Unit 6: Chapter 50

Question 1

Rheumatoid Arthritis

Answer 1

Systemic inflammatory disease
More females are affected, increases with age
Uncertain but point to a genetic predisposition and the development of joint inflammation that is immunology mediated
T cell mediated trigger to a microbial agent, which causes a release of cytokines (TNF)

Question 2

Pannus

Answer 2

Contributes to advance,ment of RA.
Destructive vascualr gransulation tissues that extend from the synovium to involve a region of unprotected bone at the junction between cartilage and subchondral bone.

Question 3

Treatment of RA

Answer 3

to prevent and/or reduce the pain, decrease stiffness and swelling, maximize mobility, and possibly halt the pathologic process.
The treatment plan includes education about the disease and its treatment, rest, therapeutic exercises, and medications.

Question 4

Systemic Lupus Erythematous

Answer 4

chronic inflammatory disease that can affect virtually any organ system, including the musculoskeletal system. It is a major rheumatic disease.
Prevalence is related to gender, race, age, and genetics.
more common in females (85% of cases) than in males; is more common in African Americans, Hispanics, and Asians than in Caucasians; most cases occur between the ages of 15 and 44.
Cause is unknown

Production of a wide array of autoantibody’s against nuclear and auto plasmin cell components
Has B cell hyperactivity and increased production of antibodies against self and nonself antigens

Question 5

SLE Manifestations

Answer 5

disease has been called the great imitator because it has the capacity to affect many different body systems, including the musculoskeletal system, skin, cardiovascular system, lungs, kidneys, central nervous system (CNS), and red blood cells and platelets
onset may be acute or insidious,course is characterized by exacerbations and remissions.
Most common: arthralgias and arthritis
Joint pain, skin lesions rash on nose and checks

Question 6

Antinuclear Antibodies

Question 7

Antinuclear Antibodies (ANA)

Answer 7

High levels are found with untreated SLE.
Common test for this is: imminofluorescense test
Not specific to SLE, as high levels may be found in healthy people or with other disease

Question 8

Systemic Sclerosis/Scleroderma

Answer 8

is an autoimmune disease of connective tissue characterized by excessive collagen deposition in the skin and internal organs such as the lungs, gastrointestinal tract, heart, and kidneys.
the skin is thickened through fibrosis, with an accompanying fixation of subdermal structures, including the sheaths or fascia covering tendons and muscles.
Rare disorder
Correct action between autoantibodies of scleroderma and HLA-DQBI. Both humoral and cellular immune system abnormalities.

Question 9

Scleroderma Mainfestations

Answer 9

CREST

C stands for calcinosis.
R equals Raynaud phenomenon.
E is esophageal dysmobility.
S equals sclerodactyly.
T stands for telangiectasias.

Question 10

Osteoarthritis

Answer 10

Degenerative joint disease
Can be primarily or secondary related to congenital or acquired defects that affects the destruction of joint stress
Most prevalent form of arthritis, leading cause of pain in older adult
Inflammatory and degenerative aspect.
Intrinsic defect int he articular cartilage that cause joint narrowing, subchondrakl bone thickening and painful joint.

Question 11

Osteoarthritis manifestation

Answer 11

Most common area: knee
may arise suddenly or insidiously.
Initially, the pain is aching and may be somewhat difficult to localize.
Worsens with use or activity and is relieved by rest. In later stages: night pain may be experienced during rest. Pain can occur at rest, several hours after the use of the involved joints.
Crepitus and grinding may be evident when the joint is moved.
Advances disease: even minimal activity may cause pain because of the limited range of motion resulting from intra-articular and periarticular structural damage.

Question 12

Crystal Induced Arthropathies

Answer 12

Metabolic bone and joint disorders result from biochemical and metabolic disorders that affect the joints.
Crystal deposition in joints produces arthritis.
In gout, monosodium urate or uric acid crystals are found in the joint cavity.
Another condition in which calcium pyrophosphate dihydrate crystals are found in the joints sometimes is referred to as pseudogout or chondrocalcinosis.

Question 13

Gout

Answer 13

Pro typers of crystal induced arthropathies

Acute attacks of arthritis occur with gout and are characterized by the presence of monosodium urate crystals in the joint.
accompanied by hyperuricemia, which results from overproduction of uric acid or from the reduced ability of the kidney to rid the body of excess uric acid. Management of acute gout is directed first toward the reduction of joint inflammation, after which the hyperuricemia is treated.

Question 14

Hyperuricema

Answer 14

High uric acid levels
End production of purine metabolism
>7mg/dL males and > 6mg/dL in females
Component of gout but not all people will develop gout

Question 15

Reactive Arthropatheis (Arthritis)

Answer 15

may be defined as sterile inflammatory joint disorders that are distant in time and place from the initial inciting infective process.
The infecting agents cannot be cultured and are not viable once they reach the joints.
The list of triggering agents is continuously increasing and may be divided into urogenic, enterogenic, and respiratory tract associated, and the idiopathic arthritides.
Reactive arthritis also has been observed in people with acquired immunodeficiency syndrome.
SpA such as Reiter syndrome and psoriatic arthritis are more severe

Question 16

Reiter Syndrome

Answer 16

Clincal manifestation of reactive arthritis
Develops in a genetically susceptible host after a bacterial infection (STI).

Question 17

Ankylosing Spondylitis

Answer 17

Chronic, inflammatory autoimmune arthritis disorder causing pain and stiffness of the spine and neck

Question 18

DMARDS (disease modifying anti rheumatic drugs

Answer 18

Management of RA

such as methotrexate, sulfasalazine, and leflunomide should be considered early in those with active disease.
Methotrexate is indicated in psoriatic arthritis and significant psoriasis.
TNF inhibitors are indicated when there is an inadequate response to indicated DMARDs, NSAIDs, or steroid injections.

Question 19

Poly myalgia Rheumatica

Answer 19

Inflammatoryry conditon IIa of unknwon origin
Charcterixed by aching and morning STIffness in the should and pelvic areas
One of the more difficult to dignose
Female are at risk
Diagnose is pain for 1 month and elevated ESR and good respsone to small does of prednisone.