Exam 16: Inflammatory DO of Musculoskeletal
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| Arthritis | inflammation and degeneration of a joint
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| Rheumatoid Arthritis | Characterized by a chronic inflammation of the synovial membrane (synovitis) of the diarthrodial joints
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| The most serious form of arthritis, leads to severe crippling. | Rheumatoid Arthritis
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| Rheumatoid Arthritis: Incidence | Thought to be an autoimmune disorder, although there is evidence of genetic predisposition..
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| Rheumatoid Arthritis: Pathophysiology | Characterized by a chronic inflammation of the synovial membrane (synovitis) of the diarthorodial joints (synovial joints). Periods of remission and exacerbation.
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| 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.
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| Rheumatoid Arthritis: Subjective Data | 1) Malaise
2) Muscle weakness (especially grip strength)
3) Loss of appetite
4) Generalized aching
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| 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
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| Rheumatoid Arthritis: 4 Classic Symptoms | (a) Morning Stiffness
(b) Joint pain
(c) Muscle weakness
(d) Fatigue
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| 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).
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| 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).
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| Rheumatoid Arthritis: Medical Management | Directed towards:
Controlling disease, provide pain relief, reduce clinical symptoms.
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| Arthroplasty | reconstruction of the joint using an artificial joint that restores previously lost function while relieving pain is sometimes
performed.
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| 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.
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| non-systemic and non-inflammatory disorder that progressively causes bones and joints to degenerate. | Osteoarthritis
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| There are two forms of osteoarthritis: | primary and secondary.
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| Primary cause of DJD | unknown
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| 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.
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| 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.
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| 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.
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| Herberden's nodes | enlargement of the distal interphalangeal joints
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| Bouchard's nodes | bony enlargement of the proximal interphalangeal joints
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| Rheumatoid Arthritis: Pharmacological treatments | Large doses of salicylates or NSAIDs.
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| Rheumatoid Arthritis: Steroids | sometimes used in low dosages or injected into joints to produce immediate pain relief and temporarily halt the destructive process.
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| Rheumatoid Arthritis: Acetaminophen | commonly used as an analgesic and does not affect the blood pressure.
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| Rheumatoid Arthritis: Tramadol hydrochloride | synthetic analgesic used for moderate to severe pain and can be used for patients taking antihypertensives.
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| Gout | metabolic disease resulting from an accumulation of uric acid in the blood
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| Gout | acute inflammatory condition associated with ineffective metabolism of purines.
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| Primary gout | linked to heredity factors, severe dieting or starvation, or excessive ingestion of purines.
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| Secondary Gout | resulting from use of certain medications or complication of another disease.
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| Idiopathic Gout | Unknown origins
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| Tophi | a chalky deposit of sodium urate crystals
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| 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.
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| 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.
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| Ankylosing | Immobility and fixation of the joints in the hip and ascends the vertebrae.
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| aortitis | Inflammation of the aorta
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| Iridocyclitis | inflammation of the iris and the ciliary body of the eyes
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| 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.
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| 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).
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| Ankylosing Spondylitis (Marie-Strumpell disease): Medical Management | Meds.
Firm mattress.
Back brace.
Sx: hip replacement for severe hip involvement.
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