty)

peripheral nerve blockade (PNB)

One of the most recent advances in postoperative painmanagement for lower extremity total joint arthroplasty (TJA or TJR)


- the anesthesiologist injects the femoral or sciatic nerve with localanesthetic; the patient may receive a continuous infusion ofthe anesthetic by portable pump.

hemiarthroplasty

replacement of part of the joint), typically the humeral component, may be performed as an alternative to TSA ( TOTAL SHOULDER ARTHROPLASTY)

Recreational exercise

includes hobbies and sports, with no planned purpose other than relaxation.

Therapeutic exercise

-includes carefully planned activities that are designed to improve muscle strength, muscle tone, and joint range of motion.


-can also reduce pain and improve the patient’s psy- chological health.

Rheumatoid arthritis (RA)

is a common connective tissue disease that can be the most destructive to the joints

Systemic

means this disease affects the body system, affecting many joints and other tissues.

pannus

is vascular granulation tissue composed of inflammatory cells; it erodes articular cartilage and eventually destroys bone.

vasculitis

If blood vessel involvement occurs, the organ supplied by that vessel can be affected.


-The result is malfunction and eventual failure of the organ or system

migratory arthritis.

In early disease, the patient may report migrating symptoms known as

gel phenomenon

The patient usually has frequent morning stiffness ......which lasts for 45 minutes to several hours after awakening.

effusions

(joint swelling with fluid, especially the knees).


-On palpation, the joints feel soft and look puffy because of synovitis and

Baker’s cysts

(enlarged popliteal bursae behind the knee)

periungual lesions

Assess for ischemic skinlesions that appear in groups as small, brownish spots,


most commonly around the nail bed

paresthesias

-burning and tingling sensation,


-Peripheralneuropathy associated with decreased circulation can causefootdrop and ____ usually in older adults.

Sjögren’s syndrome (RA)



which includes a triad of:


-Dry eyes (keratoconjunctivitis sicca [KCS], or the sicca syndrome)


-Dry mouth (xerostomia)


-Dry vagina (in some cases)

Felty’s syndrome (RA)

hepatosplenomegaly (enlarged liver and spleen), and leukopenia

Caplan’s syndrome (RA)

is characterized by the presence of rheumatoid nodules in the lungs and pneumoconiosis, which is noted primarily in coal miners and asbestos removal workers.

synovectomy

to remove inflamed synovium may be needed for joints like the knee orelbow.

disease-modifying antirheumatic drugs (DMARDs)

-most patients are managed with


-As the name implies, thesedrugs are given to slow the progression of the disease (RA)

Methotrexate(MTX) (Rheumatrex)

-Patients taking MTX are at risk for infection.


-Teach themto avoid crowds and people who are ill.


-Remind patients to avoidalcoholic beverages while taking MTX to prevent liver toxicity.


-Teach them to observe and report other side and toxic effects,which include mouth sores and acute dyspnea from pneumoni-tis


- Strict birth control is recom-mended for childbearing women who are in need of MTX tocontrol their RA

Leflunomide (Arava)

- Teach patients to report these changes and monitor laboratoryresults carefully.


-Remind them to avoid alcohol.


-Inform themthat Arava can cause birth defects, and therefore recommendstrict birth control to women of childbearing age.


-Tell patientsto contact the health care provider immediately if pregnancyoccurs while taking the drug.


-Cholestyramine (Questran) isavailable to help block the drug’s action.

Nonsteroidal Anti-inflammatory Drugs. NSAIDs

aresometimes used for inflammatory arthritis to relieve pain andinflammation

Plasmapheresis

(sometimes called plasma exchange) is an in-hospital procedure prescribed by a health care provider in which the patient’s plasma is treated to remove the antibodies causing the disease

energy conservation

including:


- Pacing activities


- Allowing rest periods


- Setting priorities


- Obtaining assistance when needed

RA typical age

35-45 years

RA risk factors or cause

- Autoimmune (genetic basis)


-Emotional stress (triggers exacerbation)


-Environmental factors

RA Disease process

Inflammatory

RA Disease pattern

-Bilateral, symmetric, multiple joints


-Usually affects upper extremities first


-Distal interphalangeal joints of hands spared


-Systemic

RA Lab findings

-Elevated rheumatoid factor


-antinuclearantibody


-ESR

RA common drug therapy

-NSAIDs (short-term use)


-MethotrexateLeflunomide (Arava)


-Corticosteroids


-Biological response modifiers


-Other immunosuppressive agents

The two main classifications of lupus are

-discoid lupuserythematosus (DLE)


- systemic lupus erythematosus(SLE)

systemic lupus erythematosus (SLE)

is a chronic,progressive, inflammatory connective tissue disorder that cancause major body organs and systems to fail.


-characterized by spontaneous remissions and exacerbations (“flare-ups”), and the onset may be acute or insidious (slow).


- condition is potentially fatal, but the survival rate hasimproved dramatically when SLE is diagnosed early andtreated adequately

lupusnephritis (SLE)

- some degree of kidney involvement—the leading cause of death.


-Autoimmune complexes in SLE tend to be most attractedto the glomeruli of the kidneys.


-Other causes of deathfrom the disease are cardiac and central nervous systeminvolvement.

Lupus caused by

Like RA, lupus is probably caused by a


combination of genetic and environmental factors.

“butterfly”rash

The major skin manifestation of DLEand SLE is a dry, scaly, raised rash on the face

discoid lesions

-(coinlike)




the scarring lesions of discoid lupus. The lesions are especially evidentwhen the patient is exposed to sunlight or ultraviolet light.

Osteonecrosis

(bone necrosis from lack of oxygen)is often seen in those who have been treated for at least 5 yearswith steroids like prednisone

myositis

Observe for muscle atrophy, which can result from disuse,from skeletal muscle invasion by the immune complexes or from chronic steroid therapy

Myalgia

(muscle pain)

Pericarditis

is the most common cardiovascular manifesta-tion and causes tachycardia, chest pain, and myocardial ischemia.

Raynaud’s phenomenon

occurs in a small portion of lupuspatients. On exposure to cold or extreme stress, the patientreports the characteristic red, white, and blue color changesand severe pain in the digits; these changes are caused byarteriolar vasospasm.

serositis

(peritoneal involvement)


- Mesenteric arteritis, pancreatitis from arteritis of the pancreatic artery, and colonic ulcersalso can cause abdominal pain with lupus.

pancytopenia

(a decrease of all cell types)

hydroxychloroquine (Plaquenil)


(SLE)

- decreases the absorption of ultraviolet lightby the skin and therefore decreases the risk for skin lesions.


-Teach patients to have frequent eye examinations if they arereceiving _______

discoid lupus erythematosus (DLE)


the patient’s major concern

is the rash or discoid lesions

Systemic sclerosis (SSc)

-also called scleroderma


-is an uncommon chronic, inflammatory, autoimmune connective tissue disease.


-Formerly called progressive systemic disease, or PSS, this illness is not always progressive.

Scleroderma

means hardening of the skin, which is only one clinical manifestation of the problem.


-Some patients, often children, have only skin involvement, or localized scleroderma (also called linear scleroderma)

sclerotic



The inflamed tissue in patients with SSc be


comes fibrotic and ____ (hard)

two classification for systemic sclerosis

-Diffuse cutaneous SSc—skin thickening on the trunk, face, and proximal and distal extremities (over most of the body)


- Limited cutaneous SSc—thickened skin limited to sites distal to the face, neck, and distal extremities

Patients with the limited form of systemic sclerosis often have the CREST syndrome

-Calcinosis (calcium deposits)


-Raynaud’s phenomenon (1st symptom that ocurs)


-Esophageal dysmotility


-Sclerodactyly (scleroderma of the digits)


-Telangiectasia (spider-like hemangiomas)




The first symptom that usually occurs in patients with the diffuse form of the disease is hand and forearm edema, which may exist with bilateral carpal tunnel syndrome.

Arthralgia

(joint pain)

indurative phase

In this phase, the fingers are described as sausage-like. The skin is taut, shiny, and free of wrinkles. If diffusescleroderma occurs, swelling is replaced by tightening, hard-ening, and thickening of skin tissue

autoamputation

(the tips of the digits fall off spontaneously)

Gout, or gouty arthritis

is a systemic disease in which urate crystals deposit in the joints and other body tissues, causing inflammation

Primary gout

is the most common type and results from one of several inborn errors of purine metabolism.

Secondary gout

involves hyperuricemia (excessive uric acid in the blood) caused by another disease or factor. Sec- ondary gout affects people of all ages

three clinical stages of the primary disease process of gout

asymptomatic hyperuricemia,


acute gouty arthritis


chronic or tophaceous gout

asymptomatic hyperuricemia

- patient is usually unaware


- The serum uric acid level is elevated, but no treatment is needed in this stage

acute gouty arthritis

- The patient experiences excruciating pain and inflammationin one or more small joints, usually the metatarsophalangealjoint of the great toe, called podagra.


-The erythrocyte sedimentation rate (ESR) is usually increased as a result of theinflammatory process.


-- Joint inflammation is the most common finding and is usually so painful that the patient seeks medical care immedi- ately.

chronic or tophaceous gout

-uratekidney stone formation is more common than renal insufficiency.


- can begin anywhere between 3 and40 years after the initial gout symptoms occur


- inspect the skin for tophi, or deposits ofsodium urate crystals

Polymyositis

is a diffuse inflammatory disease of skeletal (striated) muscle that causes symmetric weakness and atrophy.

dermatomyositis

When a rash accompanies polymyositis, the diseaseis called

polyarthralgia

(aching around multiple joints),

Necrotizing vasculitis

is a term for a group of diseases whose primary manifestation is arteritis (inflammation of arterial walls), which causes ischemia in the tissues usually supplied by the involved vessels

Polyarteritis nodosa

affects middle-aged men most oftenand involves every body system. Treatment is similar tothat for systemic lupus, but the prognosis is not as promis-ing. Renal disorders and cardiac involvement are the mostcommon causes of death

Hypersensitivity vasculitis

is the most common form of vasculitis and primarily causes skin lesions as an allergic response to drugs, infections, or tumors.

Takayasu’s arteritis

or the aortic arch syndrome, is also called the “pulseless” disease

Polymyalgia rheumatica (PMR)

is a clinical syndrome characterized by stiffness, weakness, and aching of the proximal musculature (i.e., the shoulder and pelvic girdles).

Giant cell arteritis (GCA)

-or temporal arteritis (TA), occurs in as many as 20% of people with PMR.


-GCA is a systemic vasculitis that affects large and midsize arteries


- the cause of both PMR and GCA is unknown, but a geneticpredisposition related to HLA-DRB1 is likely.


- GCA istreated urgently with high doses of corticosteroids, often ashigh as 40 to 80 mg daily

Ankylosing spondylitis (AS)

s also known as Marie-Strüm-pell disease or rheumatoid spondylitis.


-The disease affects thevertebral column and causes spinal deformities.


- Other features include:


iritis (inflamma-tion of the iris),


arthritis or arthralgia (joint aching), andnonspecific systemic manifestations such as malaise andweight loss.

Reiter’s Syndrome

- As with ankylosing spondylitis, Reiter’s syndrome is associatedwith the HLA-B27 antigen.


-This disease usually affects youngwhite men but can also affect women.

balanitis circinata

(ringlike inflammation of the glans penis)

Marfan syndrome

is an autosomal dominant connective tissue disease in which abnormalities of the skeletal, ocular, cardiopulmonary, and central nervous systems result from a basic defect in extracellular microfibrils. Microfibrils are very small fibers within cells.


- tend tobe excessively tall and have elongated hands and feet.


- Cardiovascular problems are responsible for most deathsresulting from ______

Infectious Arthritis

Any infectious agent can invade the joint space and causeinflammation and tissue destruction.

Lyme disease

is a reportable systemic infectious diseasecaused by the spirochete Borrelia burgdorferi and results fromthe bite of an infected deer tick, also known as the black-legged tick.

erythema migrans

round or oval, flat orslightly raised rash

Pseudogout

is a disease that mimics the clinical manifesta- tions of gout.

Psoriatic arthritis (PsA)

affects about 30% of people who have psoriasis—a skin condition characterized by a scaly, itchy rash, usually on the elbows, knees, and scalp

Fibromyalgia syndrome (FMS)

also referred to as simplyfibromyalgia, is a chronic pain syndrome, not an inflamma-tory disease.

trigger points (FMS)

-can typically be palpated to elicit pain in a predictable, reproducible pattern.


-The pain is typically described as burningand gnawing.

Chronic fatigue syndrome (CFS),

also known as chronic fatigue and immune dysfunction syndrome (CFIDS),


- is a chronic illness in which patients have severe fatigue for 6 months or longer, usually following flu-like symptoms.