NURS 6501 Knowledge Check: Neurological and Musculoskeletal Disorders

Patients with gout are more at risk for uric acid stone formation due to the low urine PH of less than 5, which makes the environment conducive for uric acid precipitation. and also can increase the risk of calcium oxalate stone formation. If there is excessive uric acid in the blood, and it builds up over time  because the kidney was not able to remove, it  can cause  kidney stones which  can lead to infection scarring, and finally kidney failure

Most uric acid is eliminated from the body through the kidneys. Urate is filtered at the glomerulus and undergoes reabsorption and excretion within the proximal renal tubules. In primary gout, urate excretion by the kidneys is sluggish. This may be caused by a decrease in glomerular filtration of urate or acceleration in urate reabsorption. This allows for urate crystals to be deposited in the renal tubules.

Osteoporosis is a  bone disease that develops when bone mineral density and mass are reduced and the quality or structure of the bone changes that can increase the risk of fractures.  There are no symptoms of osteoporosis, it is considered a silent disease. It is more common in women in their menopausal stage and older. It can affect any part of the body. But most affect  the bones of the hip, vertebrae in the spine, and wrist, There are risk factors for osteoporosis which include, sex, age, body size race, family history, changes to hormones, Medications, other medical conditions such as rheumatoid arthritis, cancer, HIV/AIDS

Osteoporosis is considered a metabolic bone disease. Osteoporosis, also called porous bone, is the most common bone disease in humans. Its main features include low bone mineral density, impaired structural integrity of bone, decreased bone strength and increased risk of fractures. The two types of osteoporosis are primary and secondary. Primary osteoporosis, the most common is hormone mediated where bone loss is accelerated by declining levels of estrogen in women and testosterone in men. Secondary osteoporosis is caused by other conditions including endocrine disorders (hyperparathyroidism, hyperthyroidism, diabetes mellitus) and certain medications such as heparin, corticosteroids, phenytoin, barbiturates, and lithium) as well as tobacco and alcohol. There are three major bone cells that are involved in the formation, maintenance, and reabsorption of bone. Osteoblasts are immature bone cells that under ideal circumstances allow bone to formed and laid down. Osteocytes are cells that are responsible for the normal maintenance, or the cycle, of bone. Osteocytes removed old bone cells which allows the osteoblasts to form new bone. Osteoclasts are responsible for reabsorption of bone. Hormonal influences remain important in maintaining bone health, but new research has demonstrated that genetic factors and the role of oxidative stress also contributes to the development of osteoporosis. Reactive oxygen species (ROS) serve as signaling molecules for osteoblasts, osteocytes, and osteoclasts. An imbalance between osteoblast formation and osteoclast reabsorption is the primary cause of osteoporosis.

The  symptoms of this patient are associated with rheumatoid  arthitis,because stiffness, swelling especially in the hands, RA  usually attacks the bones of the small joints in the hands and feets,  and she also present with stiffness,as well as boggy proximal interphalageal  The   main cause between  Osteo arthritis and  rheumatoid arthritis is the  caused . Rheuatoid arthritis is an autoimmune disease  and Osteo arthritis is caused by mechanical osteoarthritis is caused by wear and tear on the joints

Rheumatoid arthritis is an inflammatory, systemic disease that is autoimmune in nature. Symptoms are mediated by antibodies against self-antigens and inflammatory cytokines, especially CD4+ T cells that promote inflammation. Multiple inflammatory cells are involved, and TNF and Interleukin-1 stimulate the synovial cells to secrete protease that damages the hyaline cartilage. The inflammatory cytokines convert the synovium into an abnormally thick layer of granulation tissue called pannus. The pannus acts like a locally invasive tumor. Pannus is the tissue responsible for destruction of the articular cartilage. The other inflammatory mediators affect the soft tissue structures like the tendons, ligaments, and even the valves of the heart, especially the aortic valve. Long standing inflammation causes interstitial fibrosis of the lungs which reduces pulmonary function. Osteoarthritis (OA) is localized destruction of articular cartilage which can either be idiopathic or secondary. Secondary OA is due to a prior injury or infectious process that may affect the normal cartilage. Primary OA is very common in people >65 years of age and there is a strong correlation between obesity and the development of OA. OA in a non-inflammatory disease process

Multiple sclerosis is a chronic inflammatory autoimmune disease that affect the brain, the nerves fibers in the central nervous system,causing degeneration and sclerosis, loss of axons, causing damage  and may cause symptoms such as numbness,  pain, problems with vision, arm and leg movement, It can  cause permant disablity. More common in woman than man. The loss of myelin  inhered the nerve conduction leading  to symptoms presention of the symptoms

MS is a chronic inflammatory disease involving degeneration of CNS myelin, scarring (or sclerosis or plaque formation) and loss of axons. It is caused by an autoimmune response to self or microbial antigens in genetically susceptible people. The usual age of onset is between 20 and 40 years of age and is more common in women. When reviewing the demyelinating lesions in the spinal cord and brain of patients with MS shows myelin loss, destruction of oligodendrocytes, and reactive astrogliosis, often with relative sparing of the axon cylinder. In some MS patients, however, the axon is also aggressively destroyed. One of the earliest steps in lesion formation is the breakdown of the blood-brain barrier. Enhanced expression of adhesion molecules on the surface of lymphocytes and macrophages seems to underlie the ability of these inflammatory cells to penetrate the blood-brain barrier. The elevated immunoglobulin G (IgG) level in the cerebrospinal fluid, which can be shown by an oligoclonal band pattern on electrophoresis, suggests an important humoral (i.e., B-cell activation) component to. Variable degrees of antibody-producing plasma cell infiltration have been demonstrated in MS lesions. The patient’s symptoms are directly related to the inflammation and demyelination of the nerve sheath. The short- term memory loss indicates that there may be demyelinating lesions in the brain as well.