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NURO 504 Module 6 - Immunological Study Set Exam
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NURO 504 Module 6 -Immunological Study Set Exam
allergic reaction - Answer An immunologic hypersensitivity reaction resulting from the
unusual sensitivity of a patient to a particular medication; a type of adverse drug event.
rheumatoid arthritis - Answer autoimmune disorder characterized by symmetric
inflammatory polyarthritis and varying degrees of extraarticular involvement
Etiology - unknown, mix of genetics environmental, hormonal and reproductive factors .
3x more in women than men, Peak age 30-40, inheritance of HLA-DRB1 alleles
RA characteristics - Answer - Prodromal systemic symptoms of malaise, fever, weight
loss, morning stiffness (up to 1-2 hours), anorexia
- Onset usually insidious and in small joints, progressing to centripetal and systemic,
deformities common
- Extra-articular findings: subcutaneous nodules (can be found in bursae, tendon
sheaths, lungs, sclerae, etc.), pleural effusion, pericarditis, lymphadenopathy,
splenomegaly with leukopenia, and vasculitis
- Sjogren's syndrome (0-30% of patients with RA), characterized by dry eyes and mouth
RA diagnostic criteria - Answer need 4 to diagnose
-AM stiffness >1hr x >6wks
-arthritis/soft tissue swelling >3 joints x>6wks
-symmetric arthritis x >6wks
-subcutaneous nodules
-RA factor >95% (in 70-80% of cases)
-xray shows joint erosion or bony calcification
- Arthritis of hand joints (wrist, MCP, PIP)
RA labs - Answer ESR/C-reactive protein (elevated), rheumatoid factor, CBC with
differential, BUN/creatinine, hepatic panel (ALT, AST, albumin), urinalysis (looking for
casts), synovial fluid analysis (signs of inflammation), ANA, and anti-CCP antibodies
(most specific)
- Imaging: radiography of selected involved joints; specific for disease (although first 6
, months of disease, X-ray will probably appear normal)
RA treatment plan - Answer Goal = control pain and preserve maximal function and
prevent deformity
- Splints: wrists
- Adaptive devices to facilitate ADL's
· Toilet seat/chair adaptors
· Built-up eating and writing utensils
NSAIDS: improve daily function by controlling pain and inflammation
· Does not modify disease or prevent deformity
· Higher doses required
o Use lowest effective dose
o CAD controversy: naproxen safest?
o Not ideal in the elderly
RA meds - DMARDS: - Answer Disease modifying antirheumatic drugs (DMARCS);
initiate early (ASAP)
· Methotrexate: well tolerated, widely used, low toxicity, easy 7.5 mg oral dosing weekly
-onset within 4 weeks
SE: pulmonary, hematologic, hepatic, teratogenic
- Folic acid 1 mg 8-12 hours after dose may decrease hematologic and GI side effects
· Leflunomide, Hydroxychloroquine, Minocycline, Sulfasalazine
· Biological agents: interfere with inflammatory process
RA meds - Corticosteroids - Answer Corticosteroids: limit use as a bridge to reduce
disease activity until DMARDs take effect or as adjunct therapy for disease persistence
despite DMARDs
· Low dose: 5 mg/day
· Disadvantage: long term SEs Osteopenia, pathologic fractures, avascular necrosis of
bone, elevated blood sugars
· Add supplemental Ca, Vitamin D, and bisphosphate in long-term steroid therapy
Surgery: joint replacement; early reconstructive surgery of the hand and foot
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