NUR 524 Exam 4 Exam Questions and Answers| New Update with 100% Correct Answers
Erythrocyte Sedimentation Rate (ESR) timed test that measures the rate at which red blood
cells settle through a volume of plasma
Non Specific marker of inflammation (Clumping from inflammation causes RBCs to sink faster)
Rheumatoid Factor (RF) An immunoglobulin IgM antibodydirected against IgG
Usually present in RA, but can be present with other disorders
Presence of RF in RA usually signifies more severe disease
Antinuclear Antibody (ANA) Pathogenic autoantibodies
Present in 95% of SLE patients; Also present in 25-30% normal patints
HLA-B27 immunogenetic marker associated with spondyloarthropathies: present in 95% of
pts with ankylosingspondylitis
50-80% of patients with spondyloarthropathy of inflammatory bowel disease, Reiter's
syndrome or psoriasis
Ankylosing Spondylitis chronic, progressive arthritis with stiffening of joints, primarily of the
spine; Seronegative spondyloarthropathies: group of inflammatory arthritides with many
shared features
Anklosing spondylitis
Reactive arthritis & Reiter's syndrome
psoriatic arthritis
Arthritis associated with inflammatory bowel disease(IBD)
These illnesses are characterized by: sacroiliitis, peripheral joint inflammation & eye
inflammation and
,Ankylosing Spondylitis Patho and Presentation Inflammation of bony insertions of ligaments
& tendons -> new bone formation
Ligamentous inflammatory granulation tissue is gradually replaced by fibrocartilage & then
ossifies
Insidious low back pain development with periods of exacerbation & remission. Diffuse, poorly
localized, described as a deep ache, nagging discomfort in low back below waist, buttocks or in
the hips; Worsens with rest improves exercise
Ankylosing Spondylitis S/S Asymmetric joint involvement, often large joints• Extra articular
manifestations: low-grade fever, fatigue and wt. loss• acute anterior uveitis: painful, red eye,
up to 30% of pts.• Cardiac involvement: aortic valve insufficiency, mild or severe
PE: Loss of normal lumbar lordosis
Often palpable muscle spasm Para spinal muscles
Decreased spine mobility
Ankylosing Spondylitis Diagnostics Rheumatology has 3 clinical criteria for diagnosis:
1. low back pain & stiffness >3 months, improving with exercise, not relieved by rest• 2. limited
ROM of lumbar spine• 3. Limited chest expansion
Presence of sacroiliitis on radiologic exam + 1 clinical criterion is diagnostic
Ankylosing Spondylitis Management Should be co-managed with rheumatology, & refer to
PT, ortho & ophthalmology
First line: NSAIDs: particularly indomethacin, tolmetin & sulindac. Other NSAIDs such as
ibuprofen & naproxen are variably effective.
High dose ASA not effective
TNF's: tumor necrosis factor agents are effective but are costly.
Pain management very important to minimize spinal deformity and allow pts.to exercise
,Variety of neurological issues: 1. cord compression 2° to spinal fx of fusedspine, 2. Atlantoaxial
subluxation from chronic cervical involvement, 3.Cauda equina syndrome
Reactive Arthritis & Reiter's Syndrome Reactive arthritis = acute sterile inflammatory
arthropathy after an infection & no microbial invasion of the synoviumor or joint space & prior
infection is remote from joint
Reiter's syndrome: an example of reactive arthritis defined by classic triad of conjunctivitis,
urethritis &arthritis
Reactive arthritis is the preferred term as many patients are first seen with an incomplete
syndrome without all 3 criteria
Reactive Arthritis: seen after Stds and GI infections: common causative agent: salmonella,
shigella, Yersinia, campylobacter & chlamydia
Reactive Arthiritis and Reiter's Incidence One study 260 individuals with Salmonella infection
19 or 7% developed reactive arthritis.
Peak incidence of RA/RS is in 3rd decade of life
Postveneral Reiter's syndrome affects men more than women ranging from 9:1 to 5:1
Reactive Arthiritis and Reiter's Presentation When there is a documented infection: arthritic
s/s occur 10-20days later.
Less than 40% of pts. Present with the classic triad
Arthropathy of RS is distinctive: lower extremity, asymmetric joint involvement, "sausage
digits", heel pain, Achilles tendinitis, plantarfasciitis & sacroiliitis.
Dactylitis: "sausage digit" result of inflammation of insertions of ligaments/tendons:
characteristic of Reiter's & psoriatic arthritis
, Course of disease is variable: initial episode 2-3 mos., may have recurrent acute attacks, 1/3 of
pts. Have sustained disease activity/chronicity
Less than 20% of patients have chronic/destructive/debilitating disease
Reactive Arthiritis and Reiter's Diagnostics Labs are non-specific, ESR & CRP will be elevated,
leukocytosis with thrombocytosis & often mild anemia.
X-ray shows sausage digits, Achilles tendinitis/plantarfasciitis & periosteal rxn of new bone
formation.
Periarticular demineralization/osteopenia notably absent in RS vs. RA
Reactive Arthiritis and Reiter's Management same as ankylosing spondylitis
Also sulfasalazine, methotrexate, abx?, ? TNF
Psoriatic Arthritis: Incidence/Pathophysiology Inflammatory arthritis assoc. with the
dermatologic dx of psoriasis.
6% of patients with mild-moderate psoriasis develop inflammatory arthritis
Severe psoriasis = 30-40% joint disease, men & women are equally affected
Common age of onset: 30-40 years
> extensive spinal involvement in men + HLA-B27
Psoriatic Arthritis Presentation Occurs before, with or after onset of the skin disease
Arthritis precedes the rash in 15-20% of pts.
Erythrocyte Sedimentation Rate (ESR) timed test that measures the rate at which red blood
cells settle through a volume of plasma
Non Specific marker of inflammation (Clumping from inflammation causes RBCs to sink faster)
Rheumatoid Factor (RF) An immunoglobulin IgM antibodydirected against IgG
Usually present in RA, but can be present with other disorders
Presence of RF in RA usually signifies more severe disease
Antinuclear Antibody (ANA) Pathogenic autoantibodies
Present in 95% of SLE patients; Also present in 25-30% normal patints
HLA-B27 immunogenetic marker associated with spondyloarthropathies: present in 95% of
pts with ankylosingspondylitis
50-80% of patients with spondyloarthropathy of inflammatory bowel disease, Reiter's
syndrome or psoriasis
Ankylosing Spondylitis chronic, progressive arthritis with stiffening of joints, primarily of the
spine; Seronegative spondyloarthropathies: group of inflammatory arthritides with many
shared features
Anklosing spondylitis
Reactive arthritis & Reiter's syndrome
psoriatic arthritis
Arthritis associated with inflammatory bowel disease(IBD)
These illnesses are characterized by: sacroiliitis, peripheral joint inflammation & eye
inflammation and
,Ankylosing Spondylitis Patho and Presentation Inflammation of bony insertions of ligaments
& tendons -> new bone formation
Ligamentous inflammatory granulation tissue is gradually replaced by fibrocartilage & then
ossifies
Insidious low back pain development with periods of exacerbation & remission. Diffuse, poorly
localized, described as a deep ache, nagging discomfort in low back below waist, buttocks or in
the hips; Worsens with rest improves exercise
Ankylosing Spondylitis S/S Asymmetric joint involvement, often large joints• Extra articular
manifestations: low-grade fever, fatigue and wt. loss• acute anterior uveitis: painful, red eye,
up to 30% of pts.• Cardiac involvement: aortic valve insufficiency, mild or severe
PE: Loss of normal lumbar lordosis
Often palpable muscle spasm Para spinal muscles
Decreased spine mobility
Ankylosing Spondylitis Diagnostics Rheumatology has 3 clinical criteria for diagnosis:
1. low back pain & stiffness >3 months, improving with exercise, not relieved by rest• 2. limited
ROM of lumbar spine• 3. Limited chest expansion
Presence of sacroiliitis on radiologic exam + 1 clinical criterion is diagnostic
Ankylosing Spondylitis Management Should be co-managed with rheumatology, & refer to
PT, ortho & ophthalmology
First line: NSAIDs: particularly indomethacin, tolmetin & sulindac. Other NSAIDs such as
ibuprofen & naproxen are variably effective.
High dose ASA not effective
TNF's: tumor necrosis factor agents are effective but are costly.
Pain management very important to minimize spinal deformity and allow pts.to exercise
,Variety of neurological issues: 1. cord compression 2° to spinal fx of fusedspine, 2. Atlantoaxial
subluxation from chronic cervical involvement, 3.Cauda equina syndrome
Reactive Arthritis & Reiter's Syndrome Reactive arthritis = acute sterile inflammatory
arthropathy after an infection & no microbial invasion of the synoviumor or joint space & prior
infection is remote from joint
Reiter's syndrome: an example of reactive arthritis defined by classic triad of conjunctivitis,
urethritis &arthritis
Reactive arthritis is the preferred term as many patients are first seen with an incomplete
syndrome without all 3 criteria
Reactive Arthritis: seen after Stds and GI infections: common causative agent: salmonella,
shigella, Yersinia, campylobacter & chlamydia
Reactive Arthiritis and Reiter's Incidence One study 260 individuals with Salmonella infection
19 or 7% developed reactive arthritis.
Peak incidence of RA/RS is in 3rd decade of life
Postveneral Reiter's syndrome affects men more than women ranging from 9:1 to 5:1
Reactive Arthiritis and Reiter's Presentation When there is a documented infection: arthritic
s/s occur 10-20days later.
Less than 40% of pts. Present with the classic triad
Arthropathy of RS is distinctive: lower extremity, asymmetric joint involvement, "sausage
digits", heel pain, Achilles tendinitis, plantarfasciitis & sacroiliitis.
Dactylitis: "sausage digit" result of inflammation of insertions of ligaments/tendons:
characteristic of Reiter's & psoriatic arthritis
, Course of disease is variable: initial episode 2-3 mos., may have recurrent acute attacks, 1/3 of
pts. Have sustained disease activity/chronicity
Less than 20% of patients have chronic/destructive/debilitating disease
Reactive Arthiritis and Reiter's Diagnostics Labs are non-specific, ESR & CRP will be elevated,
leukocytosis with thrombocytosis & often mild anemia.
X-ray shows sausage digits, Achilles tendinitis/plantarfasciitis & periosteal rxn of new bone
formation.
Periarticular demineralization/osteopenia notably absent in RS vs. RA
Reactive Arthiritis and Reiter's Management same as ankylosing spondylitis
Also sulfasalazine, methotrexate, abx?, ? TNF
Psoriatic Arthritis: Incidence/Pathophysiology Inflammatory arthritis assoc. with the
dermatologic dx of psoriasis.
6% of patients with mild-moderate psoriasis develop inflammatory arthritis
Severe psoriasis = 30-40% joint disease, men & women are equally affected
Common age of onset: 30-40 years
> extensive spinal involvement in men + HLA-B27
Psoriatic Arthritis Presentation Occurs before, with or after onset of the skin disease
Arthritis precedes the rash in 15-20% of pts.
