Rheumatic diseases

Question 2

What are rheumatoid diseases?

Answer 2

Rheumatoid diseases are chronic inflammatory disorders, mostly autoimmune in nature, affecting the musculoskeletal system, especially synovial joints.

Question 3

How are rheumatoid diseases classified?

Answer 3

They are classified under musculoskeletal disorders (MSDs) and often involve connective tissue, joints, and organs.

Question 4

What does the musculoskeletal system consist of?

Answer 4

The musculoskeletal system allows body movements and consists of bones, muscles, joints, ligaments, tendons, and cartilage.

Question 5

What are common features of rheumatic diseases?

Answer 5

Autoimmune reactions, inappropriate functioning of the immune system, inflammatory joint damages, and diseases of other supporting structures and organs. (connective tissues, vasculitis)

Question 6

What medical specialties treat musculoskeletal disorders?

Answer 6

Medical specialties include orthopaedics, traumatology, rheumatology, and physiatry.

Question 7

What is rheumatology?

Answer 7

Rheumatology is a narrow specialization field of internal medicine.

Question 8

What are examples of rheumatoid diseases?

Answer 8

Rheumatoid Arthritis, Ankylosing Spondylitis, Arthritic Psoriasis, Reactive arthritis, Lyme disease, Muscle rheumatism, Infectious arthritis, Osteoarthritis, Gout, Sjögren’s Syndrome, Fibromyalgia.

Rare rheumatic diseases.
Polymyositis, Systemic Sclerosis, Mixed Connective Tissue Disease (MCTD), Vasculitis, and Lupus (SLE).

Question 9

What is rheumatoid arthritis (RA)?

Answer 9

RA is a chronic autoimmune disease where the immune system attacks the synovial membrane, leading to joint inflammation, destruction, and potential disability.

Question 10

What are the characteristics of rheumatoid arthritis?

Answer 10

RA is symmetrical, more common in women, and often affects small and medium joints.

Question 11

What is a prerequisite for diagnosing rheumatoid arthritis?

Answer 11

A prerequisite for the diagnosis of rheumatoid arthritis is arthritis.

Question 12

What are the signs and symptoms of rheumatoid arthritis?

Answer 12

inflammation in several joints, joint swelling, morning stiffness, tenderness during movement, fatigue, lack of appetite, mild fever, weight loss, and rheumatoid nodules.
Malpositions are possible in the later stages of the disease.

Question 13

What joints are initially affected in rheumatoid arthritis?

Answer 13

Initially affects MCP, PIP, MTP joints, and wrists.

Question 14

What are the cornerstones of treatment for rheumatoid arthritis?

Answer 14

Early diagnosis, long-term medication, rehabilitation, multi-professional care, and patient education & support.

Question 15

What are the risk factors of rheumatoid arthritis?

Answer 15

Unknown cause, hereditary predisposition, smoking (primary environmental factor), more common in women, associated with increased cardiovascular risk.

Question 16

What are the pharmacological treatments for rheumatoid arthritis?

Answer 16

DMARDs: Methotrexate, Sulfasalazine, Hydroxychloroquine; Glucocorticoids: Prednisolone (oral/injections); Cortisone joint injections; NSAIDs: Ibuprofen, Naproxen; Biologics if other medications dont help: Rituximab, Infliximab; Pain meds: Paracetamol, Tramadol; Calcium and vitamin D supplements (increased risk of osteoporosis)

Question 17

What are the non-pharmacological treatments for rheumatoid arthritis?

Answer 17

Rehabilitation: Physiotherapy, occupational therapy; Exercise (including water aerobics); Heat/cold treatment, laser therapy, TENS (Transcutaneous Electrical Nerve stimulation); Underwater ultrasound therapy; Assistive devices (splints, supports); Dietician and psychosocial support; Surgery in severe cases.

Question 18

What are the pharmacological treatments for rheumatoid diseases?

Answer 18

Same as RA: DMARDs, biologics, pain management (paracetamol, antidepressants, tramadol), NSAIDs (two different NSAIDs should not be used at the same time), muscle relaxants, glucocorticoids to reduce inflammation, antirheumatic medicines.

Question 19

What are the non-pharmacological treatments for rheumatoid diseases?

Answer 19

Physiotherapy; Occupational therapy; Psychological support; Diet and weight management; Education and rehabilitation programs.

Question 20

What are the short-term treatments for rheumatoid diseases?

Answer 20

Symptom relief (NSAIDs, cortisone).

Question 21

What are the long-term treatments for rheumatoid diseases?

Answer 21

DMARDs, biologics, lifestyle changes, prevention of joint damage.

Question 22

What are some examples of antirheumatic medicines?

Answer 22

Methotrexate, Sulfasalazine, Hydroxychloroquine, Leflunomide, Azathioprine

Question 23

What is the typical onset time for antirheumatic medicines to take effect?

Answer 23

1-6 months

Question 24

What are common side effects of antirheumatic medicines?

Answer 24

Nausea, stomach upset, rash, changes in blood counts, increased liver values, kidney changes

Question 25

What is required for the usage of antirheumatic medicines?

Answer 25

Regular blood samples (follow-up blood tests 'safety blood samples')

Question 26

What are some specific side effects of antirheumatic medicines?

Answer 26

GI upset, nausea, liver or kidney damage, blood count changes, rash, infections due to immune suppression Regular blood monitoring is essential.

Question 27

What is known about the prevention of rheumatoid arthritis (RA)?

Answer 27

No known definitive prevention for RA

Question 28

What are some preventive measures for rheumatoid diseases?

Answer 28

Smoking cessation, early detection and treatment to prevent progression, healthy lifestyle, avoiding infections, vaccinations, avoiding environmental triggers

Question 29

What is monoarthritis?

Answer 29

Inflammation of 1 joint

Question 30

What is oligoarthritis?

Answer 30

Inflammation of a few joints (less than 5)

Question 31

What is polyarthritis?

Answer 31

Inflammation of several joints

Question 32

What are some aspects of clinical examination for rheumatoid diseases?

Answer 32

Joint swelling, redness, temperature, muscle and joint sensitivity to pressure, joint movement limits, skin/nail changes (nail appearance, rash, hematoma), overweight, auscultation of heart and lungs, palpation e.g. temporal arteries,

Question 33

What are signs of inflammation in rheumatoid diseases?

Answer 33

Swelling, fever, redness, pain, functional impairments

Question 34

Clinical interview for rheumatoid diseases

Answer 34

Joint pain history, Onset type ,Fatigue, fever, weight loss, Family history, Other underlying conditions and medications

Question 35

How can rheumatoid diseases be diagnosed and tested?

Answer 35

Diagnosis involves laboratory tests and imaging examinations. ## Footnote Laboratory tests include ESR, CRP, basic blood count, rheumatoid factor, HLA tissue typing, anti-CCP, anti-nuclear antibodies, and synovial fluid examination. Imaging tests include X-rays, ultrasound, MRI, CT, video capillaroscopy, angiography, and dual-energy CT.

Question 36

What laboratory tests are used for diagnosing rheumatoid diseases?

Answer 36

ESR, CRP (inflammation), basic blood count (leukocytes, thrombocytes, hemoglobin), rheumatoid factor (RF), HLA tissue typing, anti-CCP (citrulline atinbodies), anti-nuclear antibodies (ANA, ANCA), and synovial fluid examination.

Question 37

What imaging examinations are used for diagnosing rheumatoid diseases?

Answer 37

X-rays of bones and joints, ultrasound examination of the joints, MRI, CT, video capillaroscopy, angiography (for vasculitis), and dual-energy CT (for gout).

Question 38

How can rheumatoid arthritis be diagnosed and tested through result readings?

Answer 38

Findings in Rheumatoid Arthritis * Blood samples indicate elevated erythrocyte sedimentation rate (ESR, lasko in Finnish) and elevated CRP (not always). * Approximately 2/3 of patients with recently diagnosed Rheumatoid Arthritis have a positive rheumatoid factor or anti-citrulline antibodies in blood samples →Strongly indicate rheumatoid arthritis, but those are not prerequisites for a diagnosis. * White blood cells in synovial fluid. ## Footnote Key findings include elevated ESR and CRP, positive RF or anti-CCP, increased WBC in synovial fluid, MRI, X-rays showing joint erosion, and ultrasound imaging.

Question 39

What are the diagnosis criteria for rheumatoid arthritis?

Answer 39

clinical signs (swollen joints, stiffness), positive RF or anti-CCP, elevated ESR/CRP, increased WBC in synovial fluid, MRI, and X-rays showing joint erosion early in disease.Ultrasound imaging of joints Imaging examinations (X-ray) for hands and foot, thorax (Lungs, chest cavity), cervical spine if needed.

Question 40

What is the care path for a patient with rheumatoid arthritis?

Answer 40

Early examinations in primary health care, referral to a rheumatology clinic, early diagnosis leading to immediate treatment, at home self-care and lifelong medication and monitoring, and periodic follow-up visits, first in specialized medical care and imaging then primary health care (e.g. follow-up blood tests) ## Footnote Follow-ups include imaging and blood tests.

Question 41

What assessments are made for a patient with rheumatoid arthritis?

Answer 41

Pain, mobility, fatigue, medication adherence, blood tests, and signs of infection.

Question 42

What nursing interventions are important for a patient with rheumatoid arthritis?

Answer 42

Administering medications, monitoring side effects, supporting ADLs and mobility aids, educating on symptoms, medications, and lifestyle, and coordinating follow-ups.

Question 43

What is the care path for patients with rheumatoid diseases?

Answer 43

Multi-professional support and long-term follow-up with lifestyle adaptation.

Question 44

What assessments are conducted for patients with rheumatoid diseases?

Answer 44

Musculoskeletal evaluation and assessment of physical, emotional, and social status.

Question 45

What nursing interventions are recommended for patients with rheumatoid diseases?

Answer 45

Encourage physical activity, prevent falls, promote joint protection, control pain, provide nutrition support, and offer psychological support.

Question 46

What patient education is important for those with rheumatoid diseases?

Answer 46

Disease knowledge (nature and prognosis), medication adherence and monitoring, joint protection techniques, healthy nutrition, weight control, smoking cessation, exercise plans, emotional and social support access, managing fatigue, and sleep hygiene.

Question 47

What self-management information is crucial for patients with rheumatoid arthritis?

Answer 47

Understanding RA and its treatments, guidance on medication and follow-up blood tests, side effect awareness and reporting, nutrition and weight control, self-monitoring joint symptoms, pain coping strategies, physical activity guidance, infection prevention, vaccination updates, using assistive tools properly, stress management, support groups, avoid Intoxicants especially tobacco, prevention of cardiovascular diseases and self-monitoring of mouth, teeth, feet, skin, and eyes.