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M6 13-005

Exam 16: Inflammatory DO of Musculoskeletal

Arthritis  inflammation and degeneration of a joint
Rheumatoid Arthritis Characterized by a chronic inflammation of the synovial membrane (synovitis) of the diarthrodial joints
The most serious form of arthritis, leads to severe crippling. Rheumatoid Arthritis
Rheumatoid Arthritis: Incidence Thought to be an autoimmune disorder, although there is evidence of genetic predisposition..
Rheumatoid Arthritis: Pathophysiology Characterized by a chronic inflammation of the synovial membrane (synovitis) of the diarthorodial joints (synovial joints). Periods of remission and exacerbation.
Rheumatoid Arthritis: Clinical Manifestation Chronic inflammatory reaction in the synovial membrane damages the affected joint and surrounding tissue, possibly leading to gross deformity and loss of function.
Rheumatoid Arthritis: Subjective Data 1) Malaise 2) Muscle weakness (especially grip strength) 3) Loss of appetite 4) Generalized aching
Rheumatoid Arthritis: Objective Data (a) Edema in joints (b) Tenderness (c) Subcutaneous nodules (d) Limitation in range of motion (morning stiffness especially) (e) Symmetrical joint involvement (f) Fever
Rheumatoid Arthritis: 4 Classic Symptoms (a) Morning Stiffness (b) Joint pain (c) Muscle weakness (d) Fatigue
Arthrocentesis (aspiration of synovial fluid) for microscopy examination. Tell me about it. Fluid usually appears cloudy, milky or dark yellow and contains many inflammatory cells, including leukocytes and complements (a group of proteins in blood that affect the inflammatory process and influence antigen – antibody reaction).
Arthroscopy examination to visualize the extent of joint damage as well as to obtain a sample of synovial fluid (note to instructor: good idea to show a model if available to students).
Rheumatoid Arthritis: Medical Management Directed towards: Controlling disease, provide pain relief, reduce clinical symptoms.
Arthroplasty reconstruction of the joint using an artificial joint that restores previously lost function while relieving pain is sometimes performed.
Degenerative Joint Disease (DJD): aka Osteoarthritis Most common type of arthritis. (3) Referred to as "wear and tear" disease and typically affects the weight- bearing joints.
non-systemic and non-inflammatory disorder that progressively causes bones and joints to degenerate. Osteoarthritis
There are two forms of osteoarthritis: primary and secondary.
Primary cause of DJD unknown
Secondary cause of DJD caused by trauma, infections, previous fractures, rheumatoid arthritis, stress on weight-bearing joints from obesity and such occupations as coal mining or boxing.
Risk factors of DJD include increased age, previous joint injuries, obesity, congenital and developmental disorders (such as Legg-Calve-Perthes disease), heredity factors, and increased bone disease.
Signs and symptoms seen of osteoarthritis Joint stiffness and pain. Joint enlargement. Limitation of joint movement. Herberden's nodes. Bouchard's nodes. Crepitus heard when joints are moved. Progressive limitation of ROM in affected joint.
Herberden's nodes enlargement of the distal interphalangeal joints
Bouchard's nodes bony enlargement of the proximal interphalangeal joints
Rheumatoid Arthritis: Pharmacological treatments Large doses of salicylates or NSAIDs.
Rheumatoid Arthritis: Steroids sometimes used in low dosages or injected into joints to produce immediate pain relief and temporarily halt the destructive process.
Rheumatoid Arthritis: Acetaminophen commonly used as an analgesic and does not affect the blood pressure.
Rheumatoid Arthritis: Tramadol hydrochloride synthetic analgesic used for moderate to severe pain and can be used for patients taking antihypertensives.
Gout metabolic disease resulting from an accumulation of uric acid in the blood
Gout acute inflammatory condition associated with ineffective metabolism of purines.
Primary gout linked to heredity factors, severe dieting or starvation, or excessive ingestion of purines.
Secondary Gout resulting from use of certain medications or complication of another disease.
Idiopathic Gout Unknown origins
Tophi a chalky deposit of sodium urate crystals
Ankylosing Spondylitis (Marie-Strumpell disease) chronic connective tissue disorder of the spine and surrounding cartilaginous joints, such as the sacroiliac joints and soft tissues around the vertebrae.
Ankylosing Spondylitis (Marie-Strumpell disease): Etiology unknown but some theorize that an altered immune response occurs when T-cell lymphocytes mistake human cells for similar appearing bacterial antigens.
Ankylosing Immobility and fixation of the joints in the hip and ascends the vertebrae.
aortitis Inflammation of the aorta
Iridocyclitis inflammation of the iris and the ciliary body of the eyes
Ankylosing Spondylitis (Marie-Strumpell disease): S&S Difficulty in expanding the rib cage when breathing. Vision loss from glaucoma and pupil damage. Low back pain and stiffness. "Sciatica pain". Weight loss. Abdominal distension. Peripheral joint edema. Decreased ROM.
Ankylosing Spondylitis (Marie-Strumpell disease): Diagnostic Finding Elevated ESR. Elevated alkaline phosphates and creatinine phosphokinase. Presence of HLA-B27 in 90% of patients with this disorder (used to detect an inherited tissue marker).
Ankylosing Spondylitis (Marie-Strumpell disease): Medical Management Meds. Firm mattress. Back brace. Sx: hip replacement for severe hip involvement.
Created by: jtzuetrong