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Flashcards in Arthritis 1 Deck (41):
1

2 cats of rheumatic disease

1. iflamm
2. non inflamm

2

2 cats of inflamm

1. autoimmune
2. non-autoimmune

3

4 examples of auto immune

1. RA
2. lupus and other collagen
3. vasculitis
4. spondyloarthritis

4

3 examples of non-autoimmune

1. crystal induced
2. infection induced
3. hemoarthritis

5

3 possible localizations

1. mono arth
2. oligo 1-4 joints
3. poly arth - >4 joints

6

2 reasons for early intervention

1. improve function
2. prevent damage

7

4 parts of makinga diagnosis

1. Hx
2. Px
3. imaging
4. labs

8

5 features of inflammatory

1. painful joint
2. warmth
3. swelling
4. marked stiffness esp, in morning
5. typical patterns

9

5 features of non-inflammatory

1. painful joint
2. little warmth
3. swelling sometimes
4. minimal stiffness - after gelling
5. typical patterns

10

4 things to consider to decide type

1. Number of joints involved
2. Pattern of joints involved
3. time course and evolution
4. age of indiv

11

4 parts of pattern to look at

1. symetry
2. upper vs. lower
3. axial?
4. characteristic joints

12

** 3 possible causes of acute, inflamatory monoarthritis

1. infection
2. crystals
3. blood

13

features of hemarthrosis

- bleed in a joint
- most often with clotting abnormality
- if trauma, consider a fracture

14

features of septic arthritris

- life threatening
- mort 10-50%

15

where does septic come from

- mostly hematogenous
- major abct are Gr+ cocci (staph A most common)
- some Gr- bacc

16

risk factors for septic artgh

- recent infection
- portal of entry
- prosthetic joint
- damaged joint
- immunocompromised
- elderly

17

2 types of gonorrhea arth

1. typical mono in young healthy indiv
2. disseminated infection - migratory, tenosynovitis

18

def. crystal arth

inflammation created by crystals depostied in joint tissues

19

3 types of crystals

1. urate - gout
2. calcium pyrophosphate - pseudo gout
3. cal. hydroxyapatate

20

3 features of crystal arth

1. dep. in the synovial fluid
2. attacks are an acute and dramatic monoarth
3. usually self limited

21

age of onset of gout

men - 40-60
women older

22

pathway of uric acid

purine>hypoxanthine>xanthine> (via xantine oxydase)>uric acid

23

3 mech. of uric acid buidup

1. dietary intake (red meat, fish, beer)
2. synteheis (error of metabolism, ethanol, illness)
3. underexcretion (renal fail, metabolic syn, diuretics)

24

4 major gout risk factors

1. illness
2. surgery
3. meds
4. alc

25

inital gout episode (typical)

1st MTP
- acute and intermittent
- may become chronic

26

what are tophi

tissue deposits of of urate outside the joint (lumps)

27

def. CPPD

from Ca pyrophosphate
- pseudo gout - gout-like attacks

28

typical presentaion of CPPD

>60yo
- typically wrist and knee

29

typical presentation of hydroxyapatate

- younger indivs
- acute arth.
- shoulder, hip, first toe

30

3 universal features of acute monoarth

1. swelling, pain, redness
2. fever
3. malaise

31

4 features to look for on physical

1. portal of entry
2. tophi
3. bruising suggestive of coag. defect
4. skin lesions typical of GC arth

32

2 tests to do for monoarthririts

1. synovial fluid anal
2. imaging

33

3 Cs of synovial fluid anal

Culture
Cell count
Crystals

34

**what is cutoff for inflammatory

WBC>2000

35

what is typical but not always infections

WBC>50000

36

2 features of gout crystals

1. long and needle
2. neg, birefringence

37

2 feature of CPPD crystals

1. rhomboid
2. pos. birefringence

38

use of x-rays

- as a baseline
- lask spec. in acute setting

39

mgmt of acute crystal arth.

treat inflammation
- NSAIDS
- prednisone
- injections
rest, ice, elevation

40

mgmt of spetic arth

- start empiric ABs as soon as fluid drawn
- change AB when get cultures back
- daily drain of joint space

41

mgmt of hemoarth

- drain the blood
- inject glucocorticoids

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