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Patho Exam 4 > Arthritis > Flashcards

Arthritis Flashcards

1
Q

Rheumatoid arthritis

A

an inflammatory disease of exacerbations and remissions that attacks joints, but can also affect other tissues bc it is SYSTEMIC

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2
Q

Who is rheumatoid arthritis most commonly seen in

A

Women between 40 and 60 years old

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3
Q

Synovitis

A

membrane and synovial fluid become inflamed and damages the bone (seen in rheumatoid arthritis)

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4
Q

What causes rheumatoid arthritis?

A

no clear cause, but it has a genetic link and an immune-mediated response

“over activation” of the immune system where body produces antibodies agains itself

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5
Q

What can help prevent rheumatoid arthritis

A

if you block TNF or IL people tend to not have has many symptoms since the disease involves the activation of CD4 cells and production of cytokines

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6
Q

Explain the pathophysiology of Rheumatoid Arthritis

A

neutrophils, macrophages and lymphocytes are attracted to the area/joint where there are autoantibodies present

The autoantibodies are phagocytized and release destructive enzymes that attack joint cartilage and damage tissue

Inflammatory response follows= additional inflammatory cells come over = REACTIVE hyperplasia in the synovium

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7
Q

What does reactive hyperplasia during the inflammatory process of rheumatoid arthritis do?

A

causes vasodilation and increased vascular permeability = warmth, redness, and pain over joints

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8
Q

PANNUS

A

profusion of granulation tissue in rheumatoid arthritis = becomes destructive to the cartilage and underlying bone

** basically new blood vessels are formed in synovium = granulation tissue = PANNUS

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9
Q

What does PANNUS do in rheumatoid arthritis

A

spreads throughout the joint and causes deformity, reduced joint motion, and stiffness
**these destructive changes are irreversible

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10
Q

Manifestations of RA (Joints)

A

usually symmetrical and polyarticular
Involves fingers hands, wrists, feet, and knees
Pain and stiffness >30 min in AM
In the hand there is swelling and deformity of the proximal inter pharyngeal and metacarpophalangel joints)

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11
Q

Classic signs of RA

A

Swan neck deformity

Boutonniere deformity

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12
Q

Swan neck deformity

A

hyperextension of PIP joint with flexion of the DIP joint

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13
Q

Boutonniere deformity

A

flexion of the PIP and hyperextension of the DIP joint

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14
Q

Other joints involved in RA

A 
knee damage = genu valgum (knock knee)
ankles - interferes with walking
toes
rheumatoid nodules
neck discomfort
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15
Q

Systemic manifestations of RA

A

Elevated ESR
Anemia
Rheumatoid nodules in pressure points
Vasculitis (inflamed blood vessels) causes ischemia and ulcercerations of visceral organs (heart lungs GI)

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16
Q

S/Sx of RA

A

fatigue, weakness, weight loss, low grade fever, anorexia

17
Q

Rheumatoid Arthritis (other systemic manifestations

A

pulmonary disease
Cardiac disease (RA increases risk for MI or CHD)
Slceritis (vision probe)
Infection

18
Q

Rheumatoid Factor

A

lab test that can be done, but NOT A TEST FOR RA

you can have RF and not have RA or you can have RA and not have RF

19
Q

Anti-CCP (anti-cyclic citrullinated peptide antibodies)

aka ACPA

A

new test that helps diagnose RA = targets more specific autoantibodies that are seen in RA

20
Q

Tx of RA

A

DMARDS (disease modifying anti rheumatic drugs
NSAIDS
Corticosteroids
Exercises (keeps muscles around the joints stronger) with physical and emotional rest

21
Q

Osteoarthritis aka Degenerative Joint Disease (DJD)

A 
NOT SYSTEMIC (RA is)
MOST COMMON FORM OF ARTHITIS

weakening and breaking of collagen (d/t release of cytokines which release destructive enzymes)

Body is unable to repair the damage

22
Q

Primary osteoarthitis

A

localized or generalized involvement of joints with no obvious cause

23
Q

Secondary osteoarthritis

A

caused by congenital or acquired joint defects, trauma, metabolic disorders, or inflammatory diseases

24
Q

Pathology of osteoarthritis

A

articular cartilage is eroded and destroyed exposing the underlying bone = rubbing of “bone to bone”

25
Q

Osteophytes/spurs

A

new bone forms at edges of the affected joints when fragments of the bone are dislodged

*often overgrows and sticks out

26
Q

Frequent sites of OA

A

Hips
Knees
Lumbar and Cervical vertebrae
Hands and feet

***AKA WEIGHT BEARING JOINTS

27
Q

DX of OA

A

X-rays - can see if joint space is narrowed and osteophytes
NO lab tests
Synovial fluid analysis will be normal (in RA will probably be inflamed)

28
Q

Tx of OA

A 
Balance rest and exercise
Use heat and cold to control discomfort
NSAIDS
Corticosteroids
Viscosupplementation
Surgery/ joint replacement
29
Q

What is viscosupplementation

A

injection of sodium hyaluronate into joint to increase lubrication and mimic normal synovial fluid

30
Q

Gout

A

form of arthritis that refers to inflammation and accumulation of crystalline deposits in joints and other tissues = URIC ACID OR MONOSODIUM URAGE CRYSTALS DEPOSITED IN JOINT CAVITIES

31
Q

Primary gout

A

only termed this when the cause is unknown and mainly shows hyperuricemia (elevated uric acid levels in blood stream)

***NOTE MANY INDIVIDUALS HAVE HYPERURICEMIA but most do not develop gout

32
Q

Pathophysiology of Gout

A

monosodium urate crystals precipitate within joints and initiate inflammatory response (peripheral areas of the body)

Over time small hard nodules called microtophi accumulate in the synovial lining and joint cartilage

Inflammatory process continues and causes destruction of cartilage and bone

33
Q

Primary vs. Secondary Gout

A

Primary (90%) = enzyme defects d/t overproduction or inadequate elimination of uric acid crystals

Secondary = increased breakdown of nucleic acids (like what would happen for a tumor

34
Q

Tophi

A

repeated gout attacks lead to large hard nodules with irregular surfaces in synovium, helix of ear, elbow and achilles tendon

35
Q

Manifestations of Gout

A

Acute attacks
Monoarticular = only affect 1 joint at a time
Area = red, swollen, warm and EXTREMELY TENDER

36
Q

DX OF GOUT

A

Serum acid level of greater than 7.5 mg/dL
Incrased WBC and ESR during attacks
Uric acid excretion (24 hour analysis)
JOINT FLUID ANALYSIS = urate cystals (definative)

Patho Exam 4 (7 decks)

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