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Olson Day one

Clin Med II- OA, RA, FIbromyalgia, Arthritis, Septic

Chronic widespread pain, not otherwise explained, often w/ fatigue fibromyalgia
Syndrome of heightened pain perception fibromyalgia
Some syndromes that may lead to sensory amplification IBS, intersticial pain, TMJ, low back pain, HA’s, many depressive disorders
Criteria for Fibromyalgia WIDESPREAD pain for >3 m, 11 of 18 tender points when palpated with enough pressure to blanch upper nail bed
Main tx of fibromyalgia cycle exercise! Start small, don’t want to lose fxn
Is fibromyalgia genetic No links yet, but it is environmental
What % of pt’s with sjogren’s syndrome may have fibromyalgia 50%!
How do we asses for fibromyalgia pain w/ tender pts. Fatigue, sleep and its quality, psych: depression w/pain, PA and exercise everyday!
What methods may be needed to improve sxs of fibromyalgia tx sleep disturbance, mood disturbance, relaxation training, aerobic exercise training
Pharm tx TCAs, SSRIs, SNRIs, AEDs, pain relievers: NO to chronic narcotic, muscle relaxants, sedative hypnotics, dopamine agonists
Use of tramadol in fibromyalgia tx bw ASA and narcotics,
MOI of bone spurs Underlying bone responds ^production of bone d/t damage of wear and tear→bone spurs or osteophytes
Main classification of OA joint space narrowing
5 common radiographic features of OA Joint space narrowing, marginal osteophytes, subchondral cysts, bony sclerosis, malalignment
Common signs of OA knobby PIP, DIP joints, “squaring” of the CMC thumb joint: thenar muscle wasting, pain related to use, gets worse during the day, morning stiffness, ↓ROM, bony enlargement, crepitus, restricted movement d/t bone remodeling
RF’s of earlier OA Female, obesity, heredity for certain joitns, trauma, neuromuscular dysfxn, metabolic disorders: hemochromatosis
MC OA sites neck, low back, hips, knees, big toe, fingers
Non pharm txs for OA heat, exercises: PT, Bracing,
Pharm tx APAP, NSAIDs, tramadol/opiod, CS injection, surgery: replacement
When do we use the thumb CMC joint brace depending on the occupation, usually improved pain after 12m use vs 1m use
Topical NSAIDS tid, ketoprofen 20% or diclofenac gel 1%
Tx for varus or valgus OA knees Unloader knee brace: for young, active pt’s, $600 plus
When do we use hyluraonic acid injections AKA synvisc viscosupplement, or lubricant, used when CS injections don’t work. Last step before surgery
Most effective tx for knee OA quad strengthening, wt reduction
Supplement trial for OA Glucosamine/Chrondroitin, try 3m if no improvement stop, an expensive supplement and varies bw pt’s
Tylonol and NSAIDs effect what Tylenol: Liver, NSAIDs: Kidney
When will benefit seen with capsaicin 2 wks, must use daily, and it BURNS
Common strong analgeisics used for OA Tramadol, propoxyphene, codeine, hydrocodone, oxycodone
Pharm tx for nonsurgical canidates morphine and fentanyl patches
Major cell types involved w/ RA T lymphocytes, macrophages
Minor cells in RA pannus fibroblasts, plasma cells, endothelium, dendritic cells, Neutrophils in synovial fluid
What is the test for RA rheumatoid factor, + in first 6m 85% w/ established dz, Anti-CCP? More commonly used test
What commonly causes a + RA factor RA, Hep C, genetic factors for genes for RA!
More specific RA test CCP antibody, won’t b + w/ Hep C,
Firm spongy yet squishy joints synovitis consistent w/ RA
What joints are NOT effected by RA DIP, thoracic or lumbar spine, Cervical spine CAN be
Can you have both RA and OA yes, can effect different/same joints, get OA with age anyway
Signs on XR of RA, OA RA: erosions, bone loss: periarticular osteopenia, less dense around the bone edges, OA: sclerosis, or lightning up near edge of bone
d/t chronic inflammation, what happens to the MCP joints Ulnar drift d/t laxity in the ligaments, swelling in MCP and PIP joints
RF’s for RA female, heredity, HLA antigen DR-4, environment and traumatic triggers
Common deformities of the fingers swan neck deformity and boutiners finger
Commonly form on the extensor surfaces of the affected joints RA nodules subQ or periosteal at pressure pts
Inflammation where tendons/ligaments insert to bone enthesitis
Thickened synovial tissue pannus: eats away at bone underneath it
Do joint dz’s kill pt’s no, the chronic inflammation of other organs kills the pt, chronic inflammation of BV’s: Ht dz
Associated dz’s with RA Sjogrens: dry mouth, eyes, Schermer’s test, intersticial lung dz
Tx RA Pharm within 3m dx use safest related to aggressiveness of the dz, ↓pain, inflammation, Start NSAID if applicable
Substitute for NSAIDS low-dose prednisone (<10mg) but not LONG term: bridging until long term are effective
What do we need to remember with low dose predinisone tx prophylactic tx for osteoporosis, ↑blood surgar: diabetics
Gold std for RA pharm tx Methotrexate (MTX)
Can’t tolerate methotrexate use what leflunomide
When is TNF elevated RA, psoriatic arthritis, psoriatic plaques
The more TNF, the more what Inflammation
Monitoring for RA drugs Liver, lung, blood, kidney testing 4-8wks
What is gout build up of uric acid in joints d/t overproduction or underexcreation of uric acid
Red hot swollen joint d/t uric acid crystals gout: more painful acutely than RA
Common places of gout extremity, unilateral, uni-joint, in cold extremities
Signs, sxs of gout acute onset, asymmetric, monoarticular
Cause of gout high purine diet or alcohol binge
MC location of gout 1st MP joint in foot,
Can you dx gout from a blood test? No must aspirate joint and test fluid for crystals
Swelling of big toe joint podagra
Collection of uric acid that comes to the surface of the skin tophus
Does gout disfigure for life? no tx usually makes it all go away
What is most common w/ cause of Hyperuricemia overproduction 10%, Underexretaion 90%: usually d/t kidney dz
How is uric acid formed end produce of purine metabolism
Is gout autoimmune? Genetic? genetic predisposition but not autoimmune
Dx of gout synovial fluid high WBC and PMN count w/ polarized microscopy
Tx acute gout NSAID, colchicine, predinisone, IA injection
When do we use allopurinol? ONLY for chronic tx, lowers uric acid, DO NOT start during an acute attack, will ↑ attack and spread to another joint
What inhibits PMN migration colchicine
When are prednisone usually used w/ renal insufficiency, and elderly, can exacerbate diabetes
Non pharm tx p ted: Beer bad, lower purine diets, meat, fish, diary, maintain hydration, D/C diuretics, wt loss, control BP
Pseudogout Chondrocalcinosis: d/t calcium, common in elderly, embedded in cartilage
Location of pseduogout shoulders, writs, funky shapes under microscope,
Difference bw gout and pseudogout gout: uric acid, pseudogout: Calcium, embedded in cartilage on XR
Infection in a joint septic arthritis
Common ppl who get septic arthritis RA, DM, immunocomprimised, Trauma, Sepsis, Medical emergency
Dx of Septic arthritis aspiration: milky murky, thick, high in WBC (>100,000) in infected joint, culture
Why is septic arthritis so critical can cause death in 10-40%
Back pain and stiffness in adolescence and early adulthood, worsens w/ inactivity, ↑w/ Physical activity ankylosing spondylitis
Dx of ankylosing spondylitis limited lumbar motion, Schobar test: <20cm flexion common in men
A sausage shaped swelling of finger or toe dactylitis
Onset of ankylosing spondylitis prior to age 40, insidious, longer than 3m, morning stiffness, decrease w/ exercise
Inflammatory arthritis in DIP joints, asymmetric, sausage digits psoriatic arthritis
What is pitting of the nails or onycholysis associated w/ psoriatic arthritis
Triad of arthritis, urethritis, conjucivitis Reactive arthritis or Reiter’s syndrome hx of all of these but not at same time
Enteropathic arthritis ulcerative colitis and crohn’s dz
Tx for spondyloarthropathy dz exercise, NSAIDS, SI and peripheral joint CS injections
What is TNF associated w/ Inflammation, pain, plaque hyperproliferation, joint destruction
Created by: streetsmarts
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