Musculoskeletal System and Rheumatoid Arthritis Flashcards
(59 cards)
1
Q
Joints/Articulation
A
where two or more bones are attached
2
Q
Synovium
What does synovium produce?
A
Inner lining of joint capsule
- produces synovial fluid
3
Q
Synovial fluid
What does synovial fluid provide nutrient for?
A
slippery fluid that reduces friction b/w two oppossing bones
- pvds nutrients to joints/cartilage
4
Q
A
5
Q
Hyaline Cartilage
How does hyaline cartilage function?
A
glistening and white cartilage that covers the articular surface to absorb shock and allow smooth movement
- pvds lubrication aallows bones to move without sliding against each other
6
Q
Synovial Joints
A
freely moveable joining where opposing surfaces are covered with smooth layer of hyaline cartilage and are enclosed by a tough joint capsule
7
Q
Pannus
A
abnormal tissue growth in the joints
8
Q
Malalignment
A
Incorrect alignment of the joints
9
Q
RA Nodules
where cvan RA nodules also appear
A
small lumps of tissue under the skin, typically affecting fingers first
- can also appear on elbows, forearms, knees and back of the knee
10
Q
Synovectomy
A
surgery done by open incision or via laparoscopic procedure to remove synovium from joints with chronic inflammation
11
Q
Swan Neck Deformities
A
middle knuckle of a finger bends backward while the fingertip bends forward, resembling a swan’s neck
12
Q
Ulnar Deviations
A
Fingers start bending/deviating towards the pinky finger
13
Q
Sjogren’s Syndrome
A
develops in the presence of RA causing dry glands, affecting mouth, eyes, vagina
14
Q
Crepitus
A
grating sensation or sound that may occur when moving the affected joints
15
Q
Hyaluronic Acid
A
a natural substance that acts as a lubricant and shock absorber in joints
16
Q
Arthrocentesis (Joint Aspiration)
A
the joint is aspirated and tested for presence of uric acid crystals
17
Q
Hyperuricemia
A
high levels of uric acid in the blood
18
Q
kyphosis
A
outward curvature of the thoracic spine causing a humpback
19
Q
CSM
A
- Circulation
- Sensation
- Motion/Movement
20
Q
Atelectasis
A
reversible collapse of the lung
21
Q
How many bones are in the human body?
A
206
22
Q
Describe the following types of joints:
Amphiarthrosis
(Classification, Examples + Additional information)
A
Classification:
- Slightly moveable
Examples + Additional Info:
- In between vertebrae
23
Q
Describe the following types of joints:
Diarthrosis (Synovial Joints)
(Classification, Examples + Additional information)
A
Classification:
- freely moveable
- -> allow for greatest degree of movement
Examples + Additional Info:
Knee/Elbows
- Hinge Joints
only flexion/extension
Hip/Shoulders
- Ball & Socket
-> allow for: flexion/extension, abduction/adduction, & circumduction
24
Q
Describe the following types of joints:
Synarthrosis
(Classification, Examples + Additional information)
A
Classification:
- Immovable
Examples + Additional Info:
- Skull
25
What type of Arthritis is **Inflammatory/Autoimmune**?
Is it **Chronic** or **Temporary**?
Rhuematoid Arthritis
Chronic
26
What type of Arthritis is Degenerative/Degernerative Joint Dz?
Is it Chronic or Temporary?
Osteoarthritis
Chronic
27
What type of Arthritis is Inflammatory/Metabolic?
Is it Chronic or Temporary?
Gouty Arthritis
Temporary
28
What is **Rheumatoid Arthritis**?
Is **Rheumatoid Arthritis** Curable or Incurable?
- rapidly developing chronic autoimmune disorder caused by strong genetic factor
- Incurable
-> slow progression & relieve pain
29
What is the pathophysiology of **Rheumatoid Arthritis**?
- Synovium thickens in joint.
- inflammation (joint feels hot, warm, swollen).
- Fluid accumulates in the joint
-> → swelling, discomfort, pain.
- Pannus forms in the joint.
- Erosion of cartilage, and sometimes bone.
- Fibrous adhesions and calcifications form within the joint
- Malalignment, pain, and discomfort → may require surgery
30
What side of the body does **Rheumatoid Arthritis** Affect?
What joints are affect by **Rheumatoid Arthritis**?
Affects body **bilaterally**
- if unilateral = infection
**Joints Affected:**
- Fingers, Hands, Wrists
-> progress to:
- Ankle
- Spine
- Elbow
- Hips
- Knees
- Shoulders
31
What population does **Rheumatoid Arthritis** affect?
- Euro-American
- Adults (35-45)
- More Likely in Women
32
What are **Risk Factors** for **Rheumatoid Arthritis**?
- Autoimmune (genetic basis)
- Emotional Stress (trigger exacerbation)
- Environmental Factors
33
What are **Clinical Manifestations** of **Rheumatoid Arthritis**?
- Flu-like SXS
-> Fatigue (general malaise)
**Early SXS**:
- Sporadic (low grade) fevers
- Poor nutrition
-> weight loss (anorexia)
- Lymph node enlargement (r/t autoimmune disorder)
**Late SXS**
- RA Nodules
- Morning joint stiffness lasting several hours
- Anemia
- Ankylosis
34
What **deformities** can occur from **Rheumatoid Arthritis**?
- Swan Neck Deformities
- Ulnar/Radial Deviation
35
What **complication** can arise from **Rheumatoid Arthritis**? Describe the complication and what it can affect?
**Sjogren's Syndrome:**
- develops in the presence of RA causing dry glands
-> affecting mouth, eyes, vagina
36
What **Diagnostic Procesures** are used to diagnose **Rheumatoid Arthritis**?
**Hx & Physical**
**Labs**
- Rheumatoid Factor (RF)
- Anti-Nuclear Antibody (ANA) Test
- Erythrpocyte Sedimentation Rate (ESR)
- Electrophoresiss
- Immunoglobulins
- CBC
**EMG**
**Radiology**
- X-Ray
- CT/MRI
- Gallium Scan
37
# Diagnostic Procedures for Rheumatoid Arthritis
In regards to **Hx & Physical** for **Rheumatoid Arthritis**, what are you assessing for?
- Join pain/swelling
- Fatigue/Weakness
38
# Diagnostic Procedures for Rheumatoid Arthritis
In regards to **Labs** for **Rheumatoid Arthritis**, what labs are done/utliized?
**Rheumatoid Factor (RF)**
- positive for RA
**Anti-Nuclear Antibody (ANA) test**
- helps determine autoimmune disorder
-> if positive -> further reinforce RA DX
**Erythrocyte Sedimentation Rate**
- ⬆ = chronic inflammation
**⬆Electrophoresis**
- analyze changes in synovial fluids proteins
**Immunoglobulins**
- ⬆ levels
**CBC:**
- WBC ⬆- infection
- RBC ⬇ - anemia
39
# Diagnostic Procedures fro Rheumatoid Arthritis
What **Radiology imaging** is used for **Rheumatoid Arthritis**? What is each **Radiology imaging** used for?
**X-Ray**
- View joint space and deformities
**CT/MRI**
- closely examine soft tissue surrounding joints
**Gallium Scan**
- identify areas of inflamamtion
-> posstivie with inflammatory response
40
# Treatment for Rheumatoid Arthritis
Treatment for Rheumatoid Arthritis depends on ____ and ____ of ____.
labs and severity of SXS
41
# Treatment for Rheumatoid Arthritis
____ treatment is needed to prevent ____ damage
Aggressive; Irreversible
42
# Treatment for Rheumatoid Arthritis
What are the goals of treatment of **Rheumatoid Arthritis**?
- pain relief, decrease inflammation, promote quality of life
43
# Treatment for Rheumatoid Arthritis
In regards to **Rheumatoid Arthritis**, what medcaitions are utilized in the **Medciation Pyramid**?
**OTC Meds:**
- Aspirin
**NSAIDS**
**Remittive/Rheumatic Agents: DMARDS**
- Methotrexate
**Biologic Response Modifiers (BRM)/ Tumor Necrosis Factor**
- Adalimunab (Humira)
- Infliximab (Remicode)
- Etanercept (Enbrel)
44
# Treatment for Rheumatoid Arthritis
In regards to **OTC Aspirin**, what does it help with?
What is a risk of this medication?
- helps reduce inflammation
-> increases risk of GI bleeds
45
# Treatments for Rheumatoid Arthritis
In regards to **NSAIDS**, what does it help with?
What is a risk of this medication?
- Helps reduce inflammation and pain
-> icnrease risk fo GI bleeds
46
# Treatment for Rheumatoid Arthritis
In regards to **Remittive/Rheumatic Agents (DMARDs)**, what medication is used?
What are side effects/complications of this medication?
What should you monitor?
**Medication:**
- Methotrexate (form of chemotherapy)
**Side Effect/Complications:**
- Bone Marrow Suppression
- Hepatoxicity
- GI Side Effects
**Monitor:**
- SXS of infection
- decrease in CBC/WBC/PLT
47
# Treatment for Rheumatoid Arthritis
In regards to **Biologic Response Modifiers (BRM)/ Tumor Necrosis Factor**, what are they used for?
**Function:**
- used for more aggressive forms of RA due to higher risk of deformities
-> keeps patients in remission
48
# Treatment for Rheumatoid Arthritis
What **Glucocorticoids/Steroids** can be used for Rheumatoid Arthritis?
When would this medication be utilized?
**Medication:**
- **Prednisone** (fast actinging immonosuppresant/anti-inflammatory)
**Used for?**
- **ONLY** used for ***acute*** exacerbations or as chronic low-dose therapy when ***DMARDs are ineffective*** or not tolerated.
49
# Treatment for Rheumatoid Arthritis
In regards to **Prednisone**, what compliaction can come from this medication?
What patient education should be provide with the use of **Prednisone**?
**Complications:**
- Cushing Syndrome
- Peptic Ulcer DZ
-> ⬆ risk of GI bleed
- ⬆ rate of Osteoporosis
- Paper thin skin
- Diabetes
- Infection
- F/E imbalance
- HTN
**Patient Education:**
- Taper slowly
-> if abruptly ended: renal insufficiency
50
# Treatment for Rheumatoid Arthritis
When using **Prednisone** to treat for **Rheuamtoid Arthritis**, why should you taper off before a surgery?
What should you do **after** the surgery?
- Tapered off because Prednisone is an immunosuppresant -> cause delayed would healing
- Should be continued Post-Op to avoid exacerbations of DZ
51
# Treatment for Rheumatoid Arthritis
**Prednisone** can be taken ____ or ____ directly into joints
Orally; Injected
52
# Treatment for Rheumatoid Arthritis
Patients may require **multimodal pain management** for their **Rheumatoid Arthritis**. Describe what might be included in the following **methods** for **pain relief**:
**Analgesics**
**Nonpharmacologic Methods**
**Complementary Therapies**
**Psycosocial Support**
**Analgesics**
- APAP
- APAP w/ codeine
- oxycodone
- morphine
- methadone
- transdermal fentanyl
- NSAIDs
**Nonpharmacologic Methods:**
- Hot Therapy
-> after acute inflammation to decrease stiffness
- Cold therapy
-> during exacerbatiojn/acute inflammation
- Rest
- Positioning
- Splints
**Complementary Therapies:**
- Cupping
- Acupuncture
- Massage
**Pyschosocial Support**
- Self-Help/Support Groups
53
# Treatmetns for Rheumatoid Arthritis
How does **Self-Help/Su[pport Grouops** help provide pain relief?
What occurs when a patient with **Rheumatoid Arthritis** has increased stress and neglects their self care?
- helps develop positive coping mechanisms
- increased stress & neglectign self-care causes flare-ups and exacerbations of RA
54
# Interventions for Rheumatoid Arthritis
Chipper Snapper the 3rd recently got diagnosed with **Rhuematiod Arthritis**. What type of **dietary changes** should he make for this condition?
- ⬆ Protein & Calcium .
-> pvt anemia/osteoporosis
- eat small frequent meals
- take vitamin/iron supplements
55
# Interventions for Rheumatoid Arthritis
River the Beaver recently got diagnosed with **Rhuematoid Arthritis**. River is quite the active beaver, what **exercise education** might she need?
- ROM & joint strengthening important for mobility
- Weight bearing excercises
-> strengthens/supports muscles & joints
- Consult PT & OT
-> PT if joints are inflammed
--> may need splints to maintain functional position
- Conserve energy for activity participation
56
# Interventions for Rheumatoid Arthritis
Obu Obu is at risk for developing with **Rheumatoid Arthritis**. What **control modifiable factors** can cause the development/exacerbations of **Rheumatoid Arthritis**?
- Smoking
- Inactivity
- Poor Nutrition
57
# Interventions for Rheumatoid Arthritis
Chipper Snapper the 3rd's Rheumatoid Arthritis has gotten out of control. He feels as if his life has been completely affected by this disease. His doctor has recommended that he undergo surgery? What are Chipper's **surgery options** to treat his **Rhuematoid Arthritis**?
- Synovectomy
-> common in knee
- Joint Replacement/Total Joint Replacement
58
# MISC for Rheumatoid Arthritis
Generally speaking, what 3 D's does Rheumatoid Arthritis cause? How does this affect the body?
- Destruction, Deformity, Disability
-> limit ROM
59
T/F: Rheumatoid Arthritis is a rapidly developing chronic autoimmune disorder that only affects the joints.
**False**, RA is a chronic autoimmune disease that affects the joints and can impact multiple body systems
