Rheumatoid Arthritis Overview
21 Questions
1 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the prevalence of Rheumatoid Arthritis (RA) worldwide?

1%

Which of the following is NOT a clinical manifestation of Rheumatoid Arthritis?

  • Weight loss
  • Slow development of signs and symptoms
  • Insidious onset
  • Loss of vision (correct)

    • The synovial pannus in Rheumatoid Arthritis is a highly erosive enzyme-laden inflammatory exudate.

    True

    Which of the following is a common extra-articular manifestation of Rheumatoid Arthritis?

    <p>All of the above</p> Signup and view all the answers

    The ______ of morning stiffness can be a useful marker of disease activity in Rheumatoid Arthritis.

    <p>duration</p> Signup and view all the answers

    Which of the following is a common deformity associated with Rheumatoid Arthritis?

    <p>All of the above</p> Signup and view all the answers

    What are the four stages of Rheumatoid Arthritis?

    <p>Early, moderate, severe, and end stage</p> Signup and view all the answers

    Which of the following is a traditional Disease-Modifying Antirheumatic Drug (DMARD) used to treat Rheumatoid Arthritis?

    <p>All of the above</p> Signup and view all the answers

    The newest class of DMARDs for treating Rheumatoid Arthritis includes biologic agents like TNF-alpha inhibitors.

    <p>True</p> Signup and view all the answers

    What is the primary goal of treatment for an acute attack of Gout?

    <p>To relieve pain and inflammation</p> Signup and view all the answers

    Which of the following medications is often used for the treatment of acute Gout?

    <p>Colchicine</p> Signup and view all the answers

    Uricosuric agents like probenecid help to decrease uric acid production in the body.

    <p>False</p> Signup and view all the answers

    What is the name for the crystalline deposits that can accumulate in joints and surrounding tissues due to Gout?

    <p>Tophi</p> Signup and view all the answers

    Gout is more common in females than males.

    <p>False</p> Signup and view all the answers

    Which of the following is NOT a risk factor for developing Gout?

    <p>Low purine diet</p> Signup and view all the answers

    The main goal of ______ therapy for Gout is to lower serum urate concentrations.

    <p>urate-lowering</p> Signup and view all the answers

    Match the following medications used to treat Gout with their corresponding actions:

    <p>Colchicine = Lowers uric acid deposition and interferes with inflammation Probenecid = Increases uric acid excretion by inhibiting its reabsorption in the kidneys Allopurinol = Inhibits the breakdown of purines, preventing the formation of uric acid</p> Signup and view all the answers

    What is the name of the protein A Immunoadsorption column used in treating severe Rheumatoid Arthritis?

    <p>Prosorba</p> Signup and view all the answers

    Chronic Gout can be effectively treated with NSAIDs, colchicine, or corticosteroids.

    <p>False</p> Signup and view all the answers

    What is the name of the joint that is most commonly affected in early Gout?

    <p>Metatarsophalangeal joint of the big toe</p> Signup and view all the answers

    In an acute Gout attack, what is the common pattern of pain onset?

    <p>Sudden and intense</p> Signup and view all the answers

    Study Notes

    Rheumatoid Arthritis

    • Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting the connective tissues, commonly used as the prototype for inflammatory arthritis.
    • RA is a systemic inflammatory disorder characterized by deforming polyarthritis and numerous extra-articular manifestations.
    • RA prevalence is estimated at 1% worldwide.
    • RA occurs nearly twice as often in women as in men.
    • Onset usually occurs between the third and fourth decades of life.
    • Genetics contribute to 50-60% of the risk for developing RA.
    • Estrogen, pregnancy, and oral contraceptives may impact RA symptoms.
    • Diets rich in omega-3 fatty acids are associated with a lower RA risk, while vitamin D deficiency shows a correlation.
    • Smoking increases RA risk.

    Pathophysiology

    • RA-induced joint destruction begins with inflammation of the synovial lining.
    • The synovial membrane (normally thin) proliferates, forming a pannus.
    • The pannus is a highly erosive enzyme-laden inflammatory exudate.
    • Pannus invades cartilage and erodes bone, leading to joint space narrowing and osteoporosis.
    • Joint deformities result from the destruction of ligaments, tendons, and periarticular structures.

    Clinical Presentation (RA)

    • RA often presents with an insidious onset, gradual development of symptoms.
    • Early symptoms include pain, fatigue, malaise, and diffuse musculoskeletal pain.
    • Morning stiffness is a common symptom, lasting 30-60 minutes.
    • Stiffness may persist all day with decreasing intensity.
    • Duration of morning stiffness tracks with disease activity.
    • Bilateral, symmetrical joint swelling and pain are common features, involving MCP and PIP joints of the hands and MTP joints of the feet.
    • Reduced range of motion (ROM) and muscle atrophy around affected joints are also observed.
    • Unique deformities include swan neck and boutonniere deformities.
    • Progression shows stages (early, intermediate, late).
    • Systemic involvement includes organ involvement (pleuropulmonary, cardiac, vasculitis).
    • Extra-articular syndromes like Sjogren syndrome and Felty syndrome.
    • Advanced-stage RA involves progressive joint destruction, leading to deformity, and subluxation.
    • Fever, weight loss, fatigue, anemia, and Raynaud's phenomenon are frequent in advanced stages.

    Clinical Presentation (Gout)

    • Gout typically manifests as recurrent episodes of acute joint pain and inflammation secondary to MSU crystal deposition in joint fluid and lining.
    • Gout involvement usually begins with a single joint attack, often in the big toe.
    • Symptoms often start at night.
    • Attacks typically subsides in 3-10 days, even without treatment, which is followed by an intercritical stage with no symptoms until next attack.

    Epidemiology (Gout)

    • Gout usually affects males more than females (approximately 3-4 times higher incidence in men).
    • Gout risk increases with age, obesity, elevated BMI, hypertension, alcohol consumption, and diuretic use.
    • Fructose-rich beverages correlate with gout risk for both males and females.

    Pathophysiology (Gout)

    • Gout is a heterogeneous group of conditions related to genetic defects in purine metabolism, leading to hyperuricemia.
    • Gout can occur from over-secretion of uric acid or impaired renal excretion.
    • Acute inflammation develops when urate crystals precipitate in joints.
    • Continued attacks can lead to tophi formation (urate crystal accumulations).
    • Renal urate lithiasis (kidney stones) may be a complication.
    • Inflammatory reaction in asymptomatic joints suggests issues beyond crystal deposition.
    • Immunoglobulins (IgG) coat crystals leading to phagocytosis.

    Types of Hyperuricemia

    • Primary hyperuricemia: Elevated serum urate levels due to faulty uric acid metabolism (genetic, starvation, excessive dietary purines).
    • Secondary hyperuricemia: Linked to increased cell turnover or breakdown (e.g., conditions like leukemia, psoriasis), or altered renal function from drugs or alcohol.

    Risk Factors (Gout)

    • Hypertension (HTN), diabetes, hyperlipidemia, obesity, and cardiovascular disease (CHD).
    • Ethanol consumption correlates with acute gout attacks.
    • Renal dysfunction is a factor.

    Diagnostic Criteria and Findings (RA and Gout)

    • Joint involvement (numbers of involved joints, duration of symptoms, symmetry).
    • Serology (presence of rheumatoid factor or anti-CCP antibodies).
    • Acute-phase reactants (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP]).

    Assessment and Diagnostic Findings (RA)

    • History and physical examination (assess for bilateral/symmetrical stiffness, tenderness, swelling, and temperature changes).
    • Assessing extra-articular changes (weight loss, sensory changes, lymph node enlargement, fatigue).
    • Laboratory tests like rheumatoid factor, anti-CCP antibodies, ESR, CRP, and CBC.
    • Imaging (e.g., X-rays) to assess joint damage.

    Assessment and Diagnostic Findings (Gout)

    • History and physical examination (assessing joint pain, inflammation, symmetry, etc.)
    • Laboratory tests like serum uric acid level, renal function tests.
    • Diagnostic imaging (for tophi or renal stones).
    • Fluid analysis (arthrocentesis).

    Treatment (RA and Gout)

    • (RA)*
    • In early stages: education, rest, exercise, physical therapy, drug therapy.
    • Preventing progression: More aggressive therapy is needed in some cases such as disease-modifying antirheumatic drugs (DMARDs). Different types of DMARDs are used in varying doses, alone or in combination.
    • Pain relief and inflammation management for advanced cases.
    • Corticosteroids: Potent anti-inflammatory agents for short-term use during flares of activity and inflammation.
    • (Gout)*
    • Acute management: Pain management is the primary goal using NSAIDs, colchicine, or corticosteroids.
    • Long-term management (chronic gout): Urate-lowering therapies aim to reduce SUA concentration to below 6 mg/dL (aiming for below 5 mg/dL). Medication choices vary depending on the individual and presence of risk factors.

    Non-Pharmacologic Pain Management (RA and Gout)

    • Heat applications, therapeutic exercises, assistive devices (braces, splints, canes, walkers) to rest inflamed joints,
    • Educational programs and support for patients to recognize that pain may lead one to use unproven therapies or self-treat.

    Nursing Assessment (RA and Gout)

    • Address patient history and physical examination (including joint pain, inflammation, symmetry, fatigue and other manifestations)
    • Evaluate extra-articular changes (weight loss, sensory and gastrointestinal changes, etc.)
    • Assess and monitor for complications related to treatments such as disease activity, medications, and general wellbeing.

    Nursing Diagnoses (RA and Gout)

    • Pain, fatigue, impaired physical mobility, self-care deficits, disturbed body image.

    Nursing Interventions and Goals (RA and Gout)

    • Goal: Improving comfort, incorporating pain management techniques into daily life, modifying fatigue, and improving functional mobility.
    • Develop a treatment plan, emphasizing patient perceptions, and empowering them to actively participate.
    • Use suitable assistive devices for joint protection and work simplification.
    • Provide education on disease process to patients and family.
    • Monitoring for side effects (medications and physical therapy), including infection indicators and complications.
    • Referral to community health agencies and specialists, or if the patient’s condition worsens.

    Important Considerations

    • Individualized treatment plans are crucial for both conditions.
    • Symptoms, diagnostic findings, and effectiveness of treatment vary considerably among different patients.
    • Multidisciplinary approaches and ongoing monitoring are essential for optimal patient outcomes.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Related Documents

    Rheumatoid Arthritis and Gout PDF

    Description

    Explore the complexities of Rheumatoid Arthritis (RA), a chronic inflammatory disease that affects connective tissues. This quiz covers its prevalence, risk factors, pathophysiology, and the impact of genetics and lifestyle on the disease. Delve into the details of RA and enhance your understanding of this condition.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser