1. Polymyositis
    • -difuse inflammatory diseas of skeletal muscle
    • -symmeetric weakness and atrophy
    • -women 30-60 most susceptible
    • -may involve skin, rash (liliac rash
    • -may also have polyarthritis, polyarthalgia, periorbital edema
    • -malignant neoplasms ar ecommon
    • -difficulty swollowing due to muscle weakness - manage nutrition
    • -treated with high-dose stroids, immunosuppressive agents, supportive care
  2. Systemic necrotizing vasculitis
    • -primary manifestation Arteritis (inflam of arterial walls)
    • -causes ischemia in tissues
    • -drug of choice is chronic stroid therapy - prednisone
    • -may also use immunosuppressive durgs
    • -Polyarteritis nodosa affects middle age men
    • -involves every body system - renal disorders and cardiac involvment most common causes of death
    • -treat like lupus
    • Hypersensitivy Vasculitis - most common form
    • skin lesions due to allergic response to drugs infectons or tumors
    • aortic arch syndrome or takayasu's arteritis is called puleless disease (jap women in 20s)
    • S/s cerebal ischemis - visual changes, syncope, vertigo
  3. Polymyalgia rheumatica (PMR) and temporal arteritis
    • stiffness, weakness, aching of proximal musculature (shoulder, pelvic area)
    • low grade fever, arthralgias, fatigue, weight loss
    • most common joints affected are neck, shoulder, hip joints
    • stiffness worse in morning
    • increased erythrocyte sedimentation (ESR), norochromic, normycytic anemia
    • women older than 50
    • responds to low-dose steroid therapy in several days
    • Gian cell arteritis(GCA) - temporal arteritis (TA) occurs in 20% of ppl with PMR. systemic vasculitis in large, midsize arteries
    • -systemic, myalgic, arteritic. older women may report declining vision. Treat urgently with high does of coritco steroids - 40-80mg/day. Take calcium and vit D to prevent osteoporosis from steroid therapy
    • Genetic predisposition to HLA-DRB1 is likely
  4. Ankylosing Spondylitis (AS)
    • known as marie-strumpell disease or rheumatoid spondylitis
    • affects vertebral column and causes spinal deformities
    • white men <40 most common affected
    • iritis (inflamation iris)
    • arthralgia (joint aching)
    • systemic manifestations - malaise, weight loss
    • Associated with HLA-B27 alleles
    • Compromised respiratory caused by rigid chest wall is major threat
    • chronic discomfort
    • anti inflamitory drugs, heat applications, physical therapy are key components of management
    • Methotexate (Reumatrex) - disease mod antirheumatic drug
    • infliximab - (remicade) biological response modifiers
  5. Reiters Syndrome
    • affects young white men
    • triad of arthritis, conjunctivitis, urethritis (inflamation of urethra) resulting from stds or dysentary
    • may also manifest by balanitis cirinata (ring like inflammation of glans penis) and skin lesions
    • manage symptoms, NSAIDS and physical therapy. may be conplex if organ involvement
  6. Sjogren's syndrome
    • associated with rheumatoid arthritis
    • Triad of Dry eyes, dry mouth, dry vagina
    • chronic autoimmune disease in which a person’s white blood cells attack their moisture-producing glands
    • mostly women
    • TX: otc eye drops, mouth drops or more potent rx drugs if needed
  7. Marfan Syndrome
    • Autosomal dominant connective tissue disease
    • abnormalities of skeletal, ocular, cardiopulmonary cns result from basic defect in extracellular microfibrils (very small fibers in cells)
    • Excessively tall, elongated hands and feet
    • may have scoliosis, funnel shaped chest, loss of normal cervical curve, hyperextensibility of joints
    • subluxation of lens usually bilat by age 5, causes decrease visual acuity, glaucoma
    • Cardiovascular problems responsible for most deaths mitro valve prolapse with regurgitation and aortic aneurysm with regurtitation and rupture common.
    • life span shortened, often 30s
    • monitor with echocardiography, cardiovascular meds, orthopedic surgery prn
  8. lyme disease
    • systemic infectious disease caused by spirochete borrelia burgdofreri
    • from tick bite
    • most common vector borne disease in us and europe
    • Stage 1) localized, flu like symptoms, erythema migrans (round red rash)pain stiffness in muscles and joints, symptoms 3-30 days after bite. Antibiotic therapy: doxycycline, amoxicillin, erythromycin or cerfuroxime
    • Stage 2)(ealry disseminated) 2-12 wks after bite. carditis with dysrhythmias, dyspnea, dizziness, palpations, meningitis, facial paralysis, peripheral neuritis. IV antibiotics (ceftiaone or cefotaxiine given for 30 days
    • Stage 3 Chronic persistant: arthritis, chronic fatigue, memory/thinking problems, months to years after tick bite
    • may never respond to antibiotics, prevention best
  9. Psedogout
    • mimics gout, but crystals deposited in joints are calcium pyrophosphate, not sodium urate.
    • crystals collect in cartilage, tendons, ligaments, synovium
    • older hospitalized male, esp. who has met cancer or endocrine imbalances
    • NSAIDs control manifestations of the disease.
  10. Psoriatic Arthritis (PsA)
    • affects 5-10% of ppl with psoriasis
    • ichy scaley rash on elbows knees, scalp
    • joint pain with stiffness, esp. in morning
    • Neck back pain very common
    • may cause small joint arhtritis or involvement of sacroiliac joints
    • ppl betwwn 20-50yo
    • TX: manage joint pain and inflammation, controlling skin lesions, slowing the progression of disease.
    • methotexate, sulfasalazine, BRM
  11. Fiber Myalgia Syndrome (FMS)
    • Chronic pain, noninflammatory
    • pain tenderness located at specific sites in the back of the neck, upper chest, trung, low back, extremities (trigger points)
    • women between 30-50
    • Pregabalin(Lyrica) first drug approved for FMS nerve pain150mg divided 3x/day, can cause drowsiness, avoid alcohol
    • May use antidepressive agents: amitripyuline, nortriptline
    • PT along with NSAIDS and muscle relaxants may be prescribed to help derease fibromyalgia pain.
    • streatching strengthening and low impact aerobic exercise.
  12. Chronic Fatigue Syndrome (CFS)
    • severe fatigue for 6 mo or longer, follows flu-like symptoms +4 of following symptoms:
    • sore throat
    • sumstantial impairment ins short-term memory/concentration
    • tener lymph nodes
    • muscle pain
    • multiple joint pain wiht redness or swelling
    • headaches of a new type, pattern, or severity
    • unrefreshing sleep
    • postexertional malaise lasting more than 24 hrs
    • most common in women
    • no lab test to confirm
    • TX: supportive, alleviation or reduction of symptoms, NSAIDS to help with aches and pains, low does antidepressants
    • adequate sleep, proper nutrition, regular exercise, stress management, energy conservation
  13. Bursitis
    • inflammation of the fluid-filled sac (bursa) that lies between a tendon and skin, or between a tendon and bone.
    • may be acute or chronic.
    • Joint pain and tenderness Swelling Warmth over the joint
    • TX: temporary rest or immobilization of the affected joint NSAIDS,Formal physical therapy if not sucessful, then draw out fluid from the bursa and inject corticosteroids. Surgery is rarely required.
    • Exercises for the affected area should be started as the pain resolves.
    • Bursitis caused by infection is treated with antibiotics. Sometimes the infected bursa must be drained surgically.
  14. Tendinitis
    • inflammation and irritation of tendons. If the normal smooth gliding motion of a tendon is impaired the tendon will become inflamed and tendonitis will start to occur.
    • s/s: Pain when the tendon is under pressure Movement is restricted Affected area is painful when moved or touched, Burning sensation around the affect area, Affected area is swollen, red, warm or lumpy
    • rest affected area for 3 wks, apply brace as needed
  15. Paget's disease
    • Osteitis deformans
    • chronic metabolic disorder - bone is excessively broken down and rebuilt
    • disorganized bone structur - weak, increased risk for bowing of long bones and fractures
    • Active phase:rapid increase in oseoclasts
    • Mixed phase: osteoblasts react to compensate in forming new bone that is vascular structurally weak, deformed
    • Inactive phase
    • vertebrae, femur, skull, clavicle, humerus, pelvis often involved
    • skin over affected area feels warm flushed, pt may express fatigue
    • TX:NSAIDS, oral bisphosphonates:alendronate - fosamax, risedronate - actonel. Edidronate - Dridonel, tiludronate - Skelid. May need surgery
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