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NURS 2514 > Week 10 - Rheumatoid Arthritis > Flashcards

Week 10 - Rheumatoid Arthritis Flashcards

(48 cards)

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1
Q

what is rheumatoid arthritis

A
  • chronic, systemic autoimmune disease

- characterized by inflammation of CT in synovial joints

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2
Q

what are risk factors of RA (6)

A
  • can occur at any age, but more common in 60+
  • female
  • genetic
  • smoking
  • obesity
  • stress
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3
Q

what types of stress might contribute to RA (5)

A
  • recent infection
  • surgery
  • childbirth
  • emotional upset
  • oevrwork
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4
Q

what is the cause of RA (2)

A
  • unknown

- genetic factors (most)

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5
Q

describe the genetic component of RA

A
  • most people w RA have a circulating antibody called “rheumatoid factor”
  • RF binds to other antibodies (IgG) and can form immune complexes which become trapped in the joints & removed by the inflammatory response
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6
Q

what is RA cause by RF called

A
  • seropositive arthritis
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7
Q

what 4 things does the inflammatory response during RA lead to

A
  • enzymatic breakdown of cartilage & subchondrial bone
  • synovial angiogenesis
  • synovial cell proliferation
  • pannus formation
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8
Q

what is synovial angiogenesis

A
  • new blood vessels growing into the synovium
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9
Q

what is pannus formation

A
  • abnormal tissue growth in the joints
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10
Q

what causes pannus formation

A
  • the synovial angiogenesis & proliferation makes the blood thick, rough, and irregular = pannus formation
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11
Q

what symptoms does RA begin with (4)

A

generalized symptoms

  • fever
  • fatigue
  • anorexia
  • weight loss
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12
Q

what happens as the disease progresses regarding symptoms

A
  • they become more localized to joints
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13
Q

what are the acute symptoms of RA that are localized to the joints (4)

A
  • bilateral inflammation
  • stiffness
  • pain/aching
  • limited ROM
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14
Q

what are signs of inflammation during RA (4)

A
  • redness
  • heat
  • swelling
  • tenderness
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15
Q

what makes the pain worse in RA

A
  • activity
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16
Q

where does RA commonly effect (5)

A
  • proximal interphalangeal joint (PIP) & metocarpalphalangeal joint (MCP) hands)
  • wrists
  • knees
  • feet
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17
Q

describe the stiffness in RA

A
  • morning stiffness can last anywhere from 1 hr - several hours
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18
Q

what are acute manifestations of RA characterized by

A
  • exacerbations & remission
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19
Q

what 2 other manifestations occur w acute RA

A
  • vasculitis

- rheumatic nodules

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20
Q

what are rheumatic nodules

Study These Flashcards
A
  • lesions at pressure points
21
Q

what are chronic manifestations of RA (3)

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A
  • subluxation of joints (dislocation)
  • muscle wasting
  • deterioration of tendons & ligaments
22
Q

what does the deterioration of tendons and ligaments lead to (2)

Study These Flashcards
A
  • joint instability

- deformity

23
Q

what are 4 types of joint deformitys that can occur w RA

Study These Flashcards
A
  • ulnar drift
  • boutonniere deformity
  • hallux valgus
  • swan-neck deformity
24
Q

what is ulnar drift

Study These Flashcards
A
  • fingers drift towards the ulna
25
what is boutonnier deformity
- called "hitch hikers thumb" if it occurs in the thumb | - flexion of the fingers at the PIP joint, where they can not straighten out
26
what is hallux valgus
- drifting of the big toe laterally
27
what is swan-neck deformity
- binding at base of the finger, hyperextension of PIP joints, with flexion of the DIP (i recommend looking up a picture)
28
what are ways to diagnose RA
- history - physical findings - positive RF - elevations in ESR and c-reactive protein
29
what do elevation in ESR and c-reactive protein indicate
- inflammation
30
what are complications of RA (6)
- joint destruction - flexion contractures & hand deformities - nodular myositits - muscle fiber degeneration - cataracts & loss of vision - later, cardiopulmonary effects
31
what are 4 types of treatments for RA
- NSAIDs - glucocorticoids - DMARDS - TNF antagonists
32
what are DMARDS
- disease modifying antirheumatic drugs
33
what is a type of non-biologic DMARD used for RA
- methotrexate
34
what is the MOA of methotrexate
- causes immunosuppression | - reduced activity of B and T lymphocytes that are attacking the joints
35
describe the effectiveness & onset of methotrextate
- fastest acting DMARD (works in 3-6 weeks) | - 80% will improve w this drug
36
what should be taken w methotrextae? why (2)
- folic acid | - to reduce GI and liver toxity
37
what is a contraindication for methotrexate
- highly teratogenic
38
what are s/e of methotrexate (5)
serious toxicities of the: - GI tract - bone marrow - liver - lungs - kidneys
39
what should be monitored during treatment of RA with methotrexate
- LFTs (liver fnxn test) - renal function test - CBC
40
what are TNF antagonists
tumor necrotic factor antagonists
41
what is one type of TNF antagonist used for RA
- infliximab
42
what is infliximab r/t DMARDs? what does this mean?
biologic DMARD | = targets specific cellular components of the inflammatory process
43
what is the MOA of infliximab
- antibody that binds to & neutralizes TNF
44
what is infliximab often given with? how is it adminsitered?
- often w methotreate but can be alone | - given IV
45
what are 2 main side effects of infliximab
- immune suppression | - infusion rxn
46
what should you monitor regarding the s/e of immunosuppression w infliximab
- increased risk of infection | - dose should be held iif acute infection is present
47
what are signs of an infusion rxn (5)
- flu-like symptom - headache - fever - GI disturbances - hypotension
48
what can you use to treat the infusion rxn
- tylenol | - antihistamine

NURS 2514 (75 decks)

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