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Flashcards in Arthritis Deck (49):
1

List use, mechanism of action, potential side effects for medications used for arthritis: NSAIDs

Use: OA, RA, sprains, inhibition of heterotopic ossification Mech: inhibits COX Side Effects: GI upset, peptic ulcers, renal function, excessive bleeding

2

List use, mechanism of action, potential side effects for medications used for arthritis: COX-2 inhibitor

Use: OA, RA, sprains, inhibition of heterotopic ossification Mech: inhibits COX-2 Side effects: renal and possibly cardiac function

3

List use, mechanism of action, potential side effects for medications used for arthritis: glucocorticoids

Use: RA, systemic lupus erythematosus, gout, inflammatory diseases Mech: inhibits many inflammatory mediators Side effects: wt gain, bone/muscle loss, hyperglycemia

4

List use, mechanism of action, potential side effects for medications used for arthritis: methotrexate

Use: RA, seronegative arthritis Mech: inhibits adenosine metabolism side effect: pneumonitis, leukopenia, liver disease, infection

5

List use, mechanism of action, potential side effects for medications used for arthritis: Sulfasalazine

Use: RA, seronegative arthritis Mech: inhibits B cell activity side effects: bone marrow suppression, rash, hepatitis

6

List use, mechanism of action, potential side effects for medications used for arthritis: anti-TNF therapy

Use: RA, psoriatic arthritis, ankylosing spondylitis Mech: inhibits tumor necrosis factor (TNF) Side effects: infection, heart failure, possibly lymphoma

7

List use, mechanism of action, potential side effects for medications used for arthritis: antimalarials

Use: RA, lupus Mech: inhibits enzyme activity Side effects: eye changes and vision loss

8

List use, mechanism of action, potential side effects for medications used for arthritis: gold

Use: RA Mech: inhibits WBC activity Side effects: anemia low WBC, count, lung diesase proteinura

9

List use, mechanism of action, potential side effects for medications used for arthritis: minocycline

Use: RA, reiter syndrome Mech: inhibits metalloproteinase Side effects: hepatitis, lupus like reactions

10

List use, mechanism of action, potential side effects for medications used for arthritis: colchicine

Use: gout, psuedogout Mech: inhibits microtuble

11

List use, mechanism of action, potential side effects for medications used for arthritis: leflunomide

Use: RA psoriatic arthritis Mech: inhibits IMP, diarrhea, liver tocidity, HTN

12

Describe characteristic signs and symptoms of RA:

Symmetric arthritis of small joints of the hands (sparing DIPs), wrists, feet, and knees that is associated with morning stiffness. Rheumatoid nodules as well as serum rheumatoid factor may be evident. X-ray changes. Symptoms >6 wks

13

X-ray changes present in RA:

- periarticular osteopenia first - erosions may develop at joint margins - loss of joint space, malalignment, and progressive osteopenia

14

Who may be affected by RA?

1% of population. May begin at any age, most common in women of childbearing years and elderly men/women. Genetic influences

15

Describe joint pathology in RA:

Chronic thickening and edema of synovial lining; underlying connective tissue cells become activated to invade and destroy cartilage and bone at joint margins - pannus formation

16

Most common hand and wrist deformities with RA:

1.) swan neck deformity (flexion at DIP, ext at PIP) 2.) boutonniere deformity (ext DIP, flexion PIP) 3.) ulnar deviation at MCPs 4.) flexion, radial deviation, and subluxation at wrist 5.) extensor tendon rupture at wrist

17

Name the types of juvenile RA

- pauciarticular: involving < = 4 joints

- poly articular: similar in nature to adult RA

- systemic onset with fever, arthritis, rash, and other organ involvement

18

what is the prognosis for patients with RA?

variable: 50% will be disable from work within 10 yrs, 2/3 have significant trouble with ADLs after 15 yrs; severe may die within 10-15 yrs

19

Define rheumatoid factor:

antibody

20

Does RA effect the spine?

synovium of odontoid proocess of C2 and the transverse ligament that holds C2 and C1 may become involved and cause erosion leading to instability. Pain and myelopathy may develop

21

Physical therapy treatments that are helpful for RA?

Acutely inflamed: Heat, rest, splinting to avoid contracture Decreased inflammation: isometric exercise, ROM, strengthening ex, parafin, TENS

22

Orthopedic procedures that are most often used for RA involving wrist and hand:

- synovectomy - arthrodesis (joint fusion) - soft tissue reconstruction - arthroplasty

23

What is the Darrach procedure?

excision of the distal ulna often accompanied by synovectomy and extensor tendon repair when needed

24

What is systemic lupus erthematosus?

multisystem inflammatory disease that may cause fever, fatigue, rash, cytopenia, renal disease, serositis, lung disease, nervous system change, joint pain, and other problems

25

Is lupus diagnosed by the presence of antinuclear antibodies (ANA)?

99% of lupus patients have this, but there is a 30-40% false positive rate, lupus is a clinical diagnosis

26

Musculoskeletal problems arising from lupus:

arthralgia and arthritis, osteonecrosis, tendinitis and tendon rupture, fibromyalgia, steroid myopathy, polymyositis

27

Describe typical lupus arthritis:

- arthralgias are most common, without visible swelling - when inflammation is present it is typically in the small joints of the hand - not erosive but may see some swan neck or jaccound's arthropathy

28

Name the seronegative arthropathies:

ankylosing spondylitis, reiter syndrome (reactive arthritis), psoariatic arhtritis, arthritis associated with inflammatory bowel disease

29

List the clinical features that the seronegative arthropathies share:

- enthesitis (inflammation at sites of insertions of tendons and ligaments into bone) - sacroilitis and other axial involvement - Asymmetric, peripheral pauciarticular inflammatory arthritis - extra articular disease involving GI or genitourinary systems, skin, and eye - association with HLA-B27

30

what is Reiter syndrome?

seronegative arhtritis that is triggered by infection typically chlamydia, shigella, or yersinia

31

Ankylosing spondylitis vs mechanical LBP?

age of onset: late teens to 20s vs any age Timing of onset: insidious nontraumatic vs sudden/traumatic pain with rest: increased vs decreased pain with activity: decreased vs increased stiffness: ++++ vs + or - less than 15 min

32

Treatments for ankylosing spondylitis

- education and exercise - extension exercises 3x/day swimming recommended, posture, and sleeping with out a pillow to prevent kyphosis - NSAIDs for pain and inflammation, mexatrexate and sulfasalazine

33

Describe x-ray changes in ankylosing Spondilitis

- erosion, sclerosis, pseudo widening, ultimate fusion of SI joints, squaring helement pins

34

what causes gout?

aculumation of uric acid crystals in synovial joints. Polymorphonuclear leukocytes are attracted to the joint, try to engulf the crystals, and release digestive enzymes and proinflammatory mediators

35

What causes pseudogout?

Calcium pyrophosphate crystals initiate inflammation

36

How can the crystal types in gout and pseudogout be distinguished?

Examination of synovial fluid under a microsope

37

Phases of gout:

- asymptomatic hyperuricemia (elevated serum uric acid level) - acute gouty arthritis - intercritical gout (asymptomatic between episodes) - chronic gout (tophi, deposits of uric acid)

38

Describe a typical episode of acute gout:

sudden onset of severe burning pain often in the middle of the night, usually involving the first MTP. WB'ing or even wt of sheets may be unbearable. Joint is red and swollen, hot to the touch. Resolve in 7-10 days. May be percipitated by alcohol consumption, trauma, surgery, or immobilization

39

Joints other the first MTP effected by gout:

any joint can be effected, but most commonly affected are the knee, ankle, midfoot, wrist, and hand.

40

what are tophi?

painless lumps in chronic gout often seen at the olecranon, fingers, toes, or outer ear

41

How is acute gout treated?

cold packs, NSAIDs, local injection or oral administration of cortiocosteriods. Colchicine is not recommended generally.

42

Can gout be diagnosed by an elevated serum uric acid level?

No. Made by examination of joint fluid

43

Differential Dx for a single red hot joint?

infection (most serious) r/o with synovial fluid test, acute gout, hemarthrosis, pseudogout, RA, seronegative arthropathy, tumor, pigmented villodular synovitis

44

Clinical signs of infected total joint prostheses:

acute infection, wound dehiscence or drainage, inflammation (pain, redness, swelling, heat), loosing of the joint

45

Infected joint arthoplasties are treated by:

early on with aggressive lavage and intravenous antibiotics, if not caught the joint must be removed and extensive antibiotic treatment ensues before a new replacement can be put in

46

How common is OA?

prevalence increases with age: >80% of people >75 yrs of age

47

Pathological changes with OA:

thinning and damage to articular cartilage, subchondral bone sclerosis, marginal bone and cartilage growth as osteophytes, periarticular muscle wasting

48

Which joints are commonly involved with OA:

DIPs and PIPs, Hips, lumbar spine, knees, feet (first MTP)

49

Treatments able to stop progression of OA?

No, a few studies suggest minocycline may slow the progression of OA, glucosamine sulfate may increase joint space in OA knees