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• 1 Rest/ctivity Test 2

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• OA drug therapy(Mild to moderate)

  Acetaminophen 1000 mg Q6H
  Capsaicin Cream-topical 
  OTC creams-Bengay, Arthricare
  Topical Salicylates-Aspercream

• OA drug therapy(Moderate to severe)

  NSAIDS-ibuprophen-200 mg 4x a day
  Misoprostal-to decrease GI side effects
  Arthrotec-Combination of the two
  Diclofenac gel-Analgesic (avoid heat and sun)
  Cox2-Celebrex
  Corticosteroid injections
  Hyaluronic Acid-May be added to oral supplements(glucosamine)
  DMOADS-DMARDS-Antiinflammatory, blocks protein synthesis

• RA Stage 4(Terminal)

  Same as 3 with Fibrous or bony ankylosis(immobility due to fusion of bones)

• Extraarticular Manifestations (RA)

  Rheumatoid nodules-on spine, fingers, elbows, head
  Sjogren's syndrome-Decreased secretions(use eye drops)
  Felty syndrome-Splenomegaly + leukopenia 
  Flexion contractures-decreased grasp strength 
  Nodular myositis-Muscle fiber degeneration/vascular insufficiency
  Cataracts-Sclera nodules 
  Depression

• RA Diagnostic studies

  + RF, elevated Erythrocyte sedimentation rate(ESR)+C-reactive protein(CRP)=shows active inflammation, ANA, and Anti-citrullinated protein antibody(ACPA)<-- most specific. 
  Synovial fluid analysis should be straw colored in early stages, WBC >25000

• Tumor necrosis factor (TNF) inhibitors

  Enbrel, Remicade, Humira etc
  SubQ or PO
  TB test and chest xray prior 
  Monitor for infection 
  Avoid live vaccines (MMR, Flu, Varicella)

• RA Objective data

  Raynaud's phenomenon(Abnormal blood flow causing cyanosis to digits), distant heart sounds, murmurs, TB, Lymphadenopathy, Keratoconjunctivitis, skin ulcers, shiny taut skin over joints, peripheral edema, Splenomegaly

• RA Home care

  Firm mattress or bed board, encourage positions for extension, avoid flexion pillows, no pillows under knees, small flat pillow under head/shoulders. Cold for exacerbations(10-15 min), Heat for stiffness(20 min)

• Clubfoot post operative

  Q2H neurovascular checks. Elevate ankles and foot on pillows. Apply ice.

• Legg-Calve-Perthes Disease

  Avascular necrosis of the femoral head especially boys 4-8. Comes in 4 stages within 1-2 years. The ossific nucleus is prevented from growing which makes the bone more dense. The bone is reabsorbed and replaced by new bone which causes the femoral head to flatten and enlarge. They are usually shorter than normal and low birth weight children with an immature skeletal age