autoimmune dx

Question 1

rheumatoid arthritis (RA)

Answer 1

• chronic, systemic autoimmune dz
• inflammation of connective tissue in the synovial joints
• periods of remission and exacerbation
• can occur at any time, incidence increases with age

Question 2

causes of RA

Answer 2

• autoimmune
• *genetics
• smoking

Question 3

diagnosing RA

Answer 3

• H/P
• +rheumatoid factor
• ESR and CRP=active inflammation
• xray: for later disease

Question 4

RA classification criteria

Answer 4

• morning stiffness that lasts at least an hour
• polyarthritis
• arthritis in the wrist, or finger joints
• symmetrical arthritis
• positive rheumatoid factor
• radiological abnormalities of hands or wrist

Question 5

nonspecific s/s of RA

Answer 5

• fatigue
• anorexia
• wt loss
• generalized stiffness

Question 6

specific articular s/s of RA

Answer 6

• pain
• stiffness
• limited motion
• s/s inflammation

Question 7

extraarticular s/s of RA

Answer 7

• rheumatoid nodules
• Sjogren’s syndrome
• Felty syndrome
• pleural effusion, pericarditis, pericardial effusion, cardiomyopathy
• cataracts
• depression

Question 8

rheumatoid nodules

Answer 8

firm, non tender granuloma type masses locate over joints

Question 9

Sjogren’s syndrome

Answer 9

• diminished lacrimal and salivary gland secretion

- photosensitivity

Question 10

Felty syndrome

Answer 10

• splenomegaly

- leukopenia

Question 11

tx for Sjogren’s syndrome

Answer 11

• goal: to relieve symptoms
• dry eyes: artificial tears, eye lubricating ointments, or cyclosporine liquid
• dry mouth: H2O, chewing sugarless gum

Question 12

tx for RA

Answer 12

• rest
• joint protection
• heat/cold application

Question 13

systemic lupus erythematosus (SLE)

Answer 13

• multisystem inflammatory autoimmune dz
• chronic, unpredictable course
• periods of exacerbation and remission

Question 14

causes of SLE

Answer 14

• **unknown
• genetics
• hormones
• environment: sun exposure, infx
• drug reactions

Question 15

diagnosing SLE

Answer 15

• ANA, anti ENA
• complement system levels
• electrolytes
• renal function
• liver enzymes
• CBC

Question 16

diagnosing SLE

Answer 16

• SOAP BRAIN MD
• serositis
• oral ulcers
• arthritis
• photosensitivity
• blood dx
• renal dx
• antinuclear antibody test positive
• immunological dx
• neurological dx
• malar rash
• discoid rash

Question 17

general s/s of SLE

Answer 17

• fever
• malaise
• joint pains
• myalgias
• fatigue
• temp loss of cognitive abilities

Question 18

dermatological s/s of SLE

Answer 18

• cutaneous vascular lesions
• butterfly rash over cheeks
• oral/nasopharyngeal lesions
• alopecia

Question 19

musculoskeletal s/s of SLE

Answer 19

• arthritis
• polyarthralgia with morning stiffness
• swelling
• increased risk for bone loss and fx

Question 20

cardiopulmonary s/s of SLE

Answer 20

• increased RR
• cough
• dysrhythmias
• HTN
• increased cholesterol
• increased risk for clots

Question 21

renal s/s of SLE

Answer 21

• lupus nephritis
• proteinuria
• ESRD

Question 22

nervous system s/s of SLE

Answer 22

• sz
• peripheral neuropathy
• cognitive dysfunction
• depression
• psychosis
• HA

Question 23

hematological s/s of SLE

Answer 23

• anemia
• mild leukopenia
• thrombocytopenia
• excessive bleeding
• clot formation

Question 24

infection in SLE

Answer 24

• increased susceptibility to infx
• major cause of death
• avoid live virus vaccines

Question 25

tx of SLE

Answer 25

- NSAIDs, antimalarials - disease modifying anti rheumatic drugs - immunosuppresants - analgesics - lifestyle changes - renal transplant

Question 26

good prognosis for SLE

Answer 26

- early dx - prompt recognition of organ involvement - good therapeutic regimens

Question 27

fibromyalgia

Answer 27

- widespread, non articular musculoskeletal pain and fatigue | - multiple tender points

Question 28

etiology of fibromyalgia

Answer 28

- genetics - stress - central dopamine dysfunction - abnormal serotonin metabolism - deficient human growth hormone

Question 29

tender points

Answer 29

* palpation elicits pain - not all at a time - can change points throughout the day

Question 30

s/s of fibromyalgia

Answer 30

- burning, widespread pain - fatigue - tingling of the skin - prolonged muscle spasms - weak limbs - nerve pain - TMJ pain

Question 31

gout

Answer 31

- type of recurring acute arthritis | - accumulation of uric acid crystals in one or more joints

Question 32

causes of gout

Answer 32

- increase in urban acid production - underexcretion of uric acid - high purine diet will trigger

Question 33

high purine foods

Answer 33

- shellfish - lentils - asparagus - spinach - meats

Question 34

diagnosing gout

Answer 34

- serum uric acid level above 6mg/dL - 24 hour urine: decreased renal excretion vs overproduction - synovial fluid aspiration

Question 35

s/s of acute phase gout

Answer 35

- arthritis in one or more joints - joints are dusky or cyanotic - tenderness - podagra (inflamed great toe)

Question 36

s/s of chronic phase gout

Answer 36

- multiple joint involvement - tophi - kidney/urinary tract stones

Question 37

collaborative care of gout

Answer 37

- terminate acute attack: colchicine - prevent future attacks - diet and weight reduction: avoid etoh and purine - meds