Arthritis 1

Question 1

2 cats of rheumatic disease

Answer 1

1. iflamm

2. non inflamm

Question 2

2 cats of inflamm

Answer 2

1. autoimmune

2. non-autoimmune

Question 3

4 examples of auto immune

Answer 3

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

Question 4

3 examples of non-autoimmune

Answer 4

1. crystal induced
2. infection induced
3. hemoarthritis

Question 5

3 possible localizations

Answer 5

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

Question 6

2 reasons for early intervention

Answer 6

1. improve function

2. prevent damage

Question 7

4 parts of makinga diagnosis

Answer 7

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

Question 8

5 features of inflammatory

Answer 8

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

Question 9

5 features of non-inflammatory

Answer 9

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

Question 10

4 things to consider to decide type

Answer 10

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

Question 11

4 parts of pattern to look at

Answer 11

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

Question 12

** 3 possible causes of acute, inflamatory monoarthritis

Answer 12

1. infection
2. crystals
3. blood

Question 13

features of hemarthrosis

Answer 13

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

Question 14

features of septic arthritris

Answer 14

• life threatening

- mort 10-50%

Question 15

where does septic come from

Answer 15

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

Question 16

risk factors for septic artgh

Answer 16

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

Question 17

2 types of gonorrhea arth

Answer 17

1. typical mono in young healthy indiv

2. disseminated infection - migratory, tenosynovitis

Question 18

def. crystal arth

Answer 18

inflammation created by crystals depostied in joint tissues

Question 19

3 types of crystals

Answer 19

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

Question 20

3 features of crystal arth

Answer 20

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

Question 21

age of onset of gout

Answer 21

men - 40-60

women older

Question 22

pathway of uric acid

Answer 22

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

Question 23

3 mech. of uric acid buidup

Answer 23

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

Question 24

4 major gout risk factors

Answer 24

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

Question 25

inital gout episode (typical)

Answer 25

1st MTP - acute and intermittent - may become chronic

Question 26

what are tophi

Answer 26

tissue deposits of of urate outside the joint (lumps)

Question 27

def. CPPD

Answer 27

from Ca pyrophosphate | - pseudo gout - gout-like attacks

Question 28

typical presentaion of CPPD

Answer 28

>60yo | - typically wrist and knee

Question 29

typical presentation of hydroxyapatate

Answer 29

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

Question 30

3 universal features of acute monoarth

Answer 30

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

Question 31

4 features to look for on physical

Answer 31

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

Question 32

2 tests to do for monoarthririts

Answer 32

1. synovial fluid anal | 2. imaging

Question 33

3 Cs of synovial fluid anal

Answer 33

Culture Cell count Crystals

Question 34

**what is cutoff for inflammatory

Answer 34

WBC>2000

Question 35

what is typical but not always infections

Answer 35

WBC>50000

Question 36

2 features of gout crystals

Answer 36

1. long and needle | 2. neg, birefringence

Question 37

2 feature of CPPD crystals

Answer 37

1. rhomboid | 2. pos. birefringence

Question 38

use of x-rays

Answer 38

- as a baseline | - lask spec. in acute setting

Question 39

mgmt of acute crystal arth.

Answer 39

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

Question 40

mgmt of spetic arth

Answer 40

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

Question 41

mgmt of hemoarth

Answer 41

- drain the blood | - inject glucocorticoids