7. Inflammatory Arthritis Flashcards Preview

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Flashcards in 7. Inflammatory Arthritis Deck (101)
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1

What is synovial chondromatosis aka osteochondromatosis, synoviochondrometaplasia?

Metaplastic changes in synovium produce cartilaginous bodies.

1 - These cartilaginous bodies may (or may not) calcify or ossify.
2 - they may (or may not) be free within joint capsule

2

What is seen on radiograph with synovial chondromatosis?

Multiple round / oval and well-defined osseous or cartilaginous densities within joint capsule

It will not be visualized on plain film if it isn’t calcified or ossified

3

Who gets synovial chondromatosis?

20-50 yo
M>F 3:1

4

Where is the MC location for synovial chondromatosis?

Knee 70%
Elbow, hip 20%

It can form at any site with synovium

5

What are symptoms of synovial chondromatosis?

Mild
Chronic, slow, progressive

6

If there is just one osteochondritis body plus a defect in the host bone, what is DDX instead of synovial chondromatosis?

Osteochondritis dissecans

7

What is the prognosis for synovial chondromatosis?

Risk of 2˚ DJD
Malignant transformation reported, but extremely rare

8

Tax for synovial chondromatosis?

Surgical removal
Though recurrence is not uncommon

9

What are the 3 inflammatory arthropathies?

RA
Juvenile Idiopathic Arthritis
Seronegative spondyloarthropathies

10

What is the MC inflammatory arthritis?

Rheumatoid Arthritis (RA)

11

What is RA?

Multisystem AI that targets synovial tissues and joints. Progressive, bilateral symmetry.

12

Locations of RA?

Wrist and hands
Feet
Shoulder, hip, knee
Cervical spine

13

What is the pathologic process of RA?

Antigen-antibody complex deposited in synovium with resulting inflammatory cascade

A synovial proliferation = pan USA

14

What does pannus do and what is it associated with?

Erodes bone and articular cartilage

RA

15

How do you diagnose RA?

Lab tests
Radiographic changes

16

What do you expect to see for RA lab test?

RF (+)ve in 70% (2-3% are (+)ve w/o RA)

Anti-CCP in addition to RF increases sen + spec

In acute cases:
- increased ESR
- increased CRP

Anemia (normocytic normochromic)

Synovial fluid eval + biopsy

17

Know the ACR - EULAR classification criteria?

[see notepacket slide 17)

18

Age of onset of RA?

20-60 yo

19

Sex of RA?

F:M 3:1 until age 60
1:1 after 60 yo

20

What joints are MC for RA to start?

MCP
PIP
Wrist
Larger joints and spine later

21

What systemic sx show up in RA?

Fatigue
Malaise
Generalized weakness
Fever

22

PE for RA?

Morning stiffness >1 hour
Pain with motion or tenderness
Soft tissue swelling or joint effusion but NO REDNESS
Bilateral symmetrical joint swelling (except DIP)
Sometimes nodules

23

Where are boutonnière deformities located?

DIP extension
PIP flexion

24

Where are swan neck deformities located?

DIP flexion
PIP extension

25

Where are hitchhiker thumb deformities located?

MCP flexion
IP extension

26

In RA, what is the earliest change and where is it located?
What are other changes in the same area?

Tendinopathy around the wrist

Ulnar and radial styloid erosion

27

What sign is visible in RA wrist?

“Spotty carpal” sign

28

Cervical spine involvement happens in ___% of RA patients

50-80%

29

Foot is the initial site of involvement in ___% of RA patients

15%

30

Canal stenosis possible due to “______” kyphotic changes in RA spine

Stepladder