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Arthritides Flashcards

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1
Q

Define Arthritides

A

Types of arthritis

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2
Q

Key Manifestations of Arthritis

A

Pain
Swelling
Limited motion

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3
Q

Types of Joints

A

Fibrous/Bony
Cartilaginous
Synovial

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4
Q

Fibrous/Bony Joint Motion

A

Minimal to no motion

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5
Q

Cartilaginous Joint Motion

A

Limited motion

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6
Q

Synovial Joint Motion

A

Freely mobile
Comprised of 2+ bones
May have meniscus

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7
Q

Define Osteoarthritis

A

Degenerative arthritis or joint disease

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8
Q

Pathophysiology of Osteoarthritis

A

Damage to normal articular cartilage
Chondrocytes react by releasing degradative enzymes
Bone reacts with subchondral sclerosis & osteophytes
Degredation of cartilage & bony reaction
Complete loss of cartilage
Joint space narrowing & possible deformity
Hypertrophy/hyperplasia of osteocytes -> subchondral sclerosis -> osteophyte formation

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9
Q

Predisposing Factors of Osteoarthritis

A 
Age
Female sex
Previous injury
Obesity
Heavy physical labor
Positive family history
Sports activities
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10
Q

Features of Osteoarthritis

A 
Joint pain
Swelling
Crepitation
Tenderness
Effusions
Hands, hips, knees, spine
Tenderness on palpation & on passive motion (late signs)
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11
Q

Osteoarthritis in the Hands

A

Middle-aged & elderly women
Strong family history
DIP & PIP joints

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12
Q

Location of Heberden’s Nodes

A

DIP

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13
Q

Location of Bouchard’s Nodes

A

PIP

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14
Q

Osteoarthritis in the Shoulder

A

Progressive anterior shoulder pain, worse with motion
Difficulty with overhead activities, sleeping, axillary hygiene
Seen frequently with rotator cuff disease/tears, AC joint arthritis

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15
Q

Osteoarthritis of the Hip

A

Pain deep in the groin- can radiate to anterior thigh, knee, & buttock
Starts with prolonged standing/walking becoming intolerable
Then difficulty putting on socks/shoes
Pain with abduction

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16
Q

Osteoarthritis of the Knee

A

Difficulty doing stairs, getting out of low chairs, off of toilets
Pain with kneeling/squatting

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17
Q

Osteoarthritis of the Cervical Spine

A

Pain & stiffness

Aching pain down the arm

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18
Q

Osteoarthritis of the Lumbar Spine

A

Pain across low back/buttocks with LOM flex/ext

Can develop spinal stenosis

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19
Q

Diagnosis of Osteoarthritis

A

Clinical supported by H&P, labs, & imaging
No specific labs
X-ray sufficient

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20
Q

Findings on Osteoarthritis Imaging

A 
Joint space narrowing
Surface irregularity
Osteophytes
Subchondral sclerosis
Subchondral cysts
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21
Q

Non-pharmacological Treatment of Osteoarthritis

A 
Moderate weight loss
Exercises
PT/OT
Braces
Heat/cold
Rest
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22
Q

Pharmacologic Treatment of Osteoarthritis

A 
Acetaminophen
NSAIDs
Tramadol
Opioids
Intra-articular Injections
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23
Q

Benefits of Glucocorticoid Intra-Articular Injection for Osteoarthritis

A

Slow cartilage degradation

Provide pain relief

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24
Q

Benefits of Hyaluronans Intra-Articular Injection for Osteoarthritis

A

Macromolecules absorb water & may protect cartilage

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25
How to Perform a Knee Injection/Aspiration
``` Thorough skin prep Supero-lateral portal Patient supine Sit with knee at eye level Little pain when slow Aspiration/injection ```
26
Surgical Treatment for Osteoarthritis
Arthroscopic procedures Total joint replacement Chondrocyte grafting
27
Arthroscopic Procedures
May aggravate underlying arthritis
28
Total Join Replacement
Gold standard for severe knee, hip, or shoulder joint arthritis
29
Chondrocyte Grafting
Perhaps for small, isolated defects
30
Benefits of Total Joint Replacement
Relieves pain Corrects deformity Improves function
31
Infections & Joint Replacements
More susceptible due to implant
32
Replacements & Loosening
May be due to bone resorption or macrophage response | Follow-up x-rays
33
Replacements & Periprosthetic Fractures
Metal creates stress risers | Difficult to treat
34
Rheumatoid Arthritis
Women > men Autoimmune disease that primarily involves joints Breakdown of immune tolerance to synovial inflammation
35
Pathophysiology of Rheumatoid Arthritis
Prominent immunologic abnormalities Plasma cells produce antibodies Macrophages migrate to synovium Macrophages & lymphocytes produce pro-inflammatory cytokines & chemokines in synovium Synovium thickens over time Hyperplastic synovial tissue releases inflammatory mediators
36
Clinical Presentation of Rheumatoid Arthritis
Gradual, insidious onset Symptoms wax & wane Usually multiple joints Can cause significant disability
37
Systemic Symptoms of Rheumatoid Arthritis
Early morning stiffness Generalized afternoon fatigue & malaise Anorexia Generalized weakness & fever
38
Joint Symptoms of Rheumatoid Arthritis
Pain Swelling Stiffness Erythema
39
Rheumatoid Arthritis Imaging
X-ray (initially) | MRI, ultrasound (shows more damage)
40
Findings on X-ray for Rheumatoid Arthritis
``` Joint space narrowing Soft tissue swelling Bony erosions Osteopenia Laxity -> deformity Destruction/fusion (late) ```
41
Rheumatoid Arthritis in the Hand
``` Swollen, painful MP, PIP joints Reduced grip strength Tendon ruptures, triggering Joint deformities (ulner deviation) 5% carpal tunnel ```
42
Rheumatoid Arthritis of the Wrist
Loss of extension Carpal drift Tendon rupture
43
Rheumatoid Arthritis of the Elbow
Loss of extension Olecranon bursitis Ulnar neuritis
44
Rheumatoid Arthritis of the Shoulder
Adhesive capsulitis Rotator cuff disease Joint destruction
45
Rheumatoid Arthritis of the Foot
MP joint involvement Toe deformities Heel, annkle pain
46
Rheumatoid Arthritis of the Knee
Synovitis & effusion Backer's cyst Loss of flexion
47
Rheumatoid Arthritis of the Hip
Groin pain | Loss of rotation
48
Locations of Extra-Articular Rheumatoid Arthritis
``` Skin & pulmonary nodules Pericarditis Splenomegaly Neuropathy Vasculitis Episcleritis Lymphadenopathy ```
49
Laboratory Findings in Rheumatoid Arthritis
``` Rheumatoid factor Anti-CCP ESR CRP Synovial fluid: elevated WBCs ```
50
Diagnosis of Rheumatoid Arthritis
Inflammatory arthritis in 3+ joints for 6+ weeks Positive RF & ACCP Elevated ESR & CRP Have excluded gout, CPDD, viral arthritis, SLE, psoriatic arthritis
51
General Treatment of Rheumatoid Arthritis
Management of acute flares Use DMARDs early Surgery for soft tissues & joints Helping the patient manage
52
How to manage acute flares of rheumatoid arthritis?
NSAIDs | Glucocorticoids
53
Types of DMARDS
Non-biologics | Biologics
54
How to help the patient manage?
PT OT Bracing Support groups
55
Non-Pharmacological Treatment of Rheumatoid Arthritis
Heat/cold Orthotics & splints Therapeutic exercise PT/OT
56
Treat of Acute Pain in Rheumatoid Arthritis
NSAIDs | Glucocorticoids: systemic
57
SE of Glucocorticoids
``` Hyperglycemia Skin fragility Osteoporosis Weight gain Adrenal insufficiency Muscle breakdown Euphoria Glaucoma ```
58
SE of NSAIDs
GI | CV
59
Non-Biologic Agents for Rheumatoid Arthritis
``` Methotrexate Sulfasalazine Leflunomide Hydroxychloroquine Cyclosporine Gold salts Azathioprine ```
60
Biologic Agents for Rheumatoid Arthritis
TNF inhibitors Entanercept (Enbrel) Infliximab (Remicade) Adalimumab (Humira)
61
MOA of Methotrexate
Inhibits biosynthesis
62
AE of Methotrexate
``` Ulcerative stomatitis Leukopenia Predisposition to infection Nausea Abdominal pain Fatigue Fever Dizziness Pneumonia Pulmonary fibrosis ```
63
Contraindications of Methotrexate
Renal dysfunction | Pregnancy or possible pregnancy
64
Surgery for Rheumatoid Arthritis
``` Synovectomy Tendon repairs Removal of nodules Total joint replacements Fusions ```
65
Gout Characterized by
Painful joint inflammation in the first metatarsophalageal joint
66
Pathophysiology of Gout
Precipitation of monosodium rate crystals in joint space Joint space damaged Top may also form in joint space
67
Reasons for Gout
Decreased excretion Increased production Increased purine taste
68
Risk Factors for Gout
``` Increases with age Estrogen increases urinary excretion of uric acid Alcohol Meat Seafood ```
69
Clinical Presentation of Gout
``` Severe pain Redness/warmth Swelling/disability Onset more at night Overlying skin becomes tense ```
70
Diagnosis of Gout
Clinical criteria Synovial fluid analysis Elevated serum urate level X-rays
71
Treatment of Acute Gout
NSAIDs Cholchicine Glucocorticoids
72
SE of Cholchicine
GI upset Neutropenia Peripheral neuropathy
73
Intra-articular Glucocorticoids
Often quickly resolves symptoms
74
Oral Glucocorticoids
Multiple joints | Can't use NSAIDs or cholchicine
75
Treatment of Hyperuricemia
``` Reduced intake of purines Xanthine oxidase inhibitors (allopurinol) Uricosuric drugs (probenecid) ```
76
Preventing Recurrent Gout Attacks
Lifestyle changes Diet Lowering serum uric acid
77
Lifestyle Changes in Preventing Gout Attacks
Weight loss | Decreased ETOH intake
78
Diet & Preventing Recurrent Gout Attacks
Decreasing meat & fish | Increasing dairy products
79
Lowering Serum Uric Acid & Preventing Recurrent Gout Attacks
Uricosuric agents | Xanthine oxidase inhibitors
80
Define Pseudogout
Calcium pyrophosphate dehydrate (CPPD) crystal deposition disease (Chondrocalcinosis)
81
Etiology of Pseudogout
Trauma Hypomagnemia Hyperparathyroidism
82
Clinical Presentation of Pseudogout
Similar to gout but less severe | Large peripheral joints
83
Diagnosis of Pseudogout
Synovial fluid | X-rays
84
Treatment of Pseudogout in a Single Joint
Aspirate & inject with steroids Immobilize Apply ice or cool pack
85
Treatment of Pseudogout in Multiple Joints
NSAIDs Colchicine Systemic steroids
86
Prevention of Pseudogout After 3+ Attacks
Daily colchicine
87
Major Features of OA, RA, Gout/Pseudogout
OA: degeneration of cartilage leads to joint damage RA: Autoimmune disease that attacks synovium & soft tissue Gout: deposition of crystals leads to joint inflammation & damage
88
Clinical Features of OA, RA, Gout
OA: limited to the joint RA: generalized disease- multiple, swollen, painful joints Gout: red, hot swollen joint/skin sensitivity
89
Imaging Findings in OA, RA, Gout
OA: joint space narrowing, subchondral sclerosis, osteophytes, subchondral cysts RA: joint space narrowing, soft tissue swelling, bony erosions, osteopenia about joint Gout: erosions & joint descruction
90
Swelling, Stiffness, & Fingers in OA & RA
OA: hard, bony; worse after use (PM); DIP/PIP + nodes RA: soft, warm, tender; worse after resting (AM), MP & PIP + deformity
91
Lab Work in OA, RA, Gout
OA: normal RA: ESR, CRP, RF, & ACCP Gout: elevated uric acid, crystals in joint fluid
92
Synovial Analysis in OA, RA, Gout
OA: clear fluid, negative for crystals RA: slightly to moderate turbid Gout: turbid
93
Goals of Treatment of Arthritides
Prevent progression, recurrence Relief of pain Improvement of function
94
Modalities of Arthritides
Lifestyle changes Braces, OT, PT Medications Reconstructive surgery

Rheumatology (8 decks)

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