Rheumatoid Arthritis 2 (Week 12)

Question 1

side effects of RA

Answer 1

fever
rash
lymph node enlargement
spleen enlargement
malaise
Raynaud's

Question 2

Rheumatoid nodules cause

Answer 2

excessive esudate escapes from the joint capsule and forms nodules in the region of the joint

Question 3

where do rheumatoid nodules most commonly occur

Answer 3

dorsum of hands

Question 4

Tx of RA

Answer 4

minimize inflammatory and immune processes

joint replacement

Question 5

OT and PT goals for RA patients

Answer 5

• maintain joint ROM and muscle strength
• maintain independence in daily fxn
• modify activities to minimize stress and avoid continued joint destruction

Question 6

best OT/PT interventions when not in a flare

Answer 6

heat application
ROM exercise
mild/moderate physical activity
pool exercise (warm pool)
splinting to prevent further contracture

Question 7

best OT/PT interventions during a flare

Answer 7

cold application
rest affected joints
NO EXERCISE

Question 8

vasculitis

Answer 8

inflammation of vascular endothelium

Question 9

adenopathy

Answer 9

swollen lymph nodes

Question 10

pathologies involved in RA

Answer 10

vasculitis
neurologic dysfunction
cardiopulmonary disease
splenomegaly
adenopathy

Question 11

what percent of the population has RA

Answer 11

1%

Question 12

what is the peak age for RA

Answer 12

7th decade

Question 13

genetic predisposition for RA?

Answer 13

genetic predisposition that requires an environmental trigger

Question 14

gender and RA

Answer 14

age 15-45: more women (6:1)

after 60: equal genders

Question 15

other diseases associated with RA

Answer 15

smoking
pulmonary disease
epstein barr
e. coli
periodontal disease

Question 16

what happens at the affected joint in RA

Answer 16

• chronic inflammation of synovial tissue
• inflammation of synovial tissue forms pannus, which invades cartilage and bone
• pannus destroys cartilage and bone

Question 17

rheumatoid factors

Answer 17

autoantibodies in the IgM or IgG class

• present in blood of all RA patients
• bind to synovial membranes to form immune complexes

Question 18

anticitrullinated protein (ACPA)

Answer 18

antibody produced by patients with RA

-typically present before symptoms are present

Question 19

RA progression at synovial membrane and articular cartilage

Answer 19

• inflammation of the synovium causes movement of leukocytes into the tissue
• immune complexes promote inflammation

Question 20

how do immune complexes promote inflammation at joint

Answer 20

• proinflammatory cytokines (TNF, IL-1, IL-6) promote release of more free radicals and hydrogen peroxide
• macrophages cause production of prostaglandins and other cytotoxins

Question 21

what is used to treat RA

Answer 21

TNF inhibitors (biologic DMARDs)

Question 22

janus kinase

Answer 22

hastens maturation and activity of leukocytes in the area

Question 23

what is released at joint in RA

Answer 23

janus kinase
histamines
kinins
leukocytes
prostaglandins
free radicals
hydrogen peroxide

Question 24

how does RA damage joint structure

Answer 24

• swelling of articular cartilage & synovial membrane
• swollen synovial membrane puts pressure on small vessels and other joint structures
• causes decreased BF to joint
• decreased BF causes hypoxia and acidosis (carbon dioxide levels increase)

Question 25

what does acidosis cause in the joint

Answer 25

stimulate the release of hydrolytic enzymes from synovial cells

Question 26

what do hydrolytic enzymes do

Answer 26

erode articular cartilage and inflame tendons and ligaments | -they break down just about anything

Question 27

joints most commonly affected in RA

Answer 27

``` fingers feet wrists elbows ankles knees ```

Question 28

areas less commonly affected in RA

Answer 28

``` shoulders hips cervical spine lungs heart kidney ```