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Exam 4 > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What is rheumatoid arthritis?

A

A chronic systemic autoimmune disorder.

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2
Q

What is the most prevalent inflammatory arthritis?

A

Rheumatoid arthritis.

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3
Q

Where does the inflammation show up in RA?

A

In connective tissues, primarily in joints.

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4
Q

How does the course and severity vary in RA?

A

May have small symptoms, oral symptoms.

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5
Q

What is an autoimmune disorder?

A

The body attacks itself.

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6
Q

When does RA typically begin?

A

Third decade.

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7
Q

When dos RA typically peak?

A

70 yrs old.

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8
Q

What type of pain typically accompanies RA?

A

Chronic pain.

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9
Q

True or False.

RA contributes to disability factors.

A

True.

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10
Q

True or False.

RA does not shorten life expectancy.

A

False. RA DOES shorten life expectancy.

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11
Q

What type of alterations accompany RA?

A

Alterations in body image; deformed joints, stiffness, pain.

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12
Q

RA is typically an aberrant immune response in what type of host?

A

A genetically susceptible host.

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13
Q

What are rheumatoid factors?

A

Normal antibodies become autoantibodies, These transformed antibodies are known as rheumatoid factors.

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14
Q

What are leukocytes attracted to during RA?

A

The synovial membrane. (Membranes that surrounds joints)

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15
Q

What of patients with RA have rheumatoid factors?

A

80%

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16
Q

What does inflammation cause in RA?

A

Hemorrhage, coagulation, and fibrin deposits on synovial membrane.

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17
Q

What is Pannus tissue?

A

Abnormal tissue layer within synovial membrane.

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18
Q

What does the presence of pannus tissue lead to?

A

Greater loss of bone and cartiledge, and scar formation.

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19
Q

What does atrophy mean?

A

Waste away due to lack of use

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20
Q

What is the most common form of arthritis in older adults?

A

Osteoarthritis

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21
Q

Which gender does RA typically affect more?

A

Women

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22
Q

When will RA occur?

A

At any age.

Kids could go into remission and never get it again, adults will always have it, but can have “clinical remission”

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23
Q

What is the age of typical onset of RA?

A

Between 40-60 years of old.

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24
Q

When is RA remission most likely?

A

In the first year after DX

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25
Q

True or False.

The cause of RA is unknown,

A

True

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26
Q

Which is more rehabilitating? Regular arthritis or RA?

A

RA

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27
Q

What are the risk factors of RA?

A

-FAmily history of RA
-Femal gender
-Obesity
-Heavy smokers
-Risk can be reduced IF smoking stops
(Just because you lower risk factors it doesn’t mean you will not get RA)

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28
Q

What are the clinical manifestations of RA?

A
  • Joint deformity

- Redness, warmth, pain, swelling of affected sites

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29
Q

What are the clinical manifestations of RA during the ACTIVE phase (when joint inflammation is active)?

A
  • Fever
  • Anorexia
  • Fatigue
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30
Q

Why is RA described as a cyclical disease?

A

It has cycles of getting better and then worse,

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31
Q

How will the clinical manifestations of RA always present?

A

Bilaterally and symmetrical. (Although they may be in different stages)

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32
Q

What are signs of onset joint manifestations in RA?

A
  • Usually insidious
  • Possibly acute, following a stressor
  • Possibly following systemic manifestations of inflammation
  • Polyarticular, symmetrical
  • The development rate can fluctuate
  • Stiffness
  • Skin over affected joint may be red and shiny.
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33
Q

What does polyarticular mean?

A

Affects many joints.

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34
Q

How is stiffness in the onset of joint manifestations described?

A

More stiff in morning, lasting more than 1 hour.
May occur with prolonged rest during the day.
May get worse after strenuous activity.

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35
Q

What are the joint manifestations of RA in the hands and fingers?

A
  • Ulnar deviation (any change in the wrist)
  • Boutonnière deformity (large nodules)
  • Swan neck deformity (one hyperextended joint and one flexed joint)
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36
Q

Wrist involvement in RA is nearly what?

A

Universal. (Wrist is almost always involved)

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37
Q

What are the joint manifestations in knees?

A

Visible swelling, instability, atrophy in the quads (not bending knees anymore)

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38
Q

What can you test for to check for RA?

A

An significantly elevated erythocyte sendimentation rate (ESR) and elevated amount of C-reactive proteins (CRP) on blood test.

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39
Q

What are the joint manifestations in the ankles and feet?

A

Ambulation is limited due to pain and deformities.

  • subluxation (incomplete or partial dislocation of joint)
  • hallux valgas (bunion)
  • lateral deviation of the toes
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40
Q

What are the joint manifestations of the spine?

A

Usually limited to the cervical vertebrae and neurological complications.

41
Q

What are the extra articular manifestations of RA?

A
  • Systemic disease
  • Anemia of chronic disease (resistance to IRON therapy)
  • skeletal muscle atrophy (from disuse)
  • rheumatoid nodules
  • not an exhaustiive list
42
Q

What is resistance to iron therapy?

A

Bone marrow not taking in iron, therefore wont be making RBCs

43
Q

What are systemic affects of rheumatoid arthritis?

A
  • fever, weight loss, fatigue
  • enlargement of lymph nodes
  • arteritis (inflammation of blood vessels)
  • neuropathy
  • scleritis (inflammation affecting white outer coating of the eye
  • pericarditis (inflammation around heart muscle)
  • splenomegaly (enlarged spleen)
  • sjogren’s syndrome (DRY eyes, mouth, vagina)
  • raynauds syndrome (narrowing of small arteries, limiting blood flow to fingers and toes)
44
Q

How does RA increase risk of coronary heart disease?

A
  • RA has direct affects on blood vessels.
  • increased risk for Low LDLs, High cholesterol and triglycerides, HTN, High homocysteine levels
  • many RA drugs have damaging side effects: methotrexaide is a cancer drug (kills good and bad cells)
45
Q

How is juvenile idopathic arthritis described?

A
  • Chronic inflammatory autoimmune disorder
  • similar to RA but diagnosed in children
  • a little more prevelant in girls then boys
  • characterized by pain and joint inflammation
  • treatment similar to RA in adults
  • may be chronic OR may involve remission
46
Q

What percentage of those diagnosed with juvenile idiopathic arthritis will go into remission?

A

70%

47
Q

How many of 1000 children will develop juvenile idiopathic arthritis?

A

One.

48
Q

What are the complications for juvenile idiopathic arthritis?

A
  • eye chronic uveitis (inflammation of the middle layer of the eye)
  • interference with normal growth
  • bone growth disturbances
49
Q

When could juvenile idiopathic arthritis begin in children?

A

In preschool or puberty

50
Q

What can be used to help treat pain and inflammation in children as long as there is no evidence of the flu or chicken pox?

A

Aspirin. (Per MD order)

51
Q

What are the goals for RA treatment?

A

Relieve manifestations, interdisciplinary approach that includes a balance of rest and exercise, PT, and suppression of inflammation, joint replacement or joint infusion.

52
Q

What is Anti-CCP?

A

An autoantibody produced by the body’s immune system that attacks the body

53
Q

What are the dx tests for RA?

A
  • CBC
  • rheumatoid factor
  • ESR
  • CRP
  • Anti-CCP
  • synovial fluid examination
  • antinuclear antibody (ANA)
  • complement levels
  • X-rays of joints affected
54
Q

What are the results of a synovial fluid examination of a healthy person?

A

Yellow, clear.

55
Q

What are the results of a synovial fluid examination of a RA patient?

A

Yellow, cloudy.

56
Q

American college of Rheumatology: 4 of 7.

A

If patient has 4 of these 7 they have RA.

57
Q

What are the 7 things on the 4 for 7 test?

A
  • morning stiffness greater then one hr
  • arthritis of >three joint areas
  • arthritis of hand joints
  • rheumatoid nodules (on body prominence)
  • symmetric arthritis
  • Positive rheumatoid factor
  • radiographic changes
58
Q

What is a DMARD?

A

Disease modifying antirheumatic drugs

59
Q

What does a DMARD do?

A

Blocks inflammation and slows progression of disease. Reduces damage to bone and cartiledge.

60
Q

When should you use DMARDS?

A

Within first 2 yrs of diagnosis.

61
Q

What are the 4 types of meds for RA?

A
  • DMARDS
  • NSAIDs, ASA, COX-2 inhibitors
  • Corticosteroids
  • Antidepressants
62
Q

What are the 3 types of DMARD drugs?

A
  • Antimalarials, gold
  • Immunosuppressors
  • Bilogic response modifiers
63
Q

Other than RA, what is methotraxaide given for?

A

Abortion. :(

64
Q

When you discontinue DMARDS what will happen?

A

Rebound flare-ups.

65
Q

DMARD antimalarial MOA?

A

Relieves severe inflammation

66
Q

DMARD antimalarial Contraindications?

A

Hepatic or renal disease, alcoholism

67
Q

DMARD antimalarial AE?

A
  • retinopathy
  • anorexia
  • GI disturbances
  • loss of hair
  • agranulocytes
  • unusual skin pigmentation
  • thrombocytopenia
68
Q

When will the benefits to taking antimalarials finally show up?

A

By 6 months.

69
Q

How often do you take an antimalarial?

A

Weekly

70
Q

DMARD - immunosuppressor: Methotrexate MOA?

A

Immunosuppressor and antimitotic (prevents breakdown of cells)

71
Q

DMARD - immunosuppressor: methotrexate Contraindications?

A
  • hepatic and renal disease
  • infections
  • Blood dyscrasias
  • very young
  • very old
72
Q

DMARD - immunosuppressor: methotrexate AE?

A
  • hepatotoxicity
  • bone marrow suppression
  • malaise
  • fetal defects (X)
  • infections
  • sudden death
73
Q

What should you not take with methotrexate?

A

Vitamins with folic acid, PPI

Decreases clearance, causes build up of drug, Folic acid - reduces effectiveness

74
Q

What is important to get and monitor with methotrexate?

A

CBC, Liver and kidney function tests

75
Q

True or false.

It is important to stay well hydrated when on methotrexate.

A

True.

76
Q

DMARD - Bilogic response modifier drug?

A

Adalimumab

77
Q

DMARD - Adalimumab MOA?

A

Inhibits tumor necrosis factor which is a cytokine, thereby blocking the normal inflammatory and immune response controlled by TNF

78
Q

DMARD - Adalimumab Contraindications?

A

Active infection, neoplasticism disease,

CV disease, neuro disease, active or latent TB

79
Q

DMARD - Adalimumab AE?

A

Infections, fatigue, HTN, injection site irritation

80
Q

What should you NEVER give with Adalimumab?

A

LIve vaccines.

81
Q

How often do you take Adalimumab?

A

Weekly.

82
Q

How long until you see effects of taking Adalimumab?

A

12 weeks.

83
Q

COX - 2 (celecoxib) MOA?

A

No inhibition of COX-1; inhibits prostglandin synthesis by inhibiting COX-2.

84
Q

Celecoxib Contraindications?

A

Advanced renal disease, hepatic failure, anemia, GI bleed

85
Q

Celecoxib AE?

A

CV events, dizziness, sinusitis, edema, nausea, flatulence, diarrhea, rash

86
Q

Celecoxib special considerations include?

A

Monitoring for fluid retention(HTN and CHF); black tarry stools
Monitor CBC, LFT, BUN, creatinine

87
Q

Systemic Corticosteroid - prednisone MOA?

A

Suppress histamine and prostglandins; immunosuppressant and anti inflammatory

88
Q

Systemic corticosteroid - Prednisone contraindications?

A

Systemic infections, cataracts, peptic ulcer disease, osteoporosis, HTN, Renal disease.

89
Q

Should prednisone be given with food?

A

Yes.

90
Q

Why should you never abruptly withdraw corticosteroids?

A

While on the steroid, the adrenal gland has basically gone to sleep, you need to give them time to “wake up” and recover

91
Q

Do steroids raise or lower blood sugar?

A

Raise

92
Q

COX - 2 inhibitors increase risk of?

A

Heart attack or stroke.

93
Q

Systemic corticosteroids - prednisone serious AE?

A

Suppression of adrenal gland function, hyperglycemia, Cushing syndrome, mood changes, cataracts, peptic ulcers, hypokalemia, osteoporosis

94
Q

What can systemic corticosteroids like prednisone mask?

A

Infections. (Creates potential for existing infections to grow rapidly and undetected)

95
Q

What are some nonpharmacologic therapies for RA?

A
  • rest and exercise
  • physical and occupational therapy
  • heat and cold therapy
  • orthotic and assistive devices
  • nutrition
  • plasmapheresis and irradiation
96
Q

What is plasmapheresis?

A

A process that filters the blood and removes harmful antibodies.

97
Q

What are some complementary and Alternative therapies for RA?

A
  • Acupuncture
  • hydrotherapy
  • nutritional supplements: like fish oils
  • non traditional treatments such as diets, hormones, and plant extracts (costly and not shown to be effective.
98
Q

Assessment for RA includes?

A
  • healthy history, pain, stiffness, fatigue, joint problems, fever, sleep patterns, past illnessses, surgery, ability to carry out ADLs, physical assessment, height, weight, gait, joints, skin, respiratory, cardiovascular
99
Q

DX for RA?

A
  • Chronic Pain
  • Fatigue
  • Ineffective role performance
  • Disturbed body image
  • impaired physical mobility
  • Anxiety
  • Activity intolerance
  • Knowledge deficit

Exam 4 (13 decks)

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