Arthridities Flashcards
RA
inflammatory arthropathy
women >35 yo
+RA, +ESR, +CRP, normocytic normochromic anemia
tx: rest, anti-inflammatory drugs, exercise, PT, comanage with rheumatologist
RA s/s and xray
symmetrical immune related begins in small joints (PIP, MCP) swan neck deformity ulnar deviation swelling of carpals, feet and elbows morning stiffness intra-articular rat bit erosions pannus formation localized peri-articular osteoporosis symmetrical
OA
non-inflammatory
no labs
tx: mobilization, patient education, exercise, anti-inflammatory drugs
OA s/s and xray
asymmetrical stress related peri-articular pain with exercise morning stiffness improved with activity joint enlargement spurs subchondral sclerosis decreased joint space asymmetrical large weight bearing joints most commonly affected osteophytes
gout
metabolic
UA, joint aspiration for uric acid crystals
blood tests: uric acid, leukocytosis
tx: decrease purines (red meat, cheese, beer, red wine), increase cherries
refer to rheumatologist
acute: cochicines
chronic: allopurinol
gout s/s and xray
appears without warning by stress/fatigue or food/alcohol assymetrical poor purine metabolism pain is progressive podagra fever tachycardia malaise tophi on auricle of ear toe, instep, knee, wrist elbow xray findings late stage bone involvement overhanging edge sign on xray
CPPD/chondrocalcinosis
females and males >50 yo
UA, joint aspriation for calcium crystals
CPPD/chondrocalcinosis s/s and xray
appears without warning by stress/fatigue or food/alcohol asymmetrical poor purine metabolism pain is progressive podagra fever tachycardia malaise tophi on auricle of ear thin linear calcification in knee
neurogenic arthropathy (charcot’s joint)
caused by: diabetes mellitus, tabes dorsalis, syringomyelia, leprosy, drugs
neurogenic arthropathy (charcot’s joint) s/s and xray
early appears like OA not much pain deformity Xray: swollen joint space deformity sclerosis loose bodies spurs
SLE
inflammatory or non-inflammatory
women
+LE, +FANA, +RA, +Coombs, +ESR
non-steroidal anti-inflammatory drugs
SLE s/s and xray
acute episodes polyarthritis malar rash raynaud's phenomenon oral ulcers, alopecia renal involvement xray: deformity but not xray erosion (jaccoud's arthritis)
scleroderma s/s and xray
\+FANA, +RA latex calcinosis raynaud's esophageal dysfunction sclerodactyly telangiectasia xray: erosion of terminal phalanges tx: cortisone, PT
sjogren’s s/s and xray
women 20-40
+HLA B27, +ESR, +LE prep
dry eyes, dry mouth, associated with RA
no xray features
Marie Strumpell
AS males 15-35yo \+HLA B27, +ESR, -RA latex anemia tx: non-steroidal anti-inflammatory drugs
Marie Strumpell s/s and xray
AS begins in SI joints morning stiffness \+orthopedic tests Xray: blurring of SI joints, syndesmophytes on AP&lateral, daggar sign, shiny corner sign
psoriatic arthritis s/s and xray
young male 20s -RA latex, +/- HLA B27 asymmetrical skin rash (silver scales) DIPS often affected pitted nails xray: distal phalanges involvement resorption of distal tufts
bacterial/septic
adults: N. gonorrhea
children: H. influenza
tissue biopsy, gram stain, increased WBCs
tx: aspirate and culture joint daily, drugs, splinting
bacterial/septic s/s and xray
usually acute affects synovial tissue warm, tender, swollen fever and chills no xray findings
reactive arthritis s/s and xray
males, adults
-RA, +/- HLA B27, +CRP, +ESR
arthritis, urethritis, conjunctivitis
