Rheumatic Disorders Flashcards by Sydney Perry

rheumatic diseases are _____ diseases of the ________ tissue

chronic
connective

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rheumatic diseases are characterized by ________, pain, and degeneration

inflammation

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tissues that are affected by rheumatic diseases

joints
ligaments
tendons
cartilage
synovial membranes
skin

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Two categories of rheumatic diseases

Systemic, autoimmune rheumatic disease

Non-systemic osteoarthritis

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Systemic, autoimmune rheumatic disease examples

Rheumatoid arthritis, scleroderma, lupus, gout, fibromyalgia

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Non-systemic osteoarthritis examples

Osteoarthritis, bursitis, tendonitis

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Inflammation is a normal process:

Occurs to ___________ damaged tissues by _______________

Inflammation usually subsides after the tissue is healed/free of infection

protect & repair
moving blood & WBC to the site of injury

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Inflammatory diseases is when

Inflammation continues out of control and causes more damage rather than repair

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The inflammatory response is initiated by tissue injury

Release of _____, _____, _____, _____

initiates the ______________

histamine, prostaglandins, plasma proteases, cytokines

Arachidonic acid cascade

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The Arachidonic Acid cascade releases ________, ________, and ________

Prostaglandin E2
Thromboxane A2
Leukotriene B4

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what does Prostaglandin E2 do ?

pain, vasodilation

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what does Thromboxane A2 do?

platelet aggregation, vasoconstriction

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what does Leukotriene B4 do ?

attract WBC, inflammation

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Most prevalent form of osteoarthritis

Osteoarthritis (OA)

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Osteoarthritis is also called ___________________

Degenerative joint disease (DJD)

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Osteoarthritis is characterized by loss of ___________, __________, and ____________

OA _____(is/is not) an autoimmune disease

loss of articular cartilage
vascular congestion
osteoblastic activity (abnormal bone growth)

Not

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osteoarthritis results in _____ inflammation and destruction that is caused by joint overuse.
The OA is usually _____ in the body

can occur in ______, ______, _____, _____, and _____

cartilage
localized

knees
hips
ankles
spine
interphalangeal joints

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clinical manifestations of OA include pain that worsens when ___________
also ______ after periods of _______

weight bearing and activity

stiffness after periods of inactivity

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risk factors for OA

Obesity
Repetitive-use injury
Aging
Female gender
Caucasian
Greater bone density
Genetic factors

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pharmacologic therapy for OA

NSAIDS
Corticosteroids (stronger than NSAIDS & more side effects)

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NSAIDS side effects

decrease secretion in stomach = ulcers and bleeding
nausea

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examples of NSAIDS

ibuprofen
naprozen

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side effects of corticosteroids

calcium deficiency
raise blood sugar
hyperlipidemia
edema
hunger

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Treatment for osteoarthritis

Physical therapy

Massage therapy

Exercise=>non-loading aerobic; range of motion; strengthening exercises

Surgical treatment=> total joint arthroplasty

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MNT for osteoarthritis

weight loss to achieve desirable body weight

MNT for OA

Weight loss to achieve desirable body wt Well-balanced diet DRI for calcium & vitamin D ? Use of antioxidant supplements

Possible use of “____________” for MNT for OA

anti-inflammatory diet

Anti Inflammatory Diet - Aims for variety, with a whole foods, plant-based diet with minimal _________ foods - Increased fruits & veg - High in ________ and ______ FA; lower in ______ fatty acids - Low in SFA - Low in______________ and added _________

processed MUFA & omega-3 omega-6 refined CHO & added sugars

Complementary & Integrative Therapies for OA

Glucosamine & chondroitin sulfate

Glucosamine & chondroitin sulfate is involved in ________ production Sold as ______________ Unclear whether ____________ helps with OA pain ____________ may improve OA pain slightly in the short term No serious side effects

cartilage dietary supplements glucosamine Chondroitin sulfate

Chronic, autoimmune, systemic disease characterized by inflammatory changes in joints & related structures resulting in crippling deformities

Rheumatoid Arthritis (RA)

Rheumatoid Arthritis (RA) is Marked by periods of ______ and _______ More common in ______ Peak onset: age _______ yrs

flare-up & remission women 20-45

Pathophysiology of RA Unknown etiology Inflammation starts in the_________ and progresses to ___________ Small joints of extremities are the most affected=> __________________ _________ is a risk factor

synovial membrane joint cartilage interphalangeal joints of the hands & feet Smoking

Manifestations of RA Pain, stiffness, & swelling of joints Decline in function/ability to perform _______________ ______ syndrome=> __________=> ____________________ _________________ syndrome => _________________ Anorexia due to=> pain, fatigue, depression, FMI, & cytokines

activities of daily living (ADLs) Sjögren’s xerostomia dental decay, dysgeusia, dysphagia Temporomandibular joint syndrome (TMJ) pain and chewing issues

Rheumatoid Cachexia Characterized by loss of _______ and elevated ______ Excessive __________ due to_________ and by __________ Causes muscle weakness, loss of function, and may hasten morbidity & mortality

muscle mass REE muscle catabolism cytokines disuse atrophy

Goal of Pharmacologic Therapy for RA

control pain & inflammation

Different types of medications for RA and examples

NSAIDS & salicylates - aspirin Methotrexate: FDI=> inhibits conversion of folate to active form Corticosteroids Azathioprine (Imuran): FDI=> can cause N/V, loss of appetite, steatorrhea TNF-α inhibitors: adalimumab (Humira) => increases infection risk

Nutritional Assessment for RA Current disease _____ Past ______ & ______ history Food-medication interactions Laboratory values Weight ______ & anthropometrics Nutrition-Focused Physical Examination

status medical & surgical history

Diet history for nutrition assessment for RA should include... - Appetite - Assessment of usual _____ - Ability to prepare food &_______ - Chewing & ________ ability - _____ status - Modified diets - Supplement use; alternative therapies

intake feed self swallowing GI

Energy needs for RA _______ REE due to inflammatory process TEE is often________ in individuals due to decreased physical activity Need to assess individually

Elevated lower

Protein for RA Elevated whole-body protein catabolism For individuals who are poorly nourished or having a flare-up=> _______ g/kg

1.2-1.5

Individuals with RA are at increased risk for _____ Change the type of fat in the diet=> “_______________ diet”) ______ animal fat, SFA, & trans-fats _______ omega-3 fatty acids=> reduce inflammatory activity

CVD anti-inflammatory Decrease Increase

Antioxidants->________ May need _______ & ___________ supplementation Those on methotrexate=> _____________ supplementation daily

vit E calcium & vit D 1 mg folic acid

MNT for Rheumatoid Arthritis - Healthy diet with a variety of foods - Consider use of the “____________ diet” - TMJ: ___________ diet - Self-feeding: Adaptive feeding devices—referral to __________

anti-inflammatory easy-to-chew an occupational therapist

Complementary & Integrative Therapies for RA __________________ Can be converted in the body to _______________ May relieve______ and joint ________ side effects?

Gamma-linolenic acid (GLA) anti-inflammatory prostaglandins pain and joint stiffness no serious side effects

Note for RA GLA as alternative or integrative therapy some ____________ preparations contain ____________ that can cause________disease Only preparations that are labeled as "_______" should be used

borage seed oil pyrrolizidine alkaloids (PAs) liver PA-free

Gout is a disorder of ___________ metabolism Resulting in accumulation of high levels of ______ in the blood=> ________________ are formed and become deposited__________________ These deposits destroy_________ Affects ____ gender more Peak incidence is in the ______

purine uric acid monosodium urates in and around small joints joint tissue male 50s

Common sites of Gout? ____________ Characterized by a sudden & _____ onset of _______ pain generally beginning in the_______ and continues__________ __________ & __________ may occur

large toe, elbow, wrist & finger joints, and helix of the ear acute localized large toe up the leg Uric acid nephrolithiasis & renal disease

Risk Factors for Gout Hereditary _____ gender Age Obesity Excessive alcohol use Diseases: ____________________ Use of ______________________________

Male HTN, DM, hyperlipidemia, renal insufficiency thiazide diuretics (e.g., hydrochlorothiazide)

Medical management of Gout

Allopurinol Probenecid Colchicine NSAIDS

Allopurinol function

inhibits uric acid production

Probenecid function

increases excretion of uric acid via the kidneys

Colchicine is used to ______________

treat joint pain in acute flares

MNT for Gout Purines are found in a many ___________ Drugs have become the primary treatment and have replaced the “rigid” ________ diet because most ________ is produced endogenously Avoid foods high in _______

high protein foods low purine uric acid purines

MNT for Gout Well-balanced diet with limited intake of ____________ Increase consumption of fluids to at least_____ cups/d=>aids in the _______ Attacks can be precipitated by=> ________________ Limit/avoid alcohol (especially _______)=> increases _______ production During an acute flare=>avoid ___________

animal foods 8 excretion of uric acid excessive eating, drinking alcohol, exercise beer uric acid meat & alcohol

Some foods high in purines

Anchovies bouillon broth organ meats wild game goose gravy scallops sardines mussels herring mackerel roe meat extracts yeast taken as a supplement

MNT for Gout ______ restriction to promote gradual weight loss if overweight Limit consumption of ______ which increases serum uric acid levels

Calorie fructose

Systemic Lupus Erythematosus (SLE) is ...

Chronic inflammatory, connective tissue disorder Autoimmune disorder

Systemic Lupus Erythematosus (SLE) is characterized by periods of relapses and remissions The cause is multifactorial involving multiple ____________ and __________ factors Prevalence is greatest in ____________ More common in ___________

genes and environmental women of child-bearing age African Americans

Symptoms of SLE

Painful, swollen joints Extreme fatigue Muscle pain Sun sensitivity Skin rashes on the face Mouth ulcers

syndrome that can occur with SLE ? what organs are affected by SLE ?

Sjögren’s syndrome Raynaud’s syndrome Can affect organs: 1. Kidneys=>excessive protein excretion & renal failure 2. Pleurisy, pericarditis, primary pulmonary HTN

medical management of SLE

Corticosteroids NSAIDS Disease-modifying antirheumatic drugs (DMARDs)

Disease-modifying antirheumatic drugs (DMARDs) example

azathioprine (Imuran)

MNT for SLE Protein considerations: If on corticosteroids=> provide _______ If develops chronic kidney disease (CKD): If not on dialysis yet, restrict protein to _______ If on dialysis, provide ________ protein

1 g/kg 0.55-0.6 g/kg 1.0-1.2 g/kg

MNT for SLE Sodium & fluid=> may need to be___________ At risk for _________ deficiency Calories as needed to attain/maintain desirable body weight

restricted if renal disease vitamin D

Scleroderma is _____________________ characterized by _____________ Etiology: _________ with a ________ component More common in ________ Subtypes: ____________ ____________ cure ?

Chronic, systemic, sclerosis of the skin & visceral organs deposition of fibrous connective tissue autoimmune genetic women Localized - skin Systemic – skin and organs no cure

Manifestations of Scleroderma Widespread sclerosis of the skin & visceral organs with multisystem involvement _______ stiffness/pain ________ syndrome _______ syndrome _____________ _______ dysfunction Pulmonary _______

Joint Sjögren’s Raynaud’s Hypertension Renal fibrosis

GI manifestations of Scleroderma

GERD N/V/C/D dysphagia malabsorption loss of peristalsis small bowel bacteria growth weight loss malnutrition

MNT for Scleroderma - No specific diet - Individualize based on manifestations: _______________ for dysphagia ______ for xerostomia _______for GERD Use of _______, _______ supplements

Modify diet texture MNT MNT high-calorie, high-protein

MNT for Scleroderma If fat malabsorption: _______________ _________ nutrition if needed If malabsorption= ___________ End-Stage=> may need ___________ nutrition due to _________

40 g low fat diet Enteral semi-elemental formula parenteral GIT failure

Complementary & Alternative Therapies in Rheumatic Disorders are commonly used among patients with rheumatological diseases because: ______________ and ____________ Many therapies are _______; some may be __________; lack of ________

No cure for diseases Chronic pain unproven harmful regulation

Unproven Therapies in Rheumatic Disorders

Comfrey=> contains pyrrolizidine alkaloids that are toxic to the liver Alfalfa=> not recommended for auto-immune disorders

Rheumatic Disorders Flashcards

(72 cards)