NURS 5335 Study Guide Msk | Complete Solution | Latest
Updated 2026 | University of Texas Arlington
OA and RA
• What are the signs and symptoms of Osteoarthritis?
o Destruction of cartilage and narrowing of the joint space; common in females after 55
o Fingers, knees, hips and spine most commonly affected joints (most common fingers)
o asymmetric joint pain, and it develops insidiously, and it accompanies or follows physical
activity. They'll have morning stiffness, but it lasts less than an hour and it gets worse
again at the end of the day or after they've had periods of activity.
• What are Heberdon’s and Bouchard’s nodes? Where are they located?
o Heberdon's nodes which are on the distal intra-phalanges and the Bouchard's nodes,
which are on the proximal.
• What are the treatments for Osteoarthritis?
o OA: prevention- normal wt. healthy BMI; with exercise, heat & cold therapies etc.
followed by NSAIDS (first line), followed by steroid injections. Braces and orthotics help.
▪ Surgery: arthroscopic, surgery, osteotomy, and then your total joint
replacement. x-ray and it shows bone on bone, there's really not much else they
can do but the total joint replacement.
• How do you differentiate RA and OA?
o OA: morning stiffness lasts less than an hour, knee would have coarse crepitus, joint
effusion, knee locks or pops (encourage quadricep strengthening)
o rheumatoid: they have morning stiffness for an hour or more.
• When do you refer?
o If pain is still present refer to rheumatologist
,• Know that a patient taking NSAIDS needs to have CBC, BUN/Cr and Liver functions monitored.
If you do a stool for occult blood, they need to be off NSAIDS 2-3 days.
• What is Rheumatoid Arthritis?
o RA: is an autoimmune disease and leads to joint deformity and destruction; whole body
disorder; primarily in synovial tissues- chronic inflammatory disease, joint swelling, joint
tenderness- leading cause of death Cardiac disease
o Presentation: deformed hands, restricted movement; symmetrical morning joint
stiffness with pain on movement and it takes about an hour before these patients can
get their hands to moving; warmth involved, erythema. Usually symmetrical and the
small joints are affected before the large joints, so you'll see it in the hands, the feet, the
wrists, and the distal interphalangeal. More common in women, with fam hx of
autoimmune
• What diagnostic tests are done?
▪ Do initial lab-work (because it may take several weeks to get into
rheumatologist) and refer patient ASAP
▪ CBC - mild anemia's common
▪ Elevated Sed rate
▪ CRP indicating the inflammation.
▪ chemistry baseline
▪ elevated levels of rheumatoid factor (antibody test) and the citrullinated
antibodies. ANA may or may not be positive. It is more specific to lupus but can
be positive in RA as well.
▪ Synovial fluid
▪ Possible Radiology:
• Joint X-rays
• MRI if joint derangement
• What is the treatment? What are the side effects?
o NSAIDs- s/e thrombotic events and GI ulceration and bleeding.
o DMARDS (disease modifying antirheumatic drugs)
• Not used in pregnancy
▪ Nonbiologic DMARDS (small)- Methotrexate and Sulfasalazine,
hydroxychloroquine (Plaquenil)
• Methotrexate most rapid acting, TE in 3-6 weeks ; S/e: hepatic fibrosis,
bone marrow suppression, GI ulceration, and pneumonitis and there is a
black box warning
• Sulfazaline- intolerable GI effects
▪ Biologic DMARDS (large)
• Inactivate Tumor Necrosis Factor
• pose risk of serious infections so these patients have to be tested for TB
every six months. You don't want to give them any live vaccines, but you
, want to make sure they get vaccinated against flu and pneumonia and
all of those things. And they work by neutralizing the tumor necrosis
factor.
• And these are your Etanercept, Adalimumab, Certolizumab, Golimumab
and Infliximab, rituximab, Toclizumab, Saralumab.
o Glucocorticoids - when one or two joints are affected, and intraarticular injections are
used. These do have adverse effects and the treatment is usually with Prednisone and
Prednisolone.
• Know these patients need early referral to rheumatologist.
o Sjogren’s Syndrome- decreased tearing and dry mouth
o Hydroxychloroquine- do dilated retinal imaging exam
HIP PAIN:
• Trochanteric Bursitis: lateral pain aggravated by direct pressure
o MOST COMMON CAUSE OF BURSITIS IS JOINT OVERUSE
o FIRST LINE TREATMENT NSAIDs’
o Olecranon bursitis typically presents with swelling and redness over the affected area
• Structural joint problem, OA: pain with use, better with rest
• Infectious, inflammatory, neoplastic: constant pain, especially at night
• Hip joint: OA, etc.: anterior hip and groin pain
• SI joint, Low back pain: posterior hip pain
Plantar Fasciitis
• Point tenderness at heel
• What are risk factors?
o It's a painful inflammatory process of the plantar fascia, the connective tissue or
ligament on the sole of the foot. And it's often caused but the overuse of the plantar
fascia, increases in activity or weight or age.
• Presentation?
o Heel pain that's worse in the morning or after sitting for several minutes, and it
decreases with activity. It's a sharp pain in the heel of the foot. There's point tenderness
in the anteromedial region of the calcaneus.
• Findings on physical exam?
o pain increases with dorsal flexion of the toes, and there's usually tightness in the Achilles
tendon.
• Management?
o do shoes with shock absorbing soles, rest, stretching, NSAIDS, ice massage 15 to 20
minutes 4 times a day. Steroid injections can be done; however, you want to try the
more conservative therapy first
Updated 2026 | University of Texas Arlington
OA and RA
• What are the signs and symptoms of Osteoarthritis?
o Destruction of cartilage and narrowing of the joint space; common in females after 55
o Fingers, knees, hips and spine most commonly affected joints (most common fingers)
o asymmetric joint pain, and it develops insidiously, and it accompanies or follows physical
activity. They'll have morning stiffness, but it lasts less than an hour and it gets worse
again at the end of the day or after they've had periods of activity.
• What are Heberdon’s and Bouchard’s nodes? Where are they located?
o Heberdon's nodes which are on the distal intra-phalanges and the Bouchard's nodes,
which are on the proximal.
• What are the treatments for Osteoarthritis?
o OA: prevention- normal wt. healthy BMI; with exercise, heat & cold therapies etc.
followed by NSAIDS (first line), followed by steroid injections. Braces and orthotics help.
▪ Surgery: arthroscopic, surgery, osteotomy, and then your total joint
replacement. x-ray and it shows bone on bone, there's really not much else they
can do but the total joint replacement.
• How do you differentiate RA and OA?
o OA: morning stiffness lasts less than an hour, knee would have coarse crepitus, joint
effusion, knee locks or pops (encourage quadricep strengthening)
o rheumatoid: they have morning stiffness for an hour or more.
• When do you refer?
o If pain is still present refer to rheumatologist
,• Know that a patient taking NSAIDS needs to have CBC, BUN/Cr and Liver functions monitored.
If you do a stool for occult blood, they need to be off NSAIDS 2-3 days.
• What is Rheumatoid Arthritis?
o RA: is an autoimmune disease and leads to joint deformity and destruction; whole body
disorder; primarily in synovial tissues- chronic inflammatory disease, joint swelling, joint
tenderness- leading cause of death Cardiac disease
o Presentation: deformed hands, restricted movement; symmetrical morning joint
stiffness with pain on movement and it takes about an hour before these patients can
get their hands to moving; warmth involved, erythema. Usually symmetrical and the
small joints are affected before the large joints, so you'll see it in the hands, the feet, the
wrists, and the distal interphalangeal. More common in women, with fam hx of
autoimmune
• What diagnostic tests are done?
▪ Do initial lab-work (because it may take several weeks to get into
rheumatologist) and refer patient ASAP
▪ CBC - mild anemia's common
▪ Elevated Sed rate
▪ CRP indicating the inflammation.
▪ chemistry baseline
▪ elevated levels of rheumatoid factor (antibody test) and the citrullinated
antibodies. ANA may or may not be positive. It is more specific to lupus but can
be positive in RA as well.
▪ Synovial fluid
▪ Possible Radiology:
• Joint X-rays
• MRI if joint derangement
• What is the treatment? What are the side effects?
o NSAIDs- s/e thrombotic events and GI ulceration and bleeding.
o DMARDS (disease modifying antirheumatic drugs)
• Not used in pregnancy
▪ Nonbiologic DMARDS (small)- Methotrexate and Sulfasalazine,
hydroxychloroquine (Plaquenil)
• Methotrexate most rapid acting, TE in 3-6 weeks ; S/e: hepatic fibrosis,
bone marrow suppression, GI ulceration, and pneumonitis and there is a
black box warning
• Sulfazaline- intolerable GI effects
▪ Biologic DMARDS (large)
• Inactivate Tumor Necrosis Factor
• pose risk of serious infections so these patients have to be tested for TB
every six months. You don't want to give them any live vaccines, but you
, want to make sure they get vaccinated against flu and pneumonia and
all of those things. And they work by neutralizing the tumor necrosis
factor.
• And these are your Etanercept, Adalimumab, Certolizumab, Golimumab
and Infliximab, rituximab, Toclizumab, Saralumab.
o Glucocorticoids - when one or two joints are affected, and intraarticular injections are
used. These do have adverse effects and the treatment is usually with Prednisone and
Prednisolone.
• Know these patients need early referral to rheumatologist.
o Sjogren’s Syndrome- decreased tearing and dry mouth
o Hydroxychloroquine- do dilated retinal imaging exam
HIP PAIN:
• Trochanteric Bursitis: lateral pain aggravated by direct pressure
o MOST COMMON CAUSE OF BURSITIS IS JOINT OVERUSE
o FIRST LINE TREATMENT NSAIDs’
o Olecranon bursitis typically presents with swelling and redness over the affected area
• Structural joint problem, OA: pain with use, better with rest
• Infectious, inflammatory, neoplastic: constant pain, especially at night
• Hip joint: OA, etc.: anterior hip and groin pain
• SI joint, Low back pain: posterior hip pain
Plantar Fasciitis
• Point tenderness at heel
• What are risk factors?
o It's a painful inflammatory process of the plantar fascia, the connective tissue or
ligament on the sole of the foot. And it's often caused but the overuse of the plantar
fascia, increases in activity or weight or age.
• Presentation?
o Heel pain that's worse in the morning or after sitting for several minutes, and it
decreases with activity. It's a sharp pain in the heel of the foot. There's point tenderness
in the anteromedial region of the calcaneus.
• Findings on physical exam?
o pain increases with dorsal flexion of the toes, and there's usually tightness in the Achilles
tendon.
• Management?
o do shoes with shock absorbing soles, rest, stretching, NSAIDS, ice massage 15 to 20
minutes 4 times a day. Steroid injections can be done; however, you want to try the
more conservative therapy first
