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What type of disorder is Gouty Arthritis
Purine metabolism disorder.
What disorder is hyperuricemia associated with? Define hyperuricemia. If you have hyperuricemia, does it mean will you get the disorder?
- - Gouty Arthritis
- - elevated serum uric acid levels
- - No.
What is the incidence of Gouty Arthritis? What body part is mainly involved?
male to female 20:1. over 40 y.o. 1st MTPJ
What is the etiology of Gouty Arthiritis?
- -family history in 50% of patients
- - infection, ETOH use, rich (high protein and purine) foods, injury, exposure to cold
What is the pathophysiology of gouty arthritis?
sodium monorate crytals accumulate in the synovial membrane. Leukocytes atttack the crystals, but release an enzyme that produces severe inflammation in the joint.
What are the signs and symptoms of gouty arthritis?
intense pain w/ increase AROM, marked tenderness, redness, and swelling. Possibly fever and cellulites (inflammation of overlying skin).
tophi: after attacks, not all crystals get reabsorbed, the residual crystal tend to form subcutaneous clusters aka tophi. Tophi can exist in the synovial membrane, cartilage, subchondral bone, synovial sheaths of tendons. Tophi develop in about 1/2 of people with gout.
What are the interventions of gouty arthritis?
avoid purine rich foods (organ meats, scrapple), anti-inflammatory drugs, and possible long term medications to control uric acid production in the body (people who over produce it)
It's either you make too much or your body can't get rid of it efficiently.
What is the etiology of sceroderma? course of disease?
- - unknown
- - course is variable and unpredictable
What is the incidence of scleroderma?
What is the signs and symptoms of scleroderma?
- - diffuse fibrosis and degenerative changes in skin, joints, and internal organs
- - thickening of skin in face and hands
- - cardiac / pulmonary probs: arrhthymias, pericarditis, lung fibrosus, pleurisy, and pulmonary hypertension.
- - polyarthralgias (joint aches)
- - GI disturbances and renal hypertension
What are the interventions of scleroderma?
- - steroids for acute episodes
- - meds for specific organ involvement
What is the etiology of fibromyalgia (fibromyositis)?
- - idiopathic (unknown)
- - factors: stress, trauma, other rheumatoid disorders, and injection
- - disturbed sleep cycles: less then normal "beta" sleep; body can't heal of the daily stress on tissues
What is the signs and symptoms of fibromyalgia (fibromyositis)?
- - achy, diffuse pain that "moves around" from one area or joint to another over time.
- - localized tenderness or spasm that may change location
- - pain provoked by overuse or activity
What are interventions of fibromyalgia (fibromyositis)?
- - may spontaneously resolve but can be chronic
- - aeobic exercise: gets rid of stress
- - anti-inflammatory drugs, analgesics used as needed
- - sleep disorders: SSRI's (anti-depressant); zoloft/paxil
- - local symptoms treated w/modalities, massage but you might "chase" them
What is the etiology of Paget's disease (osteitis deformans? it is inflammatory?
- - not truely inflammatory
- - unclear; could be viral orgin
- - disseminated bone disorder
What is the pathophysiology of Paget's disease (osteitis deformans)?
excessive osteoblast and osteoclast activity leading to huge bones, deformities, DJD, and pathologic fractures
What are the signs and symptoms of Paget's disease (osteitis deformans)?
- - thickening of tibia, femur, skull, pelvis, and vert. bodies
- - pain / functional limitations
What is the interventions of Paget's disease (osteitis deformans)?
- - meds for osteoclast activity
- - specific interventions (immobilization after a fracture)
What is systemic lupus erthematosus? Etiology?
- - chronic inflammatory connective tissue disease
- - unknown
What does systemic lupus erthematosus affect?
- - joints, kidneys, vessel walls
- - patients experience exacerbations and remissions
What is incidence of systemic lupus erthematosus?
What are the symptoms and complications of systemic lupus erthematosus?
- - fever, malaise, headache, polyarthralgias, malar butterfly erythema (butterfly rash on face)
- - lesions of skin of face, alopecia, pleurisy, pericarditis, CNS, renal disorders
What ar the interventions of systemic lupus erthematosus?
meds: immunosuppressive drugs, steriods, anti-inflammatories
Definition of an inflammatory disorder.
any disease or condition that involves inflammation
What are the signs of inflammation?
- - heat (warmth)
- - erythemia (redness)
- - swelling
- - pain (due to increase pressure of tissue from swelling)
- - loss of function
What are the causes of inflammation?
- - metabolic disorder
- - infection
- - disease process
- - trauma (macrotrauma / microtrauma)
Incidence of acute hematogenous osteomyelitis
- -usually children
- -more male
Etiology of acute hematogenous osteomyelitis
bacterial infection from abrasions, pimples, upper respiratory infections, local trauma to bone play a role in location
pathophysiology of acute hematogenous osteomyelitis. what does it mainly affect?
if untreated, pressure # in bones; development of subperiostial abscess; necrosis
puss increases pressure --> pain
spreads --> septic --> bloodborn infection
affects growing (metabollically active) bones in metaphyseal region
Signs and symptoms of acute hematogenous osteomyelitis
50% of time: local trauma, severe constant pain, tenderness, malaise, fever, soft tissue swelling on surface
Intervention of acute hematogenous osteomyelitis
antibiotics, rest, analgesics, surgical decompression (abcess, necrotic dead bone to remove it)
Complications of acute hematogenous osteomyelitis
bone destruction and septicemia, pathological fx, joint contracture, overgrowth or cessation of bone growth, death
Incidence of chronic hematogenous osteomyelitis
occurs when the acute version goes untreated
Pathophysiology of acute hematogenous osteomyelitis
sequestrum (piece of bone) maybe spontaneously extruded
Signs and symptoms of acute hematogenous osteomyelitis
creates draining sinus, PAIN, swelling, tenderness
intervention of acute hematogenous osteomyelitis
bed rest, antibiotics, surgical excision and. or drainage
complications of acute hematogenous osteomyelitis
chronic draining sinus, contracture, pathological fx, septicemia, malignant changes in epidermis
What is the goal of Tx for osteomyelitis?
patient is pain free and FWB
Where and who is osteomyelitis of the spine usually found?
younger children (lower TS/ upper LS) or in immunosuppressed individuals
signs and symptoms of osteomyelitis of the spine
pain, spasm, tenderness
interventions of osteomyelitis of the spine
antiobiotics, bed rest, excision, drain insertion
what is / Incidence of acute septic arthritis.
- -bacterial infection of synovial joint
- - children
etiology of acute septic arthritis.
associated w/hematogenous osteomyelitis if the metaphysis is intracapsular
pathophysiology of acute septic arthritis.
purulent exudate destroys cartilage, body forms pannus
what is pannus?
a sticky membrane that deprives nutrition, diffusion of synovial fluid
signs and symptoms of acute septic arthritis.
joint effusion, severe pain with weight bearing or movement, spasm, tenderness
what type of infection is osteomyelits and septic arthirits 2 degree to wounds?
what are the sources of exogenous infections?
- puncture wound
- open fx
- trauma that broke skin
- surgical technique that aren't sterile
intervention of osteomyelits and septic arthirits 2 degree to wounds
careful wound cleaning, debridement, drain; antibiotics
Signs and symptoms of tuberculosis osteomyelitis
back pain, tenderness, spasm
pathophysiology of tuberculosis osteomyelitis
progressive bone destruction, pathological fx
What other disease is tuberculosis osteomyelitis associated with and what is its symptoms?
- Pott's Disease
- spine kyphosis
Intervention of tuberculosis osteomyelitis
antibiotics for tuberculosis, surgery
complications of tuberculosis osteomyelitis
SCI (paraplegia), cauda equina syndrome (pressure on nerve roots), spread of abcess into pleura or psoas
Signs and symptoms of tuberculosis arthritis
pain esp with wt bearing and motion, swelling
pathophysiology of tuberculosis arthritis
pannus formation, synovial membrane hypertrophy forming an effusion, cartilage necrosis
intervention of tuberculosis arthritis
what is rheumatic disease? What is RA?
pain and stiffness in musculoskeletal tissue, include various forms of arthritis and skin diseases
inflammatory polyarthritis; cycles of exacerbation and remission; more cyles = more deformity progresses; disability progress
RA incidence? Usually involves what body part?
1.5% of adults; 3:1 female; age 20-40
distal joint first; symmetrical
not known; viral? exxagerated normal immune mechanism?
inflammation of synovial membrane, pannus formation, jt destruction (autoimmune response)
RA signs and symptoms
effusion, periarticular swelling, contractures/adhesion withing joint, fatigue, pain, stiffness, ruptured tendons
- pharmocological: corticosteroids
- protective positioning and splinting
- therapeutic exercise
- thermal agents
- surgery (synovectomy, arthroplasties, tendon repairs/grafts/transfers
- athrodesis in upper CS
- pauciarticular vs polyarticular
- systemic (joints and organ systems involved)
- intervention same as RA
what is Ankylosing spondylitis aka marie-strumpell disease
bony ankylosis of spine and proximal joints
incidence of Ankylosing spondylitis aka marie-strumpell disease
onset late teens and 20s
etiology of Ankylosing spondylitis aka marie-strumpell disease
genetic, unknown cause
pathophysiology Ankylosing spondylitis aka marie-strumpell disease
facet/iv joints become fused; bamboo spine; whole spine maybe fused
signs and symptoms Ankylosing spondylitis aka marie-strumpell disease
vague spine pain, spine pain at night, may feel temporarily better with exercise, tenderness; spasm
interventions Ankylosing spondylitis aka marie-strumpell disease
- pharmacological: corticosteroids
- orthopedic apliances: spinal brace (fuse in good posture)
- therapeutic exercise
- surgery: correction of deformity- spinal osteotomy and or reconstruction