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MSK > Arthritides > Flashcards

Arthritides Flashcards

0
Q

List 5 common types of arthritides (degenerative/inflammatory/deposition) that are M/C in males?

A
  • DISH
  • AS
  • Synoviochondrometaplasia
  • Gout
  • Reiter’s syndrome
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1
Q

What are the 3 motion characteristics of joints?

A

1) Synarthroses – fibrous (mostly immobile)
2) Amphiarthroses – cartilaginous (slightly movable)
3) Diarthroses – synovial (freely movable)

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2
Q

What is an eponym for osteoarthritis?

A

Kellgren’s arthritis

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3
Q

At what level is the M/C cervical degenerative spondylolisthesis?

A

C7

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4
Q

What is Maigne’s syndrome?

A

Apophyseal pain from lower T/S that refers to lower lumber segments.

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5
Q

What is Robert’s syndrome?

A

Costal joint involvement in lower T/S that can simulate GI disease.

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6
Q

Which portion of the sacroiliac joint is synovial?

A

Lower 2/3rds

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7
Q

What is the relationship between hip arthrosis and osteoporosis?

A

Hip arthrosis correlation with DECREASED risk for osteoporosis.

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8
Q

A person may be at risk for which degenerative condition when their “Q” angle is >20 degrees?

A

Chondromalacia patella

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9
Q

Patella alta may be a contributing factor for which condition?

A

Chondromalacia patella

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10
Q

Where are Herberden’s nodes? Where are Bouchard’s nodes?

A 
Herberden = DIP
Bouchard = PIP
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11
Q

True or false: vacuum clefts denote degeneration in any joint of the body.

A

False. Only the spine but not other joints.

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12
Q

What % of erosive osteoarthritis go on to develop RA?

A

15%

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13
Q

What is an eponym for DISH?

A

Forestier’s disease

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14
Q

What % of DISH patients have diabetes myelitis?

A

20-50%

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15
Q

What is the M/C initial site for DISH?

A

Thoracolumbar

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16
Q

What are some clinical concerns associated with DISH?

A
  • dysphagia from esophageal obstruction
  • “carrot stick” fracture
  • spinal stenosis (rare)
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17
Q

What is the diagnostic criteria for DISH?

A
  • flowing hyperostosis of at least 4 contiguous segments
  • preservation of IVD height
  • no ankylosis of facets
  • no inflammation of SI joints
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18
Q

What are two named radiograph signs for the flowing ossification in DISH?

A
  • dripping candle wax

- flame-shaped osteophytes (hyperostosis tapers either upwards or downwards)

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19
Q

Ossification of the SI joints in DISH typically involves what part of the joint?

A

Superior 1/3rd (ossify pelvic ligaments; the non-synovial part)

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20
Q

What % of DISH patients show extraspinal involvement?

A

30%

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21
Q

What % of OPLL cases have concurrent DISH?

A

85%

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22
Q

Tabes dorsalis is associated with which condition and usually affects with anatomical locations?

A

Tertiary syphilis; affects ankle, subtalar and feet joints

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23
Q

What % of diabetic patients develop peripheral neuropathy?

A

5%

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24
Q

What % of syphilis patients show arthropathic changes?

A

20%

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25
Q

What % of syringomyelia patients have upper extremity arthropathy?

A

25%

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26
Q

What is the French (Charcot) theory for neurotrophic joint?

A

Lack of nutrition from CNS trophic centers.

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27
Q

What is the German (Volkmann & Virchow) theory for neurotrophic joint?

A

Unprotected mechanical microtraumas

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28
Q

Atrophic neuropathic arthropathy usually affects which joints and with what classic radiographic sign?

A

Seen usually in non-weight bearing joints; but also hip and foot.

Licked candy stick (amputated bone) appearance.

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29
Q

What are the named radiographic signs of hypertrophic arthropathy in the spine?

A
  • Jigsaw vertebra

- Tumbling building-block spine

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30
Q

What are some causes for neurotrophic arthropathy?

A
  • Diabetes
  • Syphilis
  • Syringomyelia
  • Spinal cord injury
  • Leprosy
  • Steroid use
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31
Q

Which form of neurotrophic arthropathy occurs M/C?

A

Atrophic

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32
Q

What is the M/C/C for neuropathic arthorpathy of the spine?

A

Syphilis

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33
Q

What is the M/C to be affected by synoviochondrometaplasia?

A

Knee (70%)

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34
Q

What % of RA cases presents with rheumatoid nodules?

A

20% (overestimation!)

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35
Q

What is Felty’s syndrome?

A

Leukopenia, splenomegaly & RA

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36
Q

What is the name of the phenomenon in RA where symptoms are worse in the morning?

A

Jelling phenomenon

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37
Q

What % of cases eventually involve the C/S?

A

80%

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38
Q

What are rheumatoid soft tissue nodules at the MCP called?

A

Haygarth’s nodes

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39
Q

What is a button hole rupture in RA?

A

Rupture of the extensor digitorum tendon at PIP with the joint protruding through the rupture. Seen in boutonniere deformity.

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40
Q

Joints in a limb are spared in RA when…

A

that limb is paralyzed.

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41
Q

What is a hitchhiker’s thumb?

A

1st IP flexed w/ MCP extended

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42
Q

What is a Lanois deformity?

A

MTP dorsal subluxation w/ fibular deviation.

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43
Q

What is another name for ball catcher’s view?

A

Norgaard view

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44
Q

What are the differentials for carpal erosions?

A

“GS RAT”

  • Gout
  • Sudek Atrophy
  • RA
  • Trauma
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45
Q

Which MTP is the first to be involved in RA?

A

5th

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46
Q

What % of RA cases have sacroiliac joint findings?

A

Less than 35%

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47
Q

What are the 3 forms of Still’s disease and what are their frequencies?

A

a) Classic systemic (20%)
b) Polyarticular form (50%)
c) Pauciarticular/monoarticular form (30%)

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48
Q

What % of JCA patients have positive RF?

A

<10% (poor prognosis when present)

49
Q

What are the radiographic signs of JCA?

A
  • metaphyseal linear periostitis; esp. hands & feet
  • radiolucent submetaphyseal bands
  • ectopic calcifications
  • tibiotalar slant
50
Q

What is an epynom for AS?

A

Marie-Strumpell’s disease

51
Q

What % of AS patients develop chronic prostatitis?

A

80%

52
Q

What % of AS patients have peripheral skeletal findings in large joints? In small joints?

A

50% large joints

30% small joints

53
Q

What are some extraskeletal manifestations of AS?

A
  • unilateral iritis (25%)
  • aortic aneurysms
  • upper lung cavitating fibrosis
  • prostatitis
  • GI findings
54
Q

What % of AS patients have a positive HLA-B27 lab finding?

A

90%

55
Q

What is the earliest sign seen involving the SI joint in AS?

A

widening of the joint

56
Q

What are Forestier’s 3 stages in AS?

A

Stage 1: Pseudowidening of joint space (loss of cortical bone margin d/t subchondral osteoporosis)

Stage 2: Erosive & Sclerotic

Stage 3: Ankylosis

57
Q

What is an Andersson lesion?

A

Pseudoarthrosis at an old carrot stick fx through a previously ankylosed motion segment.

58
Q

In what condition is a shiny odontoid sign seen?

A

AS

59
Q

True or false: AS patients get posterior body scalloping?

A

True – from dural ectasia & arachnoid diverticula

60
Q

What is a Romanus lesion?

A

Anterior VB marginal erosion (caused by enthesopathy at annular fibers’ insertion site).

61
Q

What % of enteropathic arthritis cases have a positive HLA-B27 lab result?

A

10-12%

62
Q

Isolated SI involvement is more common than SI + spine involvement in what ratio?

A

4:1

63
Q

80% of psoriasis patients with which specific lesions get psoriatic arthritis?

A

nail lesions (eg. pitting, discoloration, subungual hyperkeratosis)

64
Q

Which spondyloarthropathy has no synovial hyperemia and therefore, no periarticular osteoporosis?

A

Psoriatic arthritis

65
Q

What % of psoriatic patients with just peripheral joint involvement have a positive HLA-B27 lab result? What % have it with SI involvement?

A

Just peripheral = 30% HLA-B27

SI involvement = 75% HLA-B27

66
Q

Endosteal periostitis results in sclerotic bone which is M/C seen in which bone and presents with what radiographic sign?

A

Terminal phalanx –> ivory phalanx

67
Q

Ankylosis of the interphalangeal joints is M/C seen in RA or psoriatic arthritis?

A

Psoriatic arthritis

68
Q

What % of psoriatic patients have cervical spine involvement?

A

75%

69
Q

What % of psoriatic patients have SI involvement?

A

up to 50%

70
Q

What % of psoriatic patients have atlantoaxial instablity?

A

up to 45%

71
Q

What are the 4 variations of syndesmophytes seen with psoriatic/reactive arthritis?

A

i) complete
ii) incomplete
iii) bagpipe –> bulkier base attached to mid-body
iv) floating/Bywater’s Dixon –> unattached ossification

72
Q

What is the clinical triad seen with reactive arthritis?

A

i) urethritis
ii) conjunctivitis
iii) polyarthritis

73
Q

Reactive arthritis M/C affects which gender?

A

Male (50:1)

74
Q

What are some organisms that involved in reactive arthritis?

A
  • Shigella
  • Yersinia
  • Salmonella
75
Q

What are some clinical features seen with reactive arthritis?

A
  • keratoderma blenorrhagica (pustular psoriasis)

- balanitis circinata (mucocutaneous lesions on penis)

76
Q

What is the prognosis of Reactive arthritis?

A

self-limiting (2-3 months)

77
Q

What % of reactive arthritis has positive HLA-B27 lab findings?

A

75%

78
Q

The sacroiliac joint is involved in what % of reactive arthritis patients?

A

70%

79
Q

What are some clinical features of SLE?

A
  • butterfly rash
  • alopecia
  • Raynaud’s phenomenon
  • renal failure
  • spontaneous tendon rupture
  • joint involvement (90%)
80
Q

What are the 2 unique lab findings seen with SLE?

A

i) ANF (antinuclear factor antibodies)

ii) LE cells (mature neutrophil

81
Q

What are the x-ray findings of chest seen with SLE?

A
  • small, bilateral pleural effusions
  • pleural thickening
  • cardiomegaly
  • pericardial effusion
82
Q

Which arthropathy occurs as a consequence of rheumatic fever?

A

Jaccoud’s arthritis

83
Q

What x-ray features differ Jaccoud’s arthritis from RA?

A
  • no erosions
  • usually normal joint space
  • ulnar deviation esp @ 4th & 5th digit
84
Q

An adolescent girl with narrowed hip joint space (or even protrusio acetabuli), no osteophytes but periarticular osteopenia should be considered for what condition?

A

Idiopathic chondrolysis of the hip

85
Q

What is the prognosis of idiopathic chondrolysis of the hip?

A
  • 30% spontaneous resolution
  • 20% total ankylosis
  • AVN & hip deformities
86
Q

What does CREST stand for?

A 
C = calcinosis
R = Raynaud's phenomenon
E = esophageal
S = scleroderma
T = telangiectasia
87
Q

What is another name from CREST?

A

Thibierge-Weissenbach syndrome

88
Q

What facial feature is seen in patients with scleroderma?

A

Mouselike facies

89
Q

What % of scleroderma patients have Raynaud’s phenomenon?

A

> 90%

90
Q

What skin features are seen in scleroderma?

A
  • skin thickening
  • hidebound (adherence to underlying structures)
  • nodular subcutaneous calcific masses
  • prominent muscle weakness and atrophy
91
Q

The vertical thickness of the soft tissue should not be less than what % when compared to width at base of distal phalanx?

A

<20%

92
Q

What is calcinosis cutis?

A

Calcification of the subcutaneous tissue.

93
Q

What are the osseous findings seen with scleroderma?

A
  • acro-osteolysis (phalanx & clavicle)

- bilateral resorption of 1st metacarpal base & trapezium

94
Q

What are the GI findings associated with scleroderma?

A
  • pulmonary interstitial fibrosis (lung bases)
  • bowel dilation (from decreased peristalsis)
  • pseudodiverticula (on antimesenteric surface)
95
Q

What is osteitis pubis commonly a sequel to?

A

Prostate or bladder surgery

96
Q

What is the classic clinical triad associated with heterotrophic osteoarthropathy?

A

i) digital clubbing
ii) periostitis
iii) symmetric arthritis

97
Q

Which bone is the M/C bone to develop periostitis in HOA?

A

Tibia > fibula > radius > ulna

98
Q

What is primary gout?

A

Hyperuricemia d/t overproduction (or undersecretion) of uric acid; inborn enzymatic defect (of xanthine oxidase) causing increased deposits of sodium monourate.

99
Q

Chronic tophaceous gout has a predilection for which tissues?

A

Avascular tissues (eg. tendons)

100
Q

What is Lesch-Nyhan syndrome?

A

Hyperuricemia causing mental retardation, abnormal self-destructive/aggressive behavior.

101
Q

What % of gout patients develop chondrocalcinosis?

A

5%

102
Q

What is the diagnostic hallmark of gout?

A

Soft tissue mass (w/ calcification) and erosion at superolateral patella.

103
Q

What is the “pseudotumor of gout”?

A

Prepatellar tophi

104
Q

What are causes of secondary hemochromatosis?

A

Alcoholism (cirrhosis)
Multiple transfusions
Anemia
Over-ingestion of iron

105
Q

What is the diagnostic triad associated with hemochromatosis?

A

Cirrhosis
Diabetes
Bronze colored skin

106
Q

Golden or greenish-golden corneal rings/crescents deposited in Wilson’s disease is called?

A

Kayser-Fleischer rings

107
Q

What % of shoulder calcification cases are bilateral in HADD?

A

50%

108
Q

What is the underlying problem in ochronosis?

A

Absence of homogentisic acid oxidase –> homogentisic acid build up

109
Q

Clinically, ochronosis presents as which other condition?

A

Mild AS (95% cases = spine)

110
Q

Homogentisic acid excreted in urine is:

A

alkaptonuria

111
Q

Tumoral calcinosis typically affects which age pop’n and demographics?

A

children/adolescents –> blacks

112
Q

What are the radiographic features of tumoral calcinosis?

A
  • dense, calcified mass near a joint

- may have a fluid level

113
Q

Sarcoidosis has a predilection for which pop’n?

A

black & Scandinavian

114
Q

Where is the M/C location for an erythema nodosum in sarcoidosis and what does it signify for its prognosis?

A

Anterior tibia –> good prognostic sign

115
Q

What is Lofgren’s syndrome?

A

Acute sarcoidosis, high fever, arthralgia, lymphadenopathy & erythema nodosum.

116
Q

What is the hallmark lesion associated with sarcoidosis?

A

Non-caseating granuloma

117
Q

What are lab tests associated with sarcoidosis?

A
  • reversed A:G ratio
  • Kviem test positive
  • elevated ACE
118
Q

What is the M/C location in the lower extremity for PVNS?

A

Knee

119
Q

What is the enhancement pattern of PVNS?

A

Does not enhance

120
Q

What is the angiogram appearance of PVNS?

A
  • hypervascularity –> “puddling”

- tumor “blush”

MSK (5 decks)

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