Flashcards in Arthritides Deck (31)
Types of Joints: describe and give example of each of the following:
Fibrous/bony: minimal to no motion
(e.g skill sutures)
Cartilaginous: limited motion
(e.g intervertebral discs, pubic symphysis)
Synovial: freely mobile, comprised of 2 or more bones.
(e.g knee, shoulder, hip)
Describe the type of joint for each of the following:
-ball and socket, lots of motion, stable
Shoulder: ball on small tee; more motion, less stable.
Knee: round condyles on flat surface; ligaments essential
Ankle: limited plane of motion
-what is this?
-MC age in men and women?
aka: degenerative arthritis or joint dz
What; loss of articular cartilage- leading to exposed bone.
*MC form of arthritis
-age, female, previous injury
-heavy physical labor
- + family hx
MC age in:
-men = 45YO
-women = 55YO
-triggered by damage to normal articular cartilage
-chondrocytes react by releaseing degradative enzymes causing subchondral sclerosis and osteophytes. (bony outgrowths associated with the degeneration of cartilage at joints)
-superficial erosions leading to complete loss of cartilage
-joint space narrowing and possible deformity.
Features of OA;
-general signs and sx
-joint pain, swelling, crepitation, tenderness, effusions
-radiating pain and bursitis in hands, hips knees, and spine
-tenderness on palpation and on passive motion are late signs
*pain is relieved with rest. *
-multiple joints in older pt
-hip and knee seen in middle age
-single joint in the young
Features of OA:
-- location of dz
-- common features found on exam
--MC seen with what otehr conditions?
-location: Distal interphalangeal joints and Proximal interphalangeal joints.
--Heberdens nodes (DIP)
--Bouchards nodes (PIP)
-sx: progressive anterior shoulder pai, worse with motion
-difficulty with overhead activities, sleeping, and axillary hygiene.
-MC seen with rotator cuff dz/tears, AC joint arthritis.
Features of OA:
--sx & signs
--signs and Sx
--signs and sx
Sx & Signs:
-deep groin pain
-can radiate anterior thigh, knee buttock
-difficulty putting on socks/shoes
-pain with abduction.
-signs and Sx:
--crepitus, effusion, limited motion
-difficulty doing stairs, getting out of low chairs off of toilets
-pain with kneeling/squatting
-Cervical: pain and stiffness, aching pain down arm
-Lumbar: pain across low back/buttocks with loss of motion flex/ext
Dx of OA
clinical dx supported by H&P, labs and imaging
-no specific labs
-joint space narrowing
--Intraarticular injections ---glucocoritcoid = triamcinolone methylprednisolone.
---Hyaluronans = synvisc, hyalagen
-Arthroscopy (dont typically do this, may aggravate underlying arthritis)
-Total joint replacement (**GOLD STANDARD for severe knee, hip, or shoulder joint arthritis)
-Chondrocyte grafting (for small, isolated defects)
THIS IS NOT AN INFLAMMATORY ARTHRITIS.
Cause: breakdown of immune tolerance to synovial inflammation. Complex interaction of genetic and environmental factors.
-plasma cells produce abys
-MF and lymphocytes produce pro-inflamm cytokines and chemokines
-synovium thickens, hyperplastic synovial tissue (pannus) releases inflammatory mediators which erods the cartilage.
-gradual insidious onset
-sx wax and wane
-involve multiple joints, characteristically symmetric
-early morning stiffness of affected joints
-generalized afternoon fatigue and malaise
--what test is MC?
--what is seen from the MC test?
-MC test is XRAY.
--joint space narrowing
--soft tissue swelling*
--osteopenia about joint
--laxity leading to deformity and bone displacement
-signs and sx
Signs and Sx
-swollen, painful MP and PIP joints
-tender, limited motion
-reduced grip strength
-tendon ruptures, triggering
-*ulnar deviation at MP joints*
-swan neck (weird curve at DIP) and boutonniere (thumb deformity that makes it curved out)
-soft tissue swelling in hands
-loss of extension
-loss of extension
-rotator cuff dz
-similar to hand; MP joint involved, toe deformities, heel & ankle pain
-synovitis and effusion
-Bakers cyst (popliteal cyst)
-loss of flexion
-loss of rotation
-skin and pulmonary nodules*
-synovial fluid (turbid, yellow)
-clinical dx can be made when:
-inflammatory arthritis in 3 or more joints for more than 6 weeks
-positive RF and ACCP
-elevated CRP and ESR
Based on point system, dx requires greater than 6 points.
--1 large joint = 0
--2-10 large joints = 1
--1-3 small joints =2
--4-10 small joints = 3
--greater than 10 = 5
--negative RF and negative ACPA = 0
--low positive RF and low positive ACPA = 2
--high positive RF or high positive ACPA = 3
-Acute phase reactants:
--normal CRP and normal ESR = 0
--abnormal CRP and abnormal ESR = 1
-Duration of sx:
--less than 6 wks = 0
--greater than 6 wks = 1
**ACCP = ACPA (;
Manage acute flares:
-NSAIDs and glucocorticoids
--relieve discomfort, dont stop progression
DMARDS: disease modifying anti-rheumatic drugs
Surgery for soft tissues and joints:
--synovectomy, tendon repairs, removal of nodules
--total joint replacement, fusion
-PT/OT, bracing, support groups
-orthotics and splints
RA RX acute pain
when first seen or during flare:
RA and DMARDS
-what are the nonbiologic and biologic medicatinons?
-methotrexate(first line), sulfasalzine, leflunomide
-hydroxychlorquine, cyclosporine, gold salts, azathioprine
-predisposition to infection
-pregnancy or possible pregnancy
-MC joint affected
MC joint = first metatarsophalangeal joint (podagra= gout of this big toe)
-precipitation of monosodium urate cyrstals in joint space
-over time joint space is damaged.
-tophi is pathopneumonic for gout
-decreased excretion of uric acid
-increased production of uric acid
-increased purine intake
-menopause = less estrogen = less excretion of uric acid = build up of uric acid = gout.
-worse at night
-overlying skin becomes tense
*anything that touches this hurts, even the sheets on your bed!
-synovial fluid analysis:
--needle-shaped NEGATIVE birefringent urate crystals
-elevated serum urate level
-resolves in a few days to weeks
-NSAIDS first choice! naproxen or indomethacin****)
-glucocorticoids (intraarticular or PO when multiple joints)
--reduced intake of purines (purines broken down into uric acid)
--Xanthine oxidase inhibitors: allopurinol *** DOC to lower serum urate levels.
--Uricosuric Drugs: probenecid; increase urinary excretion.
How do we prevent recurrent attacks of gout?
Lifestyle changes: weight loss, decrease alcohol intake
-decreasing meat and fish
-increase dairy products
Lowering serum uric acid:
-uricosuric agens = probenacid
-xanthine oxidase inhibitors = allopurinol
aka: calcium pyrophosphate dehydrate (CPPD) cyrstal deposition dz
Cause: trauma, hypomagnesemia, hyperparathyroidism
Presentation: -similar to gout but less severe
-usually occurs in knee or other large peripheral joints
-synovial fluid: rhomboid-or-rod shhaped crystals
-POSITIVE birefringent crystals
Single joint: aspirate and inject with steroids, immobilize and apply ice or cool pack
Multiple joints: NSAIDS, colchicine, or systemic steroids
-after 3 or more attacks = daily colchicine
Describe the major features of..
-degeneration of cartilage leading to joint damage
-autoimmune dz that attacks synovium and soft tissue
-see swelling and damage of multiple joints
Gout/pseudo: deposition of crystals leads to joint inflammation and damage
-recurrent attacks often in big toe in gout.
Clinical features of each of the following
-Crystalline arthritis (GOUT)
-dz limited to the joint
-osteophyt formation, creakign with motion
-nodes in PIP and DIP
-generalized dz that results in multiple, swollen, painful joints
-usually starts in hands and feet and progresses proximally
-red, hot, swollen joint
-resolve over time
What are common imaging findings in each of the following:
-joint space narrowing (unilateral)
-joint space narrowing (bilateral)
-soft tissue swelling
-osteopenia about joint
-can see erosion and joint destruction late
Contrast OA and RA features in the hand
-swelling = hard, bony
-stiffness = worse after use- PM
-fingers = DIP, PIP + nodes (heberdens & Bouchards)
-swelling = soft, warm, tender
-stiffness = worst after rrest - AM
-fingers = MP and PIP + deformity