Arthrides - Inflammatory

Question 0

What makes RA seropositive or seronegative?

Answer 0

Rheumatoid Factor (RF)

Question 1

MC inflammatory arthritis

Answer 1

Rheumatoid Arthritis (RA)

Question 2

Rheumatoid types are seronegative or seropositive?

Answer 2

Seropositive

Question 3

Systemic Lupus (SLE) is what type of RA? 
RF positive or negative?

Answer 3

Rheumatoid Type

Seropositive

Question 4

What is the MC form of Juvenile Chronic Arthritis (JCA) and what is the RF?

Answer 4

Polyarticular (50%)

Seronegative

Question 5

What’s another name for the classic form of JCA?

Factor? %?

Answer 5

Still’s disease.
Seronegative.
20%

Question 6

What are the most distinctive features of JCA?

Answer 6

Periostitis, and growth abnormalities (ie. bone shortening and ballooned epiphysis).

Question 7

Inflammatory and hyperemic process loosens the periosteum causing _________ in metacarpals, metatarsals, and proximal phalanges of teenagers.

Answer 7

Periostitis

Question 8

Examples of growth abnormalities caused by JCA

Answer 8

“Ballooning” of epiphyseal plates (caused by hyperemia), and bone shortening (caused by premature fusion of growth plates).

Question 9

Vertebral body and disc hypoplasia (“child’s configuration”) can be caused by _________ in the cervical spine.
What other features?

Answer 9

JCA

Erosions and posterior joint ankylosis (facet fusion).

Question 10

What joints of the hand are MC affected in RA?

Answer 10

MCP’s and PIP’s

Question 11

What sites in the body are MC affected in RA?

Answer 11

Synovial tissues of the hands, feet, wrists, hips, knees, elbows and shoulders, and the atlantoaxial subluxation of the cervical spine.

Question 12

This arthride is marked by bilateral symmetric distribution, and uniform loss of joint space; What other features are found?

Answer 12

RA

• periarticular soft tissue inflammation (pannus)
• juxta-articular osteoporosis
• marginal erosions (bare area) - “rat bites”
• subchondral erosions, cysts (or geodes) and deformities.

Question 13

In ______ the SI articulations are rarely affected.

Answer 13

RA

Question 14

What deformities are characteristic in RA?

Answer 14

Swan neck, boutonnière, and hitchhiker’s thumb.

Question 15

Flexion of the PIP’s and extension of the DIP’s

Answer 15

Boutonnière Deformity

Question 16

Extension of the PIP’s and flexion of the DIP’s

Answer 16

Swan Neck Deformity

Question 17

Elevated ESR (erythrocyte sedimentation rate) and +RA factor are two clinical features of these arthrides in young middle aged women.

Answer 17

RA and Lupus (SLE)

Question 18

Severe joint deformity / destruction

Answer 18

Arthritis mutilans

Question 19

Enlargement of the gastrocnemius bursa

Answer 19

Baker’s cyst

Question 20

Leukopenia, splenomegaly and RA

Answer 20

Felty’s syndrome

Question 21

Soft tissue swelling at the MCP joints

Answer 21

Haygarth’s nodes

Question 22

Soft tissue swelling at the PIP’s

Answer 22

Bouchard nodes

Question 23

Soft tissue swelling at the DIP’s

Answer 23

Heberden’s nodes

Question 24

Haygarths nodes are first in this type of arthride

Answer 24

RA

Question 25

Heberdens nodes are first affected in this type of arthride

Answer 25

DJD

Question 26

#1 reason for an increased ADI

Answer 26

RA in cervical spine

Question 27

An atlanto-axial subluxation is considered when the ADI is more than _____ and the PADI less than ____.

Answer 27

ADI >3 mm, PADI <14

Question 28

Reumatoid Types - what's the RF? - examples

Answer 28

- Seropositive | - Reumatoid Arthritis, Sistemic Lupus Erythematosis (SLE), Scleroderma, Jaccoud's.

Question 29

Butterfly rash

Answer 29

SLE

Question 30

SLE is MC in what sex and what ages?

Answer 30

Females (9:1), ages 20-40 yrs

Question 31

In SLE, what percentage have articular complains?

Answer 31

90%

Question 32

Most frequent and serious features of SLE

Answer 32

Kidney conditions that may lead to nephropathy and renal failure

Question 33

SLE may be accompanied by this condition where the fingers, toes or other areas get discolored in response to excessive reduced blood flow.

Answer 33

Reynaud's phenomenon

Question 34

This non-erosive arthritis involves multiple organs, is seropositive, has an elevated ESR (erythrocyte sedimentation rate) and a positive ANA (antinuclear antibodies).

Answer 34

Systemic Lupus Erythematosis

Question 35

SLE is commonly treated with ________ witch can lead to:

Answer 35

Osteoporosis, avascular necrosis (AVN), water retention, spinal fractures and gastric ulcerations

Question 36

In SLE, articular changes are most commonly seen in _______ and these deformities are reversible. - what joints are usually affected?

Answer 36

Hands | - MCP and PIP

Question 37

What is a classic deformity in the hands of patients with SLE? - what other deformities are possible?

Answer 37

``` Ulnar deviation (>50% of patients) - swan neck and boutonnière ```

Question 38

SLE deformities are reversible and non-erosive? What does that mean?

Answer 38

Yes; it means that the deformities are not rigid, and there is no bone destruction like in RA.

Question 39

What other effect can SLE can have in the spine, specifically upper cervical?

Answer 39

It can induce laxity of the transverse ligament increasing the ADI (by 8.5%)

Question 40

Ulnar deviation can be seen in SLE and what two other seropositive reumatoid types?

Answer 40

RA and Jaccoud's

Question 41

This seropositve reumatoid type follows rheumatic fever, multiple connective tissue disorders and has an antecedent of streptococcal pharyngitis

Answer 41

Jaccoud's arthropathy

Question 42

Jaccoud's arthropathy has no evidence of _________, only capsular fibrosis and DJD.

Answer 42

Synovial pathology

Question 43

Jaccoud's arthropathy causes non-erosive, reversible joint deformity, just like this other reumatoid type.

Answer 43

SLE

Question 44

Most important factor to distinguish Jaccoud's and SLE, besides the butterfly rash, is

Answer 44

History and clinical presentation

Question 45

Rehumatoid Type that causes small vessel disease and fibrosis in multiple organ systems.

Answer 45

progressive systemic sclerosis / scleroderma

Question 46

Scleroderma is MC in what gender, age population?

Answer 46

Females (3:1), ages 30-50

Question 47

In scleroderma, the skin appearance is the most unique feature with progression of 3 stages:

Answer 47

Edema, induration (hardening) and atrophy.

Question 48

If a patient with scleroderma is exposed to cold or emotional upset conditions it precipitates ___________ changes of pallor and painful ___________ producing pain and swelling. What is this condition called?

Answer 48

vasoconstrictive ; vasodilation | Reydaud's phenomenon

Question 49

Reynaud's phenomenon is a _________ nervous system dysfunction characterized by cyclic vascular changes usually in hands.

Answer 49

Sympathetic

Question 50

Vascular pathological changes consisting of a low grade inflammatory reaction in the perivascular tissue with atrophy and fibrosis is characteristic of

Answer 50

Scleroderma

Question 51

Patients with this condition can have trouble swallowing and constipation due to decreased motility and dilatation/constriction of the GI tract.

Answer 51

Scleroderma

Question 52

Scleroderma affects the lungs in all cases, however only ___% of cases are symptomatic.

Answer 52

25%

Question 53

What is the CREST syndrome? | -Where can you find this?

Answer 53

``` Calcinosis Raynaud's phenomenon Esophageal dysmotility Sclerodactyly Telangiectasia (dilated sub-dermal blood vessels) - in patients with Scleroderma ```

Question 54

Define: Acro- Miso- Rhico-

Answer 54

``` Acro= distal extremities Miso= forearms and lower legs Rhico= humerus and femur ```

Question 55

What is acro-osteolysis? Where can this be found?

Answer 55

Osseous resorption in terminal phalangeal tufts; this happens in patients with scleroderma.

Question 56

What is the main distribution of Progressive Systemic Sclerosis?

Answer 56

Hands, chest and GI

Question 57

How does scleroderma affects the hands?

Answer 57

Acro-osteolysis in finger tips, and subdermal calcification.

Question 58

How does scleroderma affects the chest?

Answer 58

Interstitial fibrosis

Question 59

How does scleroderma affects the GI tract?

Answer 59

Smooth muscle disfunction causing esophageal aperistalsis and reduced lower sphincter pressure.

Question 60

``` What reumatoid type has these clinical features: Females 3:1 30-50 yrs old Raynaud's phenomenon Joint pain and stiffness Dysphagia Elevated ESR ANA increased RF positive ```

Answer 60

Scleroderma / Progressive Systemic Sclerosis