-
systemic autoimmune rheumatic diseases are considered _____ disorders
are considered chronic disorders
-
examples of systemic autoimmune rheumatic diseases
- - rheumatoid arthritis [RA]
- - systemic lupus erythematosis [SLE]
-
systemic autoimmune rheumatic diseases are characterized by?
- - diffuse inflammatory vascular lesions [inflammation of blood vessels]
- - degeneration of connective tissue
-
incidence of rheumatoid arthritis
1/100, slow onset
-
ration of women to men that are affected with rheumatoid arthritis
2-3 : 1 women : men
-
peak onset age for rheumatoid arthritis is?
30-50 yo
-
risk factor for rheumatoid arthritis
smoking
-
what percentage of people have the rheumatoid factor [RF]
80 %
-
what is the rheumatoid factor
it is an antibody to self antigens that are being identified as foreign in the body - IgG, IgM, with altered amino acids
-
what percentage of healthy people have the rheumatoid factor [RF]
1-5 percent
-
pathology of synovial membrane
- - growth of new blood vessels "panus" that extend from the synovium to articular cartilage
- - inflammatory cells in pannus destroys adjacent cartilage and bone which is irreversible
-
bouchard's nodes
- occurs in the hand of a person with RA, the joints swell to the side and pull slightly apart
- - can be painful
-
types of joint deformities in RA
- - ulnar drift
- - swan's neck
- - nodes
- - muscle wasting
- - hip and leg deformities
-
what is ulnar drift
- - found in RA
- fingers tend to bend toward the ulnar side of the wrist [bend away from thumb]
-
what is sawn's neck
- found in RA
- - some joints will hyper-extend and bend in one direction and then another
-
treatment of RA
- - rest [physical and emotional]
- - physical therapy [ROM] [more passive instead of weight bearing]
- - assistive devices
- - education
- disease modifying agents
- - antiinflammatory agents
-
antiinflammatory agents for RA include [prescribed]
- - NSAIDs
- - corticosteroids
- - gold
- - immunosuppresion
- - minocycline [antibiotic]
-
which prescribed antiinflammatory causes more problem in pts with RA
corticosteriods
-
antiinflammatory agents for RA [OTC]
- - gamma linolenic acid
- - Capsaicin [zostrix]
-
Capsaicin [Zostrix]
- - OTC agent used for RA
- - used to relieve pain
- - decreases substance P which increases pain
-
disease modifying antirheumatic agents [DMARD]
- has antiproliferative effects which stop structural damage
-
name a few disease modifying antirheumatic agents
- - low-dose methotrexate
- - leflunomide [arava]
- - entanercept [enbrel]
- - adalimumab [humira]
-
facts about RA and taking etanercept [enbrel] and adalimumab [humira]
- - binds to TNF, prevents receptor interaction
- - can use with methotrexate
- - 2x weekly enbrel or 2x monthly with humira
-
osteoarthritis
- - also know as "degenerative joint disease" [DJD]
- - 1/3 by age 60
- - loss of articular cartilage
- - NO inflammation in initial stages
- - joint pain, stiffness that last less then 30 mins, instability, deformity
- - secondary synovitis > mild
- - weight bearing joints, ASYMMETRICAL, bas of the thumbs and fingers
-
primary osteoarthritis due to
- unknown etiology
-
secondary osteoarthritis due to
- due to injury, wear and tear, obesity
-
treatment of OA
- - weight loss
- - acetaminophen for pain
- - corticosteriod injections in joint [only for less then 3 years - may accelerate joint destruction]
- - surgery [arthoscopic lavage, total joint replacement]
- - hyaluronate injections [hyalgan] - compund that's similar to the hyaluronic acid in the body
- - synvisc [inject into the synovial bag to widen the joint a bit - last about 3 months]
- - high dose folat/b12
- - glucosamine, chondrotin
[OTC, helps widen the joint and fill with fluid again]
|
|