Term
| ____ & ____ are present during an acute phase response. Also important to help monitor treatment response. |
|
Definition
|
|
Term
| ESR Increases during the _____ _____ _____ |
|
Definition
|
|
Term
| _____ measures the distance erythrocytes fall through plasma in a Westergren or Wintrobe tube over one hour (measured in mm/hr) |
|
Definition
|
|
Term
| ESR Elevations seen in an _____ conditions |
|
Definition
|
|
Term
|
Definition
|
|
Term
| ESR False increases can occur with ...(3) |
|
Definition
| inc age, obesity, and female sex |
|
|
Term
| ESR May remain ____ even beyond the resolution of an inflammatory response. So You need to interpret ESR with caution |
|
Definition
increased
(50% inc after 1 week of inflammation resolution) |
|
|
Term
| CRP Increases in the___ ___ ___ |
|
Definition
|
|
Term
| Rise and fall of CRP are more ____ than the ESR |
|
Definition
|
|
Term
| CRP Early elevation occurs within ___ hours; and, peaks __ - __ hrs |
|
Definition
|
|
Term
| (3)... can produce false CRP positives |
|
Definition
| Cigarette smoking, diabetes, and age |
|
|
Term
| Just because a patient has a normal ESR and/or CRP doesn’t mean that the patient does not have an inflammatory disorder (ie. 10% of patients with RA have normal ESR; 20% of patients with Polymyalgia Rheumatica have normal ESR; Patients with active SLE can have normal ESR and CRP) |
|
Definition
|
|
Term
| ____ Present in a wide variety of autoimmune disorders. Its presence or absence is not a predictor if there is or is not a disease |
|
Definition
|
|
Term
| ANA Can be elevated in ..(4) |
|
Definition
| Hepatitis C, thyroid disorders, patient’s on multiple medications, and even in healthy patients |
|
|
Term
| ANA ____ – measures the proportion of actual positive which are correctly identified as such (e.g. The percentage of sick people who are correctly identified as having the condition) |
|
Definition
|
|
Term
| ANA ______– measures the proportion of negatives which are correctly identified as such(e.g. the percentage of healthy people who are correctly identified as not having the condition) |
|
Definition
|
|
Term
| It has a high sensitivity in ___, in which a negative ANA makes the dx of ___ less likely |
|
Definition
|
|
Term
| Given ANAs low _____ for many inflammatory disorders, it is recommended to only order it if you suspect SLE in a patient based on history and examination |
|
Definition
| specificity (chances patient is negative for the disease if ANA is negative) |
|
|
Term
| ANa is found in __-__% of healthy people |
|
Definition
|
|
Term
| ____ is a weak test for polymyositis, dermatomyositis, RA, and Sjogren’s syndrome |
|
Definition
|
|
Term
| _____ is Not a positive predictor of scleroderma, but useful to rule it out (sensitivity of 85%) |
|
Definition
|
|
Term
| Rheumatoid Factor (RF) = Antibody against the __ portion of Ig__, but in clinical practice it is measured as Ig__. |
|
Definition
|
|
Term
| RF Role is unclear. May be related to the binding RF on B-Cells to immunoglobulins attached to antigens for antigen presentation, resulting in the _____ of the humoral response |
|
Definition
|
|
Term
| Sensitivity for RF is around 50-85%, but is ____ over time. |
|
Definition
| increasing (eg. Initially may be negative and then seroconvert over time) |
|
|
Term
| __% of a young healthy population are positive for RF and this rate inc with age |
|
Definition
|
|
Term
| RF Positive results can be seen in other connective tissue disorders, _____ Syndrome, _____, polymyositis, chronic infections, ____ disorders, and _____. |
|
Definition
Sjogren
SLE
inflammatory
malignancy |
|
|
Term
Only ___% of RF patients are positive during early onset
___% of RF patients never test positive
Therefore, recommend ordering this test if the setting is right: joint ___ & ____; or, see ___ changes radiographically
Over ordering can lead to fear, anxiety, expense, and extensive/inappropriate investigations |
|
Definition
50
15
effusions and synovitis
erosive |
|
|
Term
|
Definition
| ANTI-CYCLIC CITRULLINATED PEPTIDE |
|
|
Term
| ____: An amino acid RA marker since 1964 |
|
Definition
|
|
Term
Anti-CCP has a _____ of 90-95%; its major advantage is its *increased ______*
It has a ______ of 50-85% |
|
Definition
specificity
specificity* know for exam
sensitivity |
|
|
Term
| Anti-CCP May be useful in the prognosis of ___ |
|
Definition
|
|
Term
| ______: Good to help RF diagnosis early in the disease and with the patients who are RF negative |
|
Definition
|
|
Term
| NSAIDs have ___ and ____ effects, but in higher doses they are used for their ____ effects |
|
Definition
analgesic
antipyretic
anti-inflammatory |
|
|
Term
| NSAIDs inhibit the ____ enzymes, thereby inhibiting the formation of _____ and _____ from arachidonic acid; ____ act as messenger molecules in the process of inflammation |
|
Definition
cyclooxygenase
prostaglandins
thromboxane
prostaglandins |
|
|
Term
| CELEBREX!!!--- what is the advange of celebrex? |
|
Definition
COX 2 is good for pt with history of stomach ulcers and reflux
They are very exensive.
Blood thinner patients can take COX 2 inhibitors.
They have not found Celebrex to mess up heart.
NSAID- can cause gastric issues– |
|
|
Term
| Celebrex (____ inhibitor generically known as celecoxib) |
|
Definition
|
|
Term
If advise the patient to take over the counter ibuprofen, and they are an adult: Take __-__ over the counter ibuprofens __ times a day with food (this is equivalent to 600mg to 800mg 3 times a day)
If you write a prescription: Ibuprofen ___mg (or ___mg), one orally ____ with food |
|
Definition
|
|
Term
With ANY of the NSAIDs, advise the patient to stop the medication immediately if ____ or ____ and to contact you (_____ less likely to cause this)
NSAIDS also have a ______ risk and can cause ______ |
|
Definition
stomach upset
blood in stool
Cox-2 inhibitors
cardiovascular
peripheral edema |
|
|
Term
|
Definition
|
|
Term
Over the counter Naproxen tablet is ___mg (2 tabs are less than one prescribed tablet)
I will advise a patient to take __ over the counter Naproxen (Aleve) tablets __ times a day with food
When I write a prescription: Naprosyn (or Naproxen, or Naproxen sodium) ___mg, one orally ___ with food |
|
Definition
|
|
Term
Mobic is a ____ a day or ______ a day drug
It can be written: Mobic ___ mg, take one tablet orally bid with food, or Mobic ___mg, take one tablet orally once a day with food |
|
Definition
once or twice
7.5
15* PA Hulsley likes this once a day dosing |
|
|
Term
Diclofenac is a common prescription I see a lot of my patients taking through their primary care provider
Diclofenac comes in 2 doses: 50mg and 75mg
Recommended dose for Diclofenac is ___mg-___mg/day
It is written: Diclofenac 50mg, take one orally bid with food; Diclofenace 50mg, take one orally tid with food; Diclofenac 75mg, take one orally bid with food |
|
Definition
|
|
Term
Relafen is another prescription drug I see many primary care providers prescribing to their patients
It comes in 500mg and 750mg tablets
Recommended starting dose is ____mg/day
It can be taken once a day or twice a day
To start with the lowest dose you can write the prescription as follows: Relafen 500mg, two tablets orally once a day with food; Relafen 500mg, one tablet orally twice a day with food
Use the lowest effective dose to treat chronic inflammation
The largest recommended dose is ___ mg/day |
|
Definition
|
|
Term
| Naprosyn (Naproxen) (ALeve) is an ____ |
|
Definition
|
|
Term
| Ibuprofen (Motrin) is an ____ |
|
Definition
|
|
Term
| Mobic (Melxociam) is an _____ |
|
Definition
|
|
Term
| Diclofenac (Voltaren) is an ____ |
|
Definition
|
|
Term
| Relafen (Nabumetone) is an ____ |
|
Definition
|
|
Term
|
Definition
|
|
Term
_____ is a great drug for patients who cannot tolerate NSAIDS
It is generally safe with patients on ____.
However, it is very, very, expensive if the patient’s insurance does not cover this medication |
|
Definition
|
|
Term
___ is great for perioperative pain, especially in orthopedics
However it is contraindicated in perioperative pain with ___. |
|
Definition
|
|
Term
| Patients with OA or RA: Celebrex ___mg, one orally q day; Celebrex __mg, one orally bid |
|
Definition
|
|
Term
Patients with Juvenile RA (age >2) dosing is based on ___. What is great about celebrex, its contents can be mixed with applesauce, but it must be ingested immediately with water. And, stable for up to 6 hrs under refrigerated conditions.
Higher doses are used in other conditions: ..(3)...
In these cases, up to ___mg/day |
|
Definition
weight
Familial Adenomatous Polyposis
Primary Dysmenorrhea
Ankylosing Spondylitis
400mg |
|
|
Term
| Patients who are on long-term treatment with NSAIDS need to have periodic ____ and ___ function tests |
|
Definition
|
|
Term
Corticosteroid Side-effects include: ..(3)..
Lowest possible dose used |
|
Definition
AVN
Drug-induced secondary adrenocortical insufficiency (minimize by gradual reduction of the dosage)
tendon ruptures |
|
|
Term
| Psychic derangements may occur with the use of _____ |
|
Definition
|
|
Term
| In children, corticosteroids can affect __ & ___ |
|
Definition
|
|
Term
| Corticosteroid Injectables can be ____ to articular cartilage if over-used |
|
Definition
|
|
Term
CORTICOSTEROIDS FYI
Can cause weight gain with long term use
Water retention
Osteoporosis
GI problems
Impaired wound healing
May suppress reactions to skin tests
Do not use if getting flu shot (wait a few weeks)
Can cause convulsions (lower seizure threshhold)
Do not give to patients with glaucoma
Careful in the diabetic patient |
|
Definition
|
|
Term
I use Medrol Dose Pack or a tapered dose of Prednisone to treat my patients who may have an acute flare of radiculitis
To prescribe Medrol Dose Pack: Medrol Dose Pack, take as directed, Disp: #1 (one), ___ refill
To prescribe Prednisone: Prednisone ___ mg, take 4 orally x 3 days, then 3 orally x 3 days, then 2 orally x 3 days, then one orally x 3 days Disp: #___, no refill |
|
Definition
|
|
Term
I use a combination of a steroid and a lidocaine medicine in a ___cc syringe
I use a __ gauge 1 ½ inch length needle (when I aspirate I use an __ gauge needle 1 ½ inch length needle)
I usually inject 5cc of xylocaine 2% without _____* mixed with 1cc of kenalog, dexamethazone, or celestone |
|
Definition
10
22
18
epinephrine* remember for test |
|
|
Term
| VISCOSUPPLEMENTATION: she uses _____ or ______ |
|
Definition
|
|
Term
SynviscOne is a ____ injection, and no need to return to the clinic each week for 2 more subsequent injections (the original Synvisc)
Supartz is a ___ weeks series of injections
Both are made from the combs of _____
Make sure patient is not allergic to ___ or ___ |
|
Definition
one time
5
chickens
eggs or chickens |
|
|
Term
ON FINAL:
Need to know the order of treating arthritis:
1.
2.
3.
4.
5. |
|
Definition
1.) nothing, just watch
2.) Oral antiiflammatories and or physical therapy
3.) Corticosteroid injection
4.) Viscosupplementation
5.)if pain is bad enough, then surgery (total knee replacement/total knee arthroplasty, or arthroscopy) |
|
|
Term
| DISEASE MODIFYING RHEUMATIC DRUGS: These drugs help ____ the joint destruction process of the disease |
|
Definition
|
|
Term
DISEASE MODIFYING RHEUMATIC DRUGS: Used to treat certain forms of ____ arthritis including RA, anklylosing spondylitis, and psoriatic arthritis
Also used to treat ____ and ______, and to reduce the risk of rejection of a transplanted organ |
|
Definition
inflammatory
cancer
inflammatory bowel disease |
|
|
Term
|
Definition
|
|
Term
| The most commonly prescribed drug in the DMARDS class is _____ since the early 80’s |
|
Definition
|
|
Term
| ______ is an effective first-line treatment among the DMARDS class of drugs |
|
Definition
|
|
Term
Methotrexate has ________(ie. Higher doses for worse disease)
Easy to monitor by testing liver function and blood counts
Reduce side effects by taking daily ________ |
|
Definition
dose flexibility
folic acid |
|
|
Term
____ was the mainstay for DMARDS treatment of RA from the 1920’s to the mid 1980’s
Reduces inflammation in the joints, but not sure of the mechanism to do this
Injectable into the ____ better than ___ form |
|
Definition
|
|
Term
______ is a drug used to treat malaria. They found this drug to help RA patients when these patients were taking the drug for malaria and they found an improvement in their arthritic symptoms. Usually used with other DMARDs. Given by mouth daily
Need to see ____
___counts may dec, blood and protein in urine may occur (check labs frequently) |
|
Definition
Plaquenil (hydroxychloroquine)
opthalmologist (retina problems are rare but recommend see doc)
WBC |
|
|
Term
| Plaquenil (hydroxychloroquine) is an .. |
|
Definition
|
|
Term
| Arava (leflunomide) is an.... |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Azulfidine (sulfasalazine) is an .... |
|
Definition
|
|
Term
| Imuran (azathioprine) is an... |
|
Definition
|
|
Term
| Cytoxan (cyclophosphamide) is an... |
|
Definition
|
|
Term
| Biologic Drugs: Genetically engineered ____ derived from human genes |
|
Definition
|
|
Term
Biologic Drugs ____specific components of the immune system involved with the inflammatory process
Used to treat moderate to severe______ that has not responded to other treatments
Helps prevent long-term disability of RA |
|
Definition
Inhibit
rheumatoid arthritis |
|
|
Term
Less than 30% of patients taking biologic drugs may develop ___ at injection site
Inc risk for ____ and other diseases |
|
Definition
|
|
Term
Should not receive ______ while taking biologics
May cause dormant disease to flare (ie ___) – test for this prior to starting drug |
|
Definition
|
|
Term
| Do not give biologics to patients with ___ or ___ |
|
Definition
|
|
Term
Biologics are Very expensive
Given by injection or IV infusion; no oral form (but, they are working on this)
Not sure how will affect human pregnancy (animal studies show they are safe in animals)
Stop biologics prior to surgery and until wounds heal and risk for infection has passed |
|
Definition
|
|
Term
| Remicade, Enbrel, Humira, Cimzia, and Simponi reduce inflmmation and damage from RA by blocking a chemical activator of inflammation called _______ |
|
Definition
| tumor necrosis factor (TNF) |
|
|
Term
| ______ the first interleukin-6 inhibitor for RA |
|
Definition
|
|
Term
| ____ blocks the action of the chemical messanger interleukin-1 in RA |
|
Definition
|
|
Term
| _____ blocks signals needed to activate T-cells of the immune system |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| ____– Given to patients who have not responded to TNF-blockers. It targets and reduces the number of specialized white blood cells, called B cells, in the blood. |
|
Definition
|
|
Term
______ should not be used to treat arthritis or inflammatory disorders
I see many primary care providers prescribing too many of these pain meds to patients |
|
Definition
|
|
Term
| HOWEVER, ONCE AGAIN: A patient with an ACUTE flare or an ACUTE injury – DO NOT BE AFRAID to prescribe a ____ pain medicine. You will have a very, very unhappy patient. |
|
Definition
|
|
Term
|
Definition
|
|
Term
Tylenol is over the counter and comes in ____mg tablets
You can advise a patient to take __ tablets over the counter __ times a day |
|
Definition
|
|
Term
It is o.k. to take Tylenol with another _____ – I advise this often
It is for pain, but also an anti-pyretic |
|
Definition
| anti-inflammatory (NSAID or steroid) |
|
|
Term
_____ is for moderate pain
I used this as a step-down medication from the narcotic pain meds. |
|
Definition
|
|
Term
| DO NOT GIVE TRAMADOL TO A PATIENT WITH A H/O OF _____ |
|
Definition
|
|
Term
To prescribe: Tramadol __mg, one to two orally every 4-6 hours, prn pain
____ is the same, but with acetominophen, and prescribed just like Tramadol above |
|
Definition
|
|
Term
I use Tylenol #3 with codeine for kids, or even adults who cannot swallow pills
It is indicated for mild to moderately severe pain
Tylenol #3 with codeine has 300mg of acetaminophen and 30 mg of No. 3 Codeine Phosphate
Tylenol #4 with codeine has 300mg of acetaminophen and 60 mg of No. 4 Codeine Phosphate |
|
Definition
|
|
Term
Prescribing Tylenol with codeine for children is determined by ____.
Prescribing for an adult: Tylenol #3 with codeine, one or two tablets every 6 hours, prn pain, no refills
Prescribing for an adult: Tylenol #4 with codeine, one tablet every 6 hours, prn pain, no refills
Do not exceed >___mg of Codeine and >____mg of acetaminophen per day |
|
Definition
|
|
Term
I commonly prescribe Vicodin and Darvocet N-100
Vicodin is indicated for mild to moderately severe pain
Vicodin has 5mg (but can go up to 10mg – known as Norco) of ____, and 500mg of ____
Lortab is also ____, and when I prescribe this it is 7.5mg of ____, and 500mg of ____ |
|
Definition
hydrocodone
acetaminophen
hydrocodone
hydrocodone
acetaminophen |
|
|
Term
So, what makes me decide on what I prescribe to my patients
If the patient has abnormal liver functions you will want to prescribe a drug with less ____
If the patient has a really, really bad liver you can prescribe another drug called _____, which is vicodin and ibuprofen (no acetaminophen), but then you want to make sure the patient has a good ____ status |
|
Definition
acetaminophen
vicoprofen
kidney |
|
|
Term
Inflammatory Disorder: There is destruction of a ___- due to significant amount of inflammatory cells that attack the joint
May cause constitutional symptoms such as low grade fever, malaise, weight loss, fatigue
Damage to _____ may ensue
______ is a common outcome
Death can also occur |
|
Definition
joint
internal organs
Disability |
|
|
Term
| Inflammatory disorders: (6) |
|
Definition
Rheumatoid Arthritis
Systemic Lupus Erythematosus
Psoriatic Arthritis
Gout
Infectious Arthritis
Ankylosing Spondylitis |
|
|
Term
| _____ disease is central to RA with a background of constitutional and internal manifestations |
|
Definition
|
|
Term
| RA can affect just the joints, but can also become ____; CAUSE IS UNKNOWN. |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| is to slow down or stop its progression, improve the patients quality of life, and decrease signs and symptoms of the disease |
|
|
Term
| _____ factors may play a 50% role in the development of RA, but it is thought that if you are ...... |
|
Definition
Genetic
are genetically-predisposed you then need to come in contact with an environmental agent, which initiates the self-perpetuating inflammation that is characteristic of RA |
|
|
Term
| _____ Symptoms of RA– Fatigue, malaise, viral-type feeling, joint pain, swelling/stiffness/tenderness, mild limitation in function and joint ROM |
|
Definition
|
|
Term
| _____ Symptoms of RA– inc fatigue, weight loss, overall dysfunction, joint damage and erosions, joint space narrowing, internal organ damage with severe disease, shortened life span unless disease is suppressed |
|
Definition
|
|
Term
| RA More common in _____ prior to age 60, but equal in both sexes after 60 |
|
Definition
|
|
Term
| 30% of RA patients developed RA after ___ years old |
|
Definition
|
|
Term
| The most common body parts affected by RA include the ____ and the ___(x-rays can help in diagnosis of ____ that are small punched-out areas of the bone and cartilage; joint space narrowing; and thinning of the bones around joints called ______) |
|
Definition
hands
feet
erosions
juxtarticular osteoporosis |
|
|
Term
To prevent joint damage and dysfunction (within the first 2-3 months after disease onset) patient needs to take _____
Treatment with _____may continue for 5 years and possibly throughout the patient’s life |
|
Definition
DMARDs
DMARDs
(however notes say to first treat w/ NSAID then DARMD) |
|
|
Term
| Using a DMARD and an NSAID are commonly used for ____. Fairly safe and effective. |
|
Definition
|
|
Term
Short course of a ___ if significant inflammation and functional limitation in RA
PT and _____ is a must
Patient education (for patient and family) |
|
Definition
|
|
Term
The goal for early treatment of RA is to avoid _____
However, ____can really help an RA patient who has progressed to the stages of hand and feet deformities, joint erosions and destruction, neurological symtoms
If not treated quickly: 80% of patients will develop joint erosions within 2 years; if untreated 50% stop work within 5-10 years of the onset; quality of life diminished significantly |
|
Definition
|
|
Term
| SLE Presents with ____-like symptoms |
|
Definition
|
|
Term
| ____ is a chronic, inflammatory autoimmune disorder (over-active immune response that attacks otherwise healthy cells and tissue) |
|
Definition
|
|
Term
| SLE Can affect the ___ and ___ small joints |
|
Definition
|
|
Term
SLE Affects women 8-9x more than men
Occurs at any age, but appears most commonly between 20-45 years of age
More frequent in AA, and Chinese/Japanese decent |
|
Definition
|
|
Term
| SLE has manifestations such as fever, rash, kidney (bx kidney and U/A for casts and PRO in urine) and heart involvement, pleurisy (may get chest x-ray for heart/lungs) and blood test abnormalities (ie dec wbc, dec rbc, dec platelet count) |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Some drugs can cause drug-induced ____ |
|
Definition
|
|
Term
| Most common SLE symptom is _____ and most develop arthritis (fingers, hands, wrists, and knees most commonly affected) |
|
Definition
|
|
Term
|
Definition
|
|
Term
SLE Treatment aimed at controlling symptoms
Mild disease may only involve rash, headaches, fever, arthritis, pleurisy, and pericarditis – treat with ___ and topical ____
Sometimes for mild to moderate disease use ____ and low dose oral ____ |
|
Definition
NSAIDs
corticosteroids
Plaquenil
corticosteroids |
|
|
Term
Severe or life-threatening SLE problems will definitely need care from the rheumatologist and specialist in the areas of system involvement
Higher dose requirement of steroids may be needed, as well as some ____ drugs (like methotrexate, Imuran) |
|
Definition
|
|
Term
| 10 year survival rate for SLE is greater than 85% |
|
Definition
|
|
Term
| There is a ____ lupus, which is isolated to the skin. Painless, do not itch, but scarring can cause permanent hair loss (alopecia) |
|
Definition
|
|
Term
Over half of patients develop a red, flat facial rash over the bridge of their nose, called the “______”
The rash is painless and does not itch
Rash is _____ and if exposed to sunlight the rash can worsen as well as the systemic problems of SLE
With treatment this rash can heal without scarring |
|
Definition
butterfly rash
photosensitive |
|
|
Term
| SLE Patients can get myositis, vasculitis, pericarditis, pleuritis, kidney failure psychosis, seizures, and even a coma |
|
Definition
|
|
Term
Some people with SLE can get ________: Blood supply to the fingers and/or toes becomes compromised upon exposure to cold, causing blanching, whitish and/or bluish discoloration
Pain and numbness in the exposed fingers and toes may occur |
|
Definition
|
|
Term
SLE Diagnosis is based on ____ criteria established by the American Rheumatism Association
criteria are based on many of the symptoms we already discussed
However, often times patients will have only 4 of the criteria, which can still suggest the disease |
|
Definition
|
|
Term
|
Definition
“Butterfly rash”
discoid skin rash
photosensitivity
mucous membrane ulcers
arthritis
pleuritis
pericarditis
kidney problems
brain irritation
blood-count abnormalities
immunologic disorder
antinuclear antibody positive
don't know why there are 12 listed |
|
|
Term
| _______:A noncontagious common skin condition that causes rapid skin cell production resulting in red, dry patches of thickened skin |
|
Definition
|
|
Term
Psoriasis: The skin appear to have ____
Common at the posterior elbow, anterior knees, and at the scalp |
|
Definition
|
|
Term
| When I was working in family medicine it was a common reason for ____ otitis due to the psoriasis rash found in the external ear canal |
|
Definition
|
|
Term
| Psoriasis Affects 2% of the ____ US population |
|
Definition
|
|
Term
5-10% of patients with psoriasis develop psoriatic arthritis
Occurs in the 4th or 5th decade and affect male and females equally
The skin disease precedes psoriatic arthritis in nearly 80% of patients, but the arthritis may precede psoriasis in 15% of patients
A systemic rheumatic disease
Cause is unknown
___ gene is found in 50% of cases that have spine arthritis |
|
Definition
|
|
Term
PSORIATIC ARTHRITIS Involves ____, ____ extremity joints in an _____ pattern
Involves joints at the ____ of the fingers, a finding not seen in RA, such as prominent swelling and deformities of the distal interphalangeal joints, and ____ changes |
|
Definition
large
lower
asymmetrical
tips
nail |
|
|
Term
psoriatic arthritis May develop low back pain and stiffness
Can cause tendonitis and synovitis
Can affect lungs (pleuritis), eyes (iritis and blindness), and aorta leading to heart failure
It can mimic __ |
|
Definition
|
|
Term
| psoriatic arthritis: Utilize x-rays, joint aspirations, HLA-B27, ESR, and RF |
|
Definition
|
|
Term
| psoriatic arthritis Treatments include exercise and NSAIDs, topical steroids for the rash, plaquenil, DMARDs, oral steroids |
|
Definition
|
|
Term
Psoriatic arthritis x ray findings: Distal head of a bone becomes ____ appearing as if it has been sharpened and the adjacent bone has become “_____”
Occurs at the ___ joint
*know this for exam |
|
Definition
|
|
Term
| pencil in a cup is an x ray finding of ___ |
|
Definition
|
|
Term
| Gout Patients generally state the pain began when they first .... |
|
Definition
|
|
Term
Gout patients They may have a history of increased ____ ingestion or ingestion of foods high in ___
They may be on ___ |
|
Definition
|
|
Term
Gout: If there is an effusion you can aspirate the knee and send the fluid for _____ analysis
However, be careful. Do not just assume patient has gout. I ask questions about sexual activity, fevers, chills, night sweats; and, run every lab I can think of on the aspirate) Do this to rule out ____ |
|
Definition
|
|
Term
I do not inject a steroid into the gouty knee unless I am absolutely sure that this is gout (ie. I trust the patient and know his history really well)
Labs I run on these patients’ aspirates include: cell count with diff, gram stain, anaerobic/aerobic, AFB, fungal, gonorrhea, uric acid crystal analysis
I also get a CBC with diff, ESR and CRP; and, sometimes other labs to help r/o other rheumatoid/autoimmune disorders |
|
Definition
|
|
Term
_____ Xrays of the hand show oval periarticular erosions
There will be sclerotic borders and will often have overhanging edges |
|
Definition
|
|
Term
| Unlike classic rheumatoid arthritis, in early gout, hand and wrist joints will have ____ joint spaces and normal mineralization |
|
Definition
|
|
Term
| Gout Diagnosis is confirmed by the finding of ___ in joint fluid |
|
Definition
|
|
Term
*Gout Treatment is with ___, ___, and ___for acute episodes
*Long-term prophylactic treatment is with ____ or ____
*know for test! |
|
Definition
NSAIDs
steroids
colchicine
allopurinol
probenecid |
|
|
Term
_____ for gout increases uric acid excretion in urine
Start once an acute gouty attack has subsided
However, do not stop or change the dosage of if pt develops a gouty attack. Just make sure the patient is put on ____ or other drug to take care of the acute attack |
|
Definition
|
|
Term
| Prescription: Probenecid 500mg, ½ tab orally bid x 1 week, and then one tablet orally bid thereafter |
|
Definition
|
|
Term
Gout: Check _____ function, because if glomerular filtration rate is 30mL/min or less then probenecid may not be effective
You can increase the probenecid dose slowly every 4 weeks to a max of 2000mg/day if needed
May increase if symptoms are not under control or the 24 hour uric acid excretion is not above 700mg
Want ____ urine |
|
Definition
|
|
Term
When acute gouty attacks subside (absent for ___ months) and serum uric acid levels remain normal you can then decrease the probenecid dose every 6 months by 500mg
As soon as the serum uric acid levels even slightly rise you need to keep the patient at the next higher dose to maintain normal levels
Treat children by weight and it is contraindicated in children less than __ years of age |
|
Definition
|
|
Term
Treatment for gout with ____ will block uric acid production
NOT for acute attack |
|
Definition
|
|
Term
Prophylactic gout treatment is ____
Can be used in patients with poor ____ function because it is not a uricosuric
However, dosing is complex and patients may be hypersensitive to it
Side effects are rare, but when occur they can be dramatic: Examples include, Stevens-Johnson Syndrome, toxic epidermal necrolysis, which are both life threatening |
|
Definition
|
|
Term
Prescription starts with: Allopurinol 100mg, one orally q day
However, may increase 100mg each week, and can max to 800mg a day, or until the uric acid levels are under control (6mg/dL or less)
Do not take more than 300mg at a time
Can take weeks or months to start working
Can cause an ____ on initial treatment |
|
Definition
|
|
Term
_____ is used to suppress the inflammation causing pain in an acute gout attack
MOI is unknown, but they think it reduces the deposition of uric acid crystals causing a reduction in inflammation |
|
Definition
|
|
Term
Prescipriton: Colchicine 0.6mg one PO q 1hr
Most patients require up to 4 to 8 mg and patients on intermittent chronic use generally know their needed dose to control the pain
Usually the pain abates in 24 to 48 hours
Stop if ____ occurs, which sometimes occurs after the first dose; however, often a narcotic pain medicine is needed and that can stop the ____ |
|
Definition
|
|
Term
When I see gout patients in my clinic I will usually aspirate, if needed, and run necessary labs
I will put the patient on a pain medicine and ____. |
|
Definition
|
|
Term
Indocin 50mg one orally tid x 3-5 days
Hulsely will put her patients on this for? |
|
Definition
|
|
Term
| If I suspect gout I send the patient back to their PCP or the rheumatologist, depending on insurance |
|
Definition
|
|
Term
___________: Can occur after a systemic infection, STD, or an open wound
It is usually viral, bacterial, or fungal
Infective agent travels through the bloodstream or has direct contact to a joint and can cause immediate joint destruction
Patient will develop joint pain, swelling, erythema at the joint, and fever within hours or a couple of days
Pain with passive and active ROM
Infants and children with bacterial infection, most common is staph and gram neg bacilli
Adults include gonococci, staph, and strep
Occasionally in adults spirochetes (Lyme dz and syphilis)
All ages can experience a viral infection or even a fungal infection |
|
Definition
|
|
Term
Infectious Arthritis Requires______
or Requires _____ to clean out the joint (ie. Arthroscopy or arthrotomy)
I run labs on the aspirate as mentioned before under gout
A WBC in the fluid >20,000 (usually >100,000) and PMNs >95%
CBC with diff, CRP, ESR |
|
Definition
|
|
Term
infectious arthritis: X-rays in 10-14 days of infection may show ____
Give the patient Abx that is the most likely organism – good history and PE important |
|
Definition
|
|
Term
_______: A long-term disease that causes inflammation of the joints between the spinal bones, and the joints between the spine and pelvis
The joints fuse over time |
|
Definition
|
|
Term
ANKYLOSING SPONDYLITIS Occurs in more ___ than ___
Most common between ages ___ and ___ |
|
Definition
males than females
20 and 40 |
|
|
Term
ANKYLOSING SPONDYLITISPain generally begins in the ___ joints and then spread to the ___
Pain is better with ___ |
|
Definition
SI
back
activity; worse with inactivity |
|
|
Term
ANKYLOSING SPONDYLITIS: The patient may struggle with ____ when the ribs are involved
Patient may complain of fatigue
Patient may complain of other joint problems
Uveitis, weight loss, and slight fever |
|
Definition
|
|
Term
ANKYLOSING SPONDYLITIS Tests: CBC, ESR, HLA-B27 antigen
X-rays of the spine and pelvis |
|
Definition
|
|
Term
| ANKYLOSKING SPONDYLITIS Treatment? |
|
Definition
is with NSAIDs, corticosteroids, TNF, cytotoxic drugs
Physical therapy
Sleeping on the back to maintain posture
Surgery |
|
|
Term
| Schober test is used to help in diagnosis of _________. |
|
Definition
|
|
Term
_____ is used to measure the ability of a patient to flex his/her lower back
Mark 5cm below and 10cm above ___ with the patient in neutral
Have the patient flex forward to touch toes, and if there is a less than ___cm increase between the marks then the patient has loss of flexion ability of the lower spine |
|
Definition
|
|
Term
| ____ is ALWAYS the first line drug treatment for all the issues in this ppt! |
|
Definition
|
|
