Arthritis + Connective Tissue Patho

Question 1

Explain the patho of Osteoarthritis (OA)

Answer 1

Gradual joint cartilage loss
-osteophytes form
-Cartilage destruction
-Cartilage becomes dull, granular, less elastic

Question 2

Osteoarthritis
-what joints involved?
-Systemic?
-What kind of inflammation?

Answer 2

Synovial joints
Not systemic
Microscopic inflammation only

Question 3

Explain manifestations of Osteoarthritis

Answer 3

Pain worsens w/ activity

Joint stiffness, usually improves w/in 30 mins of waking up

Asymmetric, unilateral

Crepitus- grating sensation

Leads to loss of function

Question 4

Explain 3 leg deformities of Osteoarthritis

Answer 4

Varus: bowlegged- medial knee
Valgus: knock-kneed- lateral knee
Hip: one leg shorter

Question 5

Explain 2 finger deformities of osteoarthritis

Answer 5

Heberden’s Nodes: Distal finger joints, caused by osteophytes

Bouchard’s Nodes: proximal finger joints, appear red, swollen, tender

Question 6

How is mild to moderate joint pain of osteoarthritis treated?

Answer 6

Acetaminophen
Topical agents

Question 7

How is moderate to severe joint pain of osteoarthritis treated?

Answer 7

NSAIDS, start low, go slow
COX-2 inhibitor: Celecoxib
Misoprostol w/ NSAIDS

Question 8

What kind of meds can be given if osteoarthritis is not relieved by Acetaminophen, topicals, NSAIDS, or celecoxib?

What is a nursing consideration for this method?

Answer 8

Injected Corticosteroids
-do not give systemically- risk of avascular necrosis

Question 9

What kind of disorder is RA (Rheumatoid Arthritis)?

Answer 9

Autoimmune
-chronic, progressive
-inflammatory
-systemic

Question 10

Which gender is at a higher risk for RA?

Answer 10

Women (3:1)

Question 11

Explain the patho of RA

Answer 11

Immune Complexes (Rheumatoid Factor) form and deposit in synovial joints (hypersensitivity 3)

Neutrophil enzymes further damage cartilage and thicken synovial lining

Question 12

What is a pannus?

Answer 12

Thickened synovial membrane and damaged cartilage caused by neutrophil enzymes in RA

Question 13

Explain RA main manifestations

Answer 13

Symmetrical joints- BIL
-warm, swollen, tender, painful
-pain increases w/ motion
-morning stiffness 60+ mins

Question 14

Which finger/hand joints are most commonly involved in OA and RA?

Answer 14

OA: DIP, PIP
RA: PIP, MCP

Question 15

List joint manifestations/deformities seen w/ RA

Answer 15

Ulnar drift
Swan’s neck fingers
Boutonniere’s deformity
Hallux Valgus
Eventual subluxation/contractures

Question 16

How does RA eventually cause contractures?

Answer 16

Eventual subluxation and tendon destruction leads to contractures

Question 17

List 4 systemic effects of RA

Answer 17

Peripheral neuropathy
Rheumatoid Vasculitis
Pericarditis
Myocarditis

Question 18

What are some diagnostic lab criteria for RA?

Answer 18

Positive RF: 80% of cases
Increased ESR, CRP
Increased ANA indicates autoimmune
Cloudy, straw-colored synovial fluid

Question 19

What must be done before starting drug therapy for RA?

Answer 19

TB test, Chest Xray to rule out TB
-would be triggered by immunotherapy

Question 20

What med treatment is done first for RA

Answer 20

DMARDs- Slow disease progression and decrease joint deformity risk
-methotrexate

Question 21

What med treatment is done if DMARDs fail to help RA?

Answer 21

BRMs/Immunotherapy
-Slow progression and can be used in combo with DMARDs
-Tumor Necrosis Factor Inhibitor: Etanercept

Question 22

What should a patient taking pharmacologic treatment for RA report immediately?

Answer 22

Bleeding/bruising
Infection signs/fever

Question 23

What meds can be given for RA that do not slow the progression of the disease?

Answer 23

Corticosteroids: for flare-ups

NSAIDS

Question 24

Explain the patho of Gout

Answer 24

Purine metabolism can lead to hyperuricemia, which causes uric acid crystal deposits in 1+ joints

Crystals and inflammation form

Question 25

What is the primary risk factor for gout? What foods have high purine levels, therefore increasing the risk of gout?

Answer 25

#1: Genetics Purine foods: red/organ meat, shellfish, fructose

Question 26

Beyond genetics and high-purine foods, what are 3 additional risk factors for Gout?

Answer 26

High alcohol intake Metabolic Syndrome Meds that inhibit uric acid excretion or raise uric acid levels

Question 27

What meds inhibit uric acid excretion? What meds raise uric acid levels in a different way?

Answer 27

Loop/thiazide diuretics inhibit excretion Chemo can cause Tumor Lysis Syndrome- Elevates uric acid

Question 28

Where is the most common site of gout? What are some pain manifestations?

Answer 28

Great Toe Tender to light touch, onset at night, sudden/severe swelling and pain Low grade fever

Question 29

What are some triggers for a gout flare-up? How long does a flare-up typically last, regardless of treatment?

Answer 29

Trauma, surgery, alcohol, systemic infection 2-10 days

Question 30

When is gout classified as chronic? What can form?

Answer 30

Multiple joints involved Tophi: painless nodules filled w/ uric acid crystals Occurs years after onset

Question 31

How can gout cause infection?

Answer 31

Large crystal deposits may pierce skin

Question 32

What serum uric acid level is indicative of gout? How is a gout diagnosis fully confirmed (gold standard)?

Answer 32

>6 Synovial fluid aspiration

Question 33

Which med is given for an acute flare-up of gout?

Answer 33

Colchicine -anti-inflammatory- not direct analgesic -Pain relief in 12 hours -Aids in diagnosis -Short term use only -Leukopenia risk

Question 34

What med is given for maintenance/prevention of gout after a flare-up is treated with Colchicine?

Answer 34

Allopurinol -Xanthine Oxidase inhibitor -Decreases uric acid production

Question 35

What other things can allopurinol be given for?

Answer 35

Any problem caused by high uric acid -Uric acid renal stones -hyperuricemia from chemo/renal impairment -prevention of Tumor Lysis Syndrome

Question 36

How is lyme disease treated?

Answer 36

Antibiotics

Question 37

Explain the patho of SLE

Answer 37

Type 3 Hypersensitivity -overreactive T and B cells -Antinuclear Antibodies (ANA) attack all cells -Immune complexes settle in capillary basement membranes

Question 38

What are 4 general symptoms often seen before a SLE flare?

Answer 38

Weight loss Low-grade fever Excessive fatigue Joint pain

Question 39

How does SLE affect the MSK system?

Answer 39

Polyarthralgia w/ morning stiffness Diffuse swelling Swan neck fingers Ulnar Drift Subluxation Increased fracture/bone loss risk

Question 40

How can SLE affect the kidneys?

Answer 40

Mild proteinuria can become glomerulonephritis -scarring/permanent damage can become ESRD

Question 41

A positive ANA is present in ___% of SLE cases

Answer 41

97%

Question 42

What class of drugs can be helpful for SLE?

Answer 42

Antimalarial- hydroxychloroquine -Help w/ fatigue, inflammation, skin/joint manifestations -reduce flares

Question 43

What is the main goal of SLE treatment with immunosuppressive drugs?

Answer 43

Decrease end-organ damage

Question 44

Explain fibromyalgia

Answer 44

Chronic central pain disorder -burning, widespread, bilateral tender points -Most common in women- 40-75

Question 45

How is fibromyalgia diagnosed?

Answer 45

Exclusion 11/18 + tender points for >3months

Question 46

What condition can Zolpidem be helpful for?

Answer 46

Fibromyalgia