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MSK > Arthritis and Gout > Flashcards

Arthritis and Gout Flashcards

1
Q

Oligo-articular involves how many joints?

A

2-4

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2
Q

Poly-articular involves how many joints?

A

> 5

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3
Q

red, swelling, heat, pain are indicative of

A

joint inflammation

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4
Q

(inflammatory/non-inflammatory) joint pain is WORSE in the morning, but IMPROVES with activity

A

Inflammatory (septic, RA, gout, SLE)

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5
Q

(inflammatory/non-inflammatory) joint pain is okay in the morning, but WORSENS with activity

A

Non-inflammatory (osteoarthritis, trauma)

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6
Q

ACUTE monoarthritis can be indicative of

A

Septic arthritis

Gout

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7
Q

Arthrocentesis is aka

A

joint aspiration

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8
Q

(lightly cloudy/tea/white) colored synovial fluid is indicative of osteoarthritis

A

lightly cloudy

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9
Q

(cloudy/tea/white) colored synovial fluid is indicative of inflammatory arthritis

A

Tea

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10
Q

(cloudy/tea/white) colored synovial fluid is indicative of septic arthritis

A

White

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11
Q

Gout as a monoarthritis most often involves 1st

A

MTP joint

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12
Q

Joint pain due to loss of normal articular cartilage with age, trauma, and obesity; pain worsens with activity; associated with popliteal cysts, DIP/PIP joints and 1st CMC joint

A

Osteoarthritis

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13
Q

X-ray characteristics of Osteoarthritis

A
  1. Osteophytes (bony lumps on vertebrae)

2. Joint space narrowing (wearing of joint cartilage)

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14
Q

The crystal involved with Gout is

A

Monosodium Urate Crystals (needle shaped and strongly negatively birefringent)

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15
Q

Acute monoarthritis due to deposition of monosodium urate crystals in the joints; more common in men; Hyperuricemia is ESSENTIAL for the development

A

Gout

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16
Q

Obesity, diabetes, alcohol and some medications (aspirin, diuretics, etc.) are the risk factors for

A

Gout

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17
Q

Hyperuricemia causing Gout is majorly due to (overproduction/under-excretion) of uric acid

A

underexcretion

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18
Q

Hyperuricemia is defined as a serum urate level…

A

> 7 mg/dL

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19
Q

Acute monoarthritis in Gout usually involves which joint?

A

1st MTP

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20
Q

Nodular masses of uric acid crystals deposited in different soft tissue areas of the body; most commonly at the fingers, at the tips of the elbows, and around the big toe

A

Tophus gout (chronic)

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21
Q

Synovial fluid analysis is the ONLY definitive diagnosis for Gout as it will be inflammatory (>5k WBCs) (True or False)

A

True

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22
Q

What characteristics of synovial fluid will indicate Gout

A

WBC >5k

+ Urate crystals (under polarized light)

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23
Q

Treatments for Gout

A

Acute: NSAIDs, steroids, colchicine

Chronic (preventative): Allopurinol (xanthine oxidase inhibitor)

24
Q

Function of colchicine

A

Inhibits tubulin in microtubules –> inhibits neutrophil fx

Doesn’t alter urate levels though!!

25
Q

Pentose phosphate Pathway produces what byproducts?

A
  1. Ribose-5-Phosphate

2. PRPP

26
Q

What is the major regulating step for purine synthesis and its enzyme?

A

Conversion of PRPP –> 5-phosphoribosyl 1-amine

  • GPA (Glutamine Phosphoribosyl Amidotransferase)
27
Q

Examples of Xanthine Oxidase Inhibitors

A

Allopurinol

Febuxostat

28
Q

Adenine, Hypoxanthine, and Guanine are purine bases that all require what in the salvage pathway to make nucleotides?

A

PRPP

29
Q

Adenine uses APRT to make AMP, while Hypoxanthine and Guanine use _____ to make IMP, GMP

A

HGPRT

30
Q

Glucose 6-phosphatase deficiency, lesch-nyhan syndrome, tumor lysis syndrome, PRPP excess, and von gierke disease (type I glycogen storage disease) can cause hyperuricemia through

A

Overproduction of uric acid

31
Q

X-linked recessive; HGPRT deficiency disorder; buildup of Hypoxanthine and Guanine –> degradation into uric acid

A

Lesch-Nyhan Syndrome

32
Q

the destruction of tumor cells releases tons of nucleic acids, stimulating degradation and uric acid production

A

Tumor Lysis Syndrome

33
Q

In excessive alcohol consumption and type 2 diabetes, excess lactic acid production competes with _____ leading to Gout

A

uric acid

34
Q

“Pseudogout”; deposition of Calcium Pyrophosphate crystals in joints; rhomboids/pleomorphic, weakly + birefringent; more knee involvement (vs. MTP in gout)

A

Calcium Pyrophosphate Deposition (CPPD)

35
Q

aging and metabolic disturbances (Hyperparathyroidism, Hemochromatosis/iron overload) are risk factors of

A

CPPD

36
Q

Tx for CPPD

A

NSAIDs
Steroids
Colchicine

  • same as acute gout
37
Q

A chronic autoimmune inflammatory disease; SYMMETRIC inflammatory POLYarthritis affecting proximal small joints in hand/foot; mediated by macrophages, cytokines, and MMPs; women are affected more; associated with HLA-DRB1 gene, Parvo/EBV viruses

A

Rheumatoid Arthritis

38
Q

Gene associated with Rheumatoid Arthritis

A

HLA-DRB1 gene

39
Q

Cytokine important for Rheumatoid Arthritis; produced mainly by MONOCYTES and MACROPHAGES

A

TNF-a

40
Q

Rheumatoid arthritis usually involves (proximal/distal) hand and foot joints

A

Proximal (wrist, MCP, ankle, and MTP joints)

41
Q

Osteoarthritis usually involves (proximal/distal) hand and foot joints

A

Distal (PIP, DIP)

  • exception 1st CMC joint
42
Q

What are some other organ complications of RA?

A
  1. CAD (cardiology)
  2. Nodules (dermatology)
  3. Interstitial lung disease
  4. Sjogren’s syndrome (decreased tear and salivary production)
43
Q

Common autoantibodies for Rheumatoid Arthritis

A
  1. Rheumatoid factor
  2. anti-cyclic citrullinated protein (anti-CCP) antibody
  • anti-CCP is most specific diagnosing antibody
44
Q

an antibody against the Fc portion of IgG

A

Rheumatoid Factor (anti-IgG antibody)

45
Q

Radiographic features of Rheumatoid Arthritis

A
  1. Periarticular osteopenia
  2. Joint space narrowing
  3. Erosion of bone (looks spongy)
46
Q

Treatments for Rheumatoid Arthritis

A

Disease-modifying agents (Methotrexate)

Biologics (TNF-a inhibitors–> Adalimumab)

Corticosteroids (short-term)

47
Q

A group of arthritis without rheumatoid factor; includes PAIR; associated with HLA-B27 gene

A

“Seronegative” Spondyloarthritis

Antibodies NOT detected

48
Q

PAIR include what types of arthritis

A

Psoriatic arthritis
Ankylosing spondylitis
IBD (UC/chron’s)
Reactive arthritis

49
Q

Common signs/symptoms of Seronegative Spondyloarthritis

A
  1. Back pain
  2. Peripheral arthritis
  3. Enthesitis (inflammation of tendons–> achilles)
  4. sausage fingers
50
Q

Gene associated with PAIR arthritis

A

HLA-B27

51
Q

Arthritis associated with psoriasis; nail lesions (onycholysis)

A

Psoriatic Arthritis

52
Q

Arthritis associated with fusion of SI joints and vertebrae; bamboo spine on x-ray; more in males

A

Ankylosing Spondylitis

53
Q

Arthritis associated with Inflammatory Bowel Diseases; usually presents with GI symptoms + skin symptoms

A

Enteropathic Arthritis

54
Q

Arthritis associated with triad (conjunctivitis, Urethritis, Arthritis); follows a recent bacterial infection (yersinia/chlamydia/salmonella)

A

Reactive Arthritis

Can’t see, can’t pee, can’t bend my knee

55
Q

What virus has been implicated in RA and SLE (both are autoimmune disorders)?

A

Parvo B19

56
Q

Osteoarthritis will involve (bony/spongy) enlargements of joints while Rheumatoid Arthritis will involve (bony/spongy) enlargements

A

OA: bony
RA: spongy

MSK (8 decks)

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