RA 1,4,6,6.5

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bcb2127
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149596
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RA 1,4,6,6.5
Updated:
2012-04-24 11:54:12
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RA
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RA 1,4,6,6.5
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  1. (obj 1)
    __ __ radiological findings:
    1.asymmetrical cartilage damage with asymmetrical joint narrowing
    2.subchondral sclerosis (and cysts)
    3.osteophyte formation
    OA
  2. (obj 1)
    __ __ radiological findings:
    1. periarticular osteopenia
    2.erosion of the joint margin
    3.symmetrical loss of cartilage and joint space
    RA
  3. (obj 1)
    __ __: radiological findings
    1. SI joints narrow and eventually ankylose
    2. syndesmophytes which result from the ossfication of the annulus, PLL, and interspinal ligament. Progresses from lumbar spine superiorly. "bamboo spine"
    ankylosing spondylitis
  4. (obj 1)
    Stiffness/gel phenomenon:
    1. __ __: stiffness after a period of inactivity that is long lasting (morning stiffness >1hr)
    2. __ __: stiffness after a period of inactivity with gradual improvement after a short period of movement.
    3.__ __: stiffness after a period of inactivity that improves with physical activity or exercise but not rest.
    • 1.RA
    • 2. OA
    • 3.AS
  5. (obj 1) "______" is a subjectively reported symptom and may not represent loss of range or resistance to PROM. In other words, a person mey report stiffness, but a PROM examination couls show joint laxity.
    -The "___" phenomenon describes stiffness with a time component added. For example, when the person with hip OA sits for too long, and then they stand up, they will experience stiffness, but it goes away after they have walked a few feet. A critical diagnostic distinction between OA and RA, is that in RA a person's morning stiffness would last >1hr.
    • Stiffness
    • gel phenomenon
  6. (obj 1)
    Swelling in RA is not the same as edema. Differentiate between RA swelling and edema (3 causes for edema)
    • 1. RA: caused by synovial hypertrophy (pannus), and by joint effusion (increased synovial fluid)
    • 2. Edema: caused by venous insufficiency, lymphadema, and trauma
  7. (obj 1)
    __ __: ligament and joint capsule not directly involved
    __ __: ligament and joint capsule are directly affected
    • OA
    • RA
  8. (obj 1) there is a bunch of stuff about what happens at each joint RA vs OA and I don't feel like putting it in here because it is relatively stupid
    it is. i mean it.
  9. (obj 4)
    1. _____ _____: 70% of persons with RA will be (RF) positive; 90% of persons with Sjorgrens will be (RF) positive.
    2._____ ____ (ANA): systemic lupus erythematosis: 99% of persons with SLE will be ANA positive.
    3. ____ _____ ____ (HLA B27): ankylosing spondylitis: 90% of persons with AS will be HLA B27 positive; 80% of persons with Reactive Arthritis will be HLA B27 positive.
    4. _____ ____ ____ (determined by synovial aspiration): gout or pseudogout.
    5. __ __ __ levels: elevated in gout and infective arthritis (determined by synovial aspiration); normal in RA, but can be elevated during inflammatory phase; leukopenia in SLE
    • 1.Rheumatoid Factor
    • 2.Antinuclear Antibodies
    • 3.Human leukocyte antigen HLA-B27
    • 4.Uric Acid Crystals
    • 5.WBC levels
  10. (obj 4)
    Gout is caused by elevated serum uric acid. Definitive diagnosis is done by joint aspiration to detect the presence of ___ ___ ____ and elevated _____.
    • uric acid crystals
    • WBC's
  11. (obj 4) Lab tests to monitor the _____ of a rheumatic condition that is already diagnosed. THese tests are most useful as serial measurements to track the ocurse of the disease, especially in active inflammation.
    1. _____ _____ ____ (ESR): for RA and polymyalgia rheumatica
    2. _____ _____ (CRP): for RA and polymyalgia rheumatica
    3. ______ _____ (CK or CPK): muscle destruction in polymyositis, dermatomyositis
    • status
    • 1.Erythrocyte sedimentation rate
    • 2.C-reactive protein
    • 3.Creatin kinase
  12. (obj 6)
    1. 3 meds commonly prescribed for OA?
    2. When pain does not respont to these analgesics, may progress to (2)
    • 1.NSAIDs, Cox-2 inhibitors, acetaminophen
    • 2.weak opiods and intraarticular injectoins
  13. (obj 6)
    ______: in the U.S. it is available OTC, so there is not a standardized preparation, however there have been several studies suggesting there may be improvements in OA pain and function.
    glucosamine
  14. (obj 6.5)
    ______: prior to DMARDS and BRM, these were the mainstays for treatment of RA. They have a low therepeutic index and result in serious impairments when used long term. Currently only used as a bridge to allow time for newly initiated regiment to begin to take effect. Only treat symptoms.
    Corticosteriods
  15. (obj 6.5)
    ____ _____ __-____ drug: takes from one to four months to begin to achieve a therapeutic effect, so corticosteriods are used as a bridge until onboard. Typically given enterally, but some may be parenteral. Immunosuppressants.
    Disease Modifiying Anti-rheumatic Drugs (DMARDS)
  16. (obj 6.5)
    ____ ____ ____: newer, more expensive, and have parenteral route of administration either by IV or subcutaneously. Given simultaneously with DMARD.
    Biologic Response Modifiers (BRM)
  17. (tool kit) What kind of Drugs?
    *methotrexate (Rheumatrex)
    *cyclophosphamide (Cytoxan)
    azathioprine, (Imuran)
    *cyclosporine (Neoral)
    DMARDS
  18. (tool kit) What kind of drugs?
    etanercept (Enbrel)
    inflixamab (Remicade)
    Biologic Response Modifiers (BRM)
  19. (tool kit) What kind of drugs?
    prednisolone (Prelone)
    prednisone (Deltasone)
    dexamethasone (Decadron)
    hydrocortisone (Cortef)
    cortisone (Cortone)
    methylprednisolone (Medrol)
    Corticosteriods
  20. (tool kit) What kind of drugs?

    naproxen (Naprosyn)
    piroxicam (Feldene)
    diflunisol (Dolobid)
    ibuprofen (Advil, Motrin, Nuprin, others)
    indomethacin (Indocin)
    NSAIDS
  21. (tool kit) what kind of drug?

    allopurinol (Lopurin) [taken daily as preventive agent]
    colchicine [taken PRN to handle intermittent flares]
    gout agent
  22. (Tool kit) SE's of Corticosteriods
    1. Immune system:
    2.Integumentary: delayed wound healing, bruising
    3.GI: peptic ulcer, gastritis
    4.Muscular:
    5.Cardiovascular:
    6.Metabolic:
    7.Skeletal:
    8.Optic:
    9.Pediatric:
    • 1.immunosuppression
    • 2.delayed wound healing
    • 3.peptic ulcer
    • 4.myopathy
    • 5.congestive heart failure
    • 6.hyperglycemia
    • 7.osteoporosis
    • 8.glaucoma
    • 9.retarded growth

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