L14: Arthritis

Question 1

what is arthritis

Answer 1

• inflammation of joints or singular joint
• most common: osteoarthritis

Question 2

is there a treatment for osteoarthritis

Answer 2

nope

Question 3

what is osteoporosis

Answer 3

• aging is a risk factor
• NOT part of normal aging process
• cartilage destruction can begin between ages 20-30
• few pt experience sympt until after age 50-60

Question 4

2 categories of arthritis

Answer 4

1. idiopathic disorder
2. secondary disorder

Question 5

what does OA result in

Answer 5

• cartilage damage that triggers a metabolic response
• cartilage erodes at articular surfaces of joint
• bone spurs (osteophytes) may form

Question 6

in OA what does cartilage become

Answer 6

• dull, yellow, and granular
• soft and less elastic
• less able to resist wear w heavy use

Question 7

what is NOT a characteristic of OA

Answer 7

secondary synovitis may result

Question 8

3 stages of OA manifestation

Answer 8

stage 1: predictable, sharp
stage 2: more constant, affecting daily activities
stage 3: constant dull/aching pain

Question 9

crepitation

Answer 9

grating sensation due to loose particles of cartilage

Question 10

does OA affect the joints asymmetrically or symmetrically

Answer 10

asymmetrically

Question 11

what is the main restriction of OA

Answer 11

mobility restriction

Question 12

heberden’s nodes

Answer 12

DIP joints
- osteophyte formation and loss of joint space
- can appear as early as 40 yrs

Question 13

bouchard’s nodes

Answer 13

PIP joints
- similar disease involvement as heberden’s nodes

Question 14

bow-leggedness

Answer 14

medial knee joint
- joint deformity

Question 15

knocked-kneed

Answer 15

lateral knee joint
- joint deformity

Question 16

diagnostic studies of OA

Answer 16

• bone scan, MRI, CT (detect early joint changes)
• x-ray
• inflammatory markers (erythrocyte sedimentation)
• synovial fluid analysis

Question 17

clinical diagnosis of OA

Answer 17

• persistent joint pain for 1 or more joints
• age greater or equal to 45 yrs
• morning stiffness less than or equal to 30 min

Question 18

collaborative care of OA

Answer 18

• no cure
• non-pharmacological interventions
• pt education and self-management
• drug therapy is considered adjunct therapy
• reconstructive surgery

Question 19

drug therapy for OA

Answer 19

• NSAIDS (oral and topical): PPI’s, topical: one or a few joints only, oral: celebrex
• capsaicin cream (1 or few joints involved)
• tylenol (not more than 4g/day)
• duloxetine (multiple joints)
• corticosteroids (intra-articular injections of corticosteroids)
• hyaluronic acid injection
• doxycycline (decreased joint deterioration **investigational)

Question 20

rheumatoid arthritis

Answer 20

chronic, systemic autoimmune disease characterized by inflammation of connective tissue in the diarthrodial (synovial) joints, typically w periods of remission and exacerbation

• early recognition and treatment are key

Question 21

rheumatoid arthritis etiology

Answer 21

is unknown: possible autoimmune, enviro triggers genetic endowment, genetic factors, antigen triggers to form abnormal immunoglobulin G

Question 22

how is RA characterized

Answer 22

• by the presence of autoantibodies against abnormal IgG - known as rheumatoid factor

Question 23

does RA occur asymmetrically or symmetrically

Answer 23

symmetrically: affects small joints of hand and feet (PIP and MTP joints)

Question 24

extra-articular manifestations of RA

Answer 24

• flexion contractors and deformity
• rheumatoid nodules
• sjögren’s syndrome
• felty’s syndrome

Question 25

is OA more commonly idiopathic or secondary

Answer 25

idiopathic

Question 26

what is sjögren’s syndrome in RA

Answer 26

• extra-articular manifestations
• decreases lacrimal and salivary gland secretion

Question 27

what is felty’s syndrome in RA

Answer 27

• extra-articular manifestations
• splenomegaly, decreased WBCs
• increased risk for infection and lymphoma

Question 28

complications of RA

Answer 28

• joint destruction begins as early as 1st yr w/o treatment
• flexion contractures and hand deformities
• cataracts and loss of vision
• later in the disease…cardiopulmonary

Question 29

RA diagnostics

Answer 29

• history and physical
• positive RF: titers rise during active disease
• synovial fluid analysis: straw colored w fibrin flecks, increased WBC
• x-ray: baseline and monitoring of joint spaces (not specifically diagnostic)
• bone scan: can confirm a dx by detecting early joint changes

Question 30

RA diagnostic criteria

Answer 30

• inflammatory arthritis involving 1+ joints
• +’ve rheumatoid factors and anti-CCP
• elevated levels of C-reactive protein (CRP) or the erythrocyte sedimentation rate (ESR)
• diseases w similar clinical features have been excluded
• duration of sympt is 6+ weeks

Question 31

drug therapy for RA

Answer 31

• DMARDs (disease modifying antirheumatic drugs): methotrexate 1st choice!
• corticosteroids, NSAIDS for sympt management

Question 32

OA
age of onset:
weight:
disease:
affected joints:
pain:
labs:

Answer 32

age of onset: usually over 40yrs
weight: usually overweight
disease: localized
affected joints: weight-bearing joints, asymmetrical
pain: subsides after 30 min of rising
labs: RF -‘ve; transient elevation of ESR in synovitis

Question 33

RA
age of onset:
weight:
disease:
affected joints:
pain:
labs:

Answer 33

age of onset: young to middle age (mostly women), may have a genetic component
weight: lost or maintained weight
disease: systemic-fever, fatigue
affected joints: small joints 1st, usually bilateral and symmetrical
pain: pain lasts 1 hr to all day; variable
labs: RF +’ve in 80% of clients, anti-CCP; elevated ESR & CRP

Question 34

what is the difference in bone impact btwn OA vs RA

Answer 34

OA: bone ends rub together
RA: swollen, inflamed synovial membrane