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NYCC Bone & Joint > (3) Rheumatoid Arthritis & JIA (DRAFT) > Flashcards

(3) Rheumatoid Arthritis & JIA (DRAFT) Flashcards

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1
Q

Inflammatory joint pathologies are generally characterized by an ____ response

A

osteolytic

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2
Q

Degenerative joint pathologies are generally characterized by an ____ response

A

osteoblastic

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3
Q

If Rheumatoid arthritis (RA) creates ankylosis, it is usually what type?

A

fibrous

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4
Q

RA generally occurs (unilateral/bilateral) and (symmetrical/asymmetrical)

A

bilateral
symmetrical

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5
Q

What is the most common inflammatory arthropathy?

A

Rheumatoid Arthritis

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6
Q

In what age group does RA begin most commonly?

A

20s - 60
(can occur at any age, biased toward younger)

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7
Q

RA generally affects ____ sized joints first, and moves to ____ sized joints

A

smaller to larger

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8
Q

TRUE/FALSE:
A patient who complains of pain only in the distal interphalangeal joints is more likely to have RA

A

FALSE
(RA does not like DIPs in early stage)

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9
Q

TRUE/FALSE:
A patient who complains of pain only in the metacarpophalangeal joints is more likely to have RA

A

TRUE
(DJD doesn’t like MCP, RA does)

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10
Q

Most inflammatory conditions follow a symptomatic pattern of ____

A

exacerbation/remission

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11
Q

Chronically inflamed synovium is called a _____

A

pannus

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12
Q

What causes cartilage destruction in RA?

A

proteases (chondrolytic enzymes) secreted by synovium destroy hyaline cartilage in uniform fashion

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13
Q

Why is joint space loss in RA uniform?

A

chemically mediated destruction of cartilage (not biomechanical)

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14
Q

Inflamed synovial tissue against the bare area causes ____ radiographically

A

marginal erosion

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15
Q

Bone destruction in the bone around a joint in RA causes ____ radiographically

A

periarticular (juxta-articular) osteopenia

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16
Q

Tendon sheathes and bursa are lined with ____

A

synovium

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17
Q

What causes ulnar deviation of the fingers in RA?

A

rupture of tendon pulleys allows tendons to pull to ulnar side (tendon subluxation)

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18
Q

What are the clinical findings of RA?

A
  • exacerbation/remission pattern
  • warm, swollen, painful jts (bilateral), crepitus
  • ^pain/tenderness with motion, worst after disuse (morning; lasts longer than DJD)
  • deformities & tendon subluxation
  • Rheumatoid nodules (*Haygarth’s nodes)
  • secondary jt degeneration
  • ACD -> fatigue (marrow fibrosis)
  • bursitis/tendinitis/tenosynovitis
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19
Q

Name 4 systemic findings of RA.

A
  • carpal tunnel syndrome (bilateral)
  • Sjogren syndrome (atrophy of mucus mem. -> dysphagia, constipation, etc.)
  • Vasculitis (Raynaud phenomenon)
  • Pleuropulmonary (Pericardial Dz, Emphysema w/o smoking Hx)
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20
Q

What is the term for severe deformities of the digits in RA?

A

arthritis mutilans

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21
Q

What is a swan neck deformity?

A

flexion of DIP jt, extension of PIP jt

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22
Q

What is a Boutonniere deformity?

A

extension of DIP jt, flexion of PIP jt

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23
Q

What joints are commonly affected by RA?

Study These Flashcards
A
  • wrists + hands (MCP, PIP)
  • ankles + feet (MTP)
  • c/s
  • hip
  • knee
  • GH jt
  • AC jt
  • elbow
24
Q

What are the relevant lab findings for RA?

Study These Flashcards
A
  • ^ESR & CRP
  • positive rheumatoid factor (RF; 70%)
  • positive Anti-CCP (cyclic citrullinated peptides)
  • low RBC & platelets (anemia of chronic disease (ACD))
25
When should labs be taken in a patient with suspected RA?
during period of exaccerbation
26
Which lab finding is more **specific** for RA?
Anti-CCP (less sensitive, more specific)
27
Which lab finding is more **sensitive** for RA?
RF (less specific, more sensitive)
28
What are the specific radiographic findings of RA in the hand?
- MCP (Haygarth nodes = radial margins of 2nd & 3rd met heads + prox. phalange base) - PIP (Bouchard nodes = radial margins of prox. phalange base) - Swan-neck or Boutonniere deformities - ulnar deviation/drift - Hitchhiker's thumb (hyperext. of IP thumb jt) - arthritis mutilans - marginal erosions
29
What are the specific radiographic findings of RA in the wrist?
- ulnar styloid process erosion (early finding) - carpal erosions (spotty carpal sign) - bony ankylosis (midcarpal) - rotation deformities (zig-zag wrist) - scapholunate dissociation (Terry-Thomas' sign, VISI/DISI)
30
What is "zig-zag" wrist?
radial rotation of proximal carpal row & ulnar drift at MCPs
31
What are the specific radiographic findings of RA in the feet?
- MTPs (5th toe, lat side met. head is earliest, then medial side from 4-1) - Lanois deformity - hallux valgus - PIPs - calcaneal erosions at tendon attachments (marginal erosions, periarticular osteopenia) (can also see pencil-in-cup deformity)
32
What are the specific radiographic findings of RA in the cervical spine?
- atlantoaxial jt instability, ^ADI (dens erosion, transverse lig rupture, dens Fx) - basilar invagination - facet jt erosion --> fusion - SP erosion (pencil sharpened spinous) - disc narrowing - no osteophytes - subluxations (stair-step deformity)
33
What is your next step before treating the cervical spine in a patient with RA?
flexion/extension radiographs (unless minimal series shows ^ADI, stress xrays unnecessary)
34
What is the main concern for a patient with RA who has transverse ligament rupture?
Guillotine effect
35
What referral would you make for a patient with RA affecting the cervical spine?
neurosurgical referral (chronic instability)
36
What is stair-step deformity in the cervical spine?
multiple levels of unstable spondylolistheses (contraindication to adjusting)
37
What percent of RA patients have cervical spine involvement?
up to 80%
38
In patients with RA, if the cervical spine is involved, they will also have ____ involvement
hand
39
What are the specific radiographic findings of RA in the hips?
(larger jt = later stage) - uniform loss of jt space (axial migration) - erosions - femoral head destruction (small femoral head) - bilateral protrusio acetabuli = Otto pelvis
40
What is the term for **unilateral** axial migration of the femoral head into the pelvis?
protrusio acetabuli
41
What is the term for **bilateral** axial migration of the femoral head into the pelvis?
Otto pelvis
42
What are the specific radiographic findings of RA in the knees?
- uniform loss of jt. space - jt. effusion (^incidence of baker cysts, "fullness" in post. knee) - no osteophytes - marginal erosions - osteoporosis - subchondral cysts
43
What are the specific radiographic findings of RA in the shoulders?
(larger jt = later stage) - uniform loss of GH jt space - marginal erosions (simulates Hill-Sach) - rotator cuff tear d/t subacromial bursitis (supraspinatus tendon) - clavicular erosions (tapered distal clavical)
44
What are the differential diagnoses for clavicular erosions?
- PTOC - RA - HPT - septic arthritis
45
What are the specific radiographic findings of RA in the elbows?
- 90% have +/ve fat pad sign - pancompartmental loss of jt space - marginal erosions - bursitis
46
What are other names for juvenile idiopathic arthritis (JIA)?
- juvenile rheumatoid arthritis (JRA) - juvenile chronic arthritis (JCA)
47
Define juvenile idiopathic arthritis
an inflammatory arthropathy with an onset prior to 16 years of age (i.e., a 30 year old that comes into your office would have JIA, bc different manifestations than adult onset RA)
48
Lab results that are positive for RF are termed ____, while labs that are negative for RF are termed ____
seropositive seronegative
49
What sex is most affected by JIA?
Female
50
What systemic symptoms may present with JIA?
- chronic, low-grade fever (99-100 F) - rash - lymphadenopathy - iridocyclitis - ACD (fatigue) - receded-hypoplastic mandible (bird-like facies) - shorter height, less muscular (d/t low energy)
51
What joints are targeted by JIA?
- c/s - hands - wrist - feet - knees - hips
52
What age group is primarily affected by JIA?
peaks at 2-5 yrs and 9-12 yrs
53
What are the radiologic features of JIA?
- soft tissue swelling - osteoporosis (transverse growth arrest lines) - periostitis (more than in adult RA) - uniform jt. space loss (late stage) - articular erosions (less than RA) - growth disturbances (ballooned epiphyses, early closure of growth plates --> smaller bones) - bony ankylosis (IP, carpals, tarsals, cervical facets)
54
How does ankylosis in JIA compare to RA?
- JIA = bony - RA = fibrous
55
What are the general radiographic characteristics of RA?
- marginal erosions (AKA "rat bite" lesions) - juxta/periarticular osteopenia - periarticular soft tissue swelling - bilateral, uniform loss of jt space - subchondral bone cysts (pseudo-cysts) - deformities - juxta-articular periostitis (linear) - ankylosis (rare; fibrous) - no osteophytes

NYCC Bone & Joint (71 decks)

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