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CORE: MSK > Arthritis > Flashcards

Arthritis Flashcards

1
Q

Categories of arthritis

A

degenerative, inflammatory, crystal deposition, hematologic, metabolic

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2
Q

OA hallmarks

A

asymmetric joints space narrowing, subchondral sclerosis, osteophytosis, subchondral cysts, lack of periarticular osteopenia

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3
Q

? extensive subchondral cystic changes

A

consider CPPD as well as OA

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4
Q

distribution of OA hand

A

DIP, PIP, 1st CMC (commonly 2nd DIP)

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5
Q

Heberden vs Bouchard nodule?

A

soft tissue swelling around H - DIP; B - PIP

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6
Q

Best view for joint space narrowing shoulder?

A

Grashey view, oblique posterior in external rotation

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7
Q

distribution OA foot?

A

MTP, hallux rigidus with dorsal osteophytes; dorsal beaking of talonavicular joint

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8
Q

OA knee?

A

tricompartmental joint space narrowing (mostly medial compartment), osteophytes

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9
Q

OA hip?

A

superolateral migration of hip, less so medial migration

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10
Q

RA hip space narrowing?

A

axial migration –> protrusio deformity

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11
Q

Kummel disease?

A

gas from vertebral body compression fracture (osteonecrosis), different from vacuum phenomenon

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12
Q

DISH diagnosis

A

4 vertebral levels of anterior bridging osteophytes; exuberant osteophytosis; associated with ossification of PLL

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13
Q

OA of SI joint?

A

inferior portion of SI joint (synovial joint); superior part is syndesmotic joint

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14
Q

Erosive OA hands?

A

same as OA (DIP, CMC thumb, PIP); characteristic gull wing appearance of DIP joint (central erosion, marginal osteophytes)

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15
Q

RA overview

A

RF+; antibody directed against IgG which targets synovium and causes symmetric joint pain, swelling, morning stiffness

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16
Q

RA involvement

A

hands/wrist first, feet; advanced cases cervical spine, knees, shoulders, hips

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17
Q

Hallmark of RA

A

marginal erosions, soft tissue swelling, diffuse/symmetric joint space narrowing, periarticular osteopniea, joint subluxations

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18
Q

RA hands?

A

MCP, PIP, carpal articulations; DIP SPARED!

typically radial aspect of 2nd/3rd MCP, ulnar styloid

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19
Q

Boutonnier, Swan neck deformity?

A

Boutonniere: PIP flex, DIP hyperextension

Swan: PIP hyperextension, DIP flex

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20
Q

Late stage RA?

A

anklysosis/fibroosseous joint fusion of wrist

JIA can also cause carpal ankylosis

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21
Q

RA feet?

A

MTP of forefoot and talocalcaneonavicular joint in midfoot

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22
Q

RA hip?

A

protruso deformity; 3 mm male, 6mm female medial deviation of femoral beyond ischial line

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23
Q

RA knee?

A

all three joints + superimposed OA possible

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24
Q

RA spine?

A

cervical spine; no bone production but C1-C2 subluxation, osteopenia, erosions of odontoid, facets, vertebral endplates, spinous processes

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25
RA shoulder
high riding shoulder; chronic rotator cuff tears; erosions on lateral aspect of humeral heads penciling of distal clavicle
26
Seronegative spondylopathy
HLA-B27 + PAIR psoriatic, ankylosing spondylitis, inflamatory bowl disease associated arthropathy, reactive arthritis/Reiters arthropathy
27
Hallmark of spondyloarthropathies
sacroilitis of the inferior SI joint - Symmetric: IBD, Ankylosing - Assymetric: Psoratic, reactive Unilateral sacroilitis can also be caused by septic arthritis
28
Types of IBD associated sacroilitis
UC, Crohn, Whipple, status post gastric bypass
29
AS associations
young men with HLA B27, pulmonary fibrosis (upper lobe predominant), aortitis, cardiac conduction defects
30
ankspond early findings, late
SI joint: symmetric erosions, widening, sclerosis Lumbar to cervical Romanus leisons: erosions of vertebral body endplates (enthesitis) inflammation of ligaments at attachment of annulus fibrosus Shiny corners: clerosis of romanus lesions Squaring of vertebral disc margins Delicate syndesmophytes which then bridge to form bamboo spine
31
Andersson lesion
pseudoarthrosis in completely ankylosed spine
32
Psoriatic arthritis classic location
HANDS HANDS HANDS
33
Psoriatic arthritis presentation
hand involvement, hx of skin psoriasis; normal mineralization; asymmetric SI joint involvement
34
Hallmark psoriatic arthritis
sausage digit soft tissue swelling pencil in cup erosions at the DIP telescoping digits or main en lorgnette (opera glass hand) deformity fluffy periostitis and ill defined erosions
35
psoriatic arthritis in the foot
great toe IP/MTP joints; "ivory phalanx" with otosclerosis plantar calcaneal spur with periosteal reaction
36
psoriatic arthritis in spine
coarse bony bridging sometimes indistinguishable from reactive arthropathy
37
Reactive arthropathy common location
FEET FEET FEET | calcaneus; posterior-superior aspect of calcaneus with erosions (bursitis) and achilles tendinitis
38
Hallmarks of reactive arthropathy
soft tissue swelling, joint space loss, aggressive marginal erosions, juxta-articular osteopenia
39
reactive arhtropathy in the hands
interphalangeal joints and MTP with erosions and diaphyseal periostitis
40
SLE joints
subluxations of MCP/PIP, reducible
41
Jaccoud arthropathy
secondary to rheumatic fever? | type III ypersensitivity
42
Scleroderma affects first?
fingertips --> atrophy of distal soft tissue | acroosteolysis
43
Ddx for acroosteolysis
collagen vascular diseases like scleroderma, neuropathy, polyvinyl chloride exposure, thermal injury, hyperparathyroidism, Hajdu-Cheney
44
polymyositis/dermatomyositis hallamrks
soft tissue calcifications,
45
calcium hydroxyapatitie deposition disease (HADD)
calcific tendinitis of periarticular tissues; NOT IN JOINT!
46
most common location HADD
shoulder, supraspinatus tendon also seen in longus colli Milwaukee shoulder-- intraarticular variant
47
CPDD
intraarticular deposition of CPPD crystals which are positively birefringemnt
48
Manifestations of CPPD
pseudogout, pseudoosteoarthritis, pseudorehumatoid, pseudoneurpathic
49
Age of CPPD, associations
>50, hemochromatosis/hyperparathyroidism, hypophosphatasi
50
Hallmarks CPPD
chondrocalcinosis (calcification of hyaline/meniscal cartilage)
51
Locations for CPPD in the wrist
trangular fibrocartilage complex (TFCC) --> SLAC SLAC is also seen in RA or trauma
52
CPPD in knee
patellofemoral compartment isolated is highly suspicious with prominent subchondral cristals
53
CPPD hand
2nd and 3rd MCP with hooklike or drooping osteophytes from radial aspect of metacarpal heads similar to hemochromatosis
54
Gout cause
sodium urate deposition in joints excess uric acid (renal isufficiency)
55
Birifringency of gout
negative
56
Common locations/presentation
Great toe overhanging margins, soft tissue gouty tophy; joint space preserved
57
Cause of hemochromatosis arthropathy
deposition of iron and CPPD crystals in joints
58
Hemochromatosis presentation
bronze pigmentation, diabetes, cirrhosis, CHF, arthropathy; autosomal recess
59
Location for hemochromatosis arthropathy
MCP joints with hook like osteophytes at metacarpal heads; involves all MCPs unlike CPPD which is usually 2nd/3rd MCP heads
60
Acromegaly presentation
beak like osteophytes of carpal heads; spade like enlargement of tufts early: widening of joint spaces later: secondary OA with space narrowing
61
Causes of amyloid arthropathy
primary: monoclonal plasma cell dyscrasia; infiltration by beta pleated sheets of amino acids secondary: chronic inflammation/infection other: beta 2 microglobulin accomulation on chronic HD
62
What is the shoulder pad sign?
bulky soft tissue noduels in shoulder superimposed on atrophic shoulder muscles ; characteristic of amyloidosis
63
Alkaptonuria --> ochronosis
intervertebral disc calcifications with disc narrowing alkaptonuria: defective homogentistic acid oxidase; black urine when oxidized
64
Multicentric reticulohistiocytosis
lipid laden macrophages deposited in soft tissue/periarticular tendons --> soft tissue nodules, erosions, sclerotic margins
65
Distribution multicentric reticulohistiocytosis
DIP symmetrically; soft tissue nodules; preserved bone; can cause arthritis mutilans
66
Types of hemophilic arthropathy
A: factor VIII | B/Christmas dx: factor IX
67
Hallmark hemophilic arthropathy
hemarthrosis --> synovial hypertrophy/hyperemia --> epiphyseal enlargement/fusion nees, elbows, ankles enlarged radial head/widened trochlear notch squaring of patella and widened intercondylar notch
68
hemophilic arthropathy can look like?
JIA
69
still disease
variant of JIA; systemic disorder in kids <5; acute febrile illness, rash, adenopathy, pericarditis, mild arthralgias
70
hallmarks of JIA
abnormal bone length (hyperemia), epiphyseal enlargement/ballooning of ends of bones; premature skeletal maturation/physeal fusion; brachydactyly
71
Ddx for cervical spine ankylosis
Klippel Feil and JIA
72
Charcot joint
neuropathic arthropathy; fragmentation of bone/cartilage; painful swollen joint
73
Causes of charcot joint
diabetes (ankle/foot); syringomyelia (upper extreity), alcohol abuse, amyloid, spinal tumors, syphilis/leprosy
74
Forms of neuropathic arthropathy
hypertrophic and atrophic
75
Hallmarks of hypertrophic
anarchy in joint: destruction, dislocation, debris, disorganizaiton, no demineralization
76
Hallmarks of atrophic form
shoulder; resorption of humeral head/surgical like margins
77
bone hallmarks of sarcoid
lace like lytic lesions of middle/distal phalanges; polyarthritis
78
ABCDEs of arthritis
alignment, bone mineral density/bone creation, calcification/cartilage spaces, distribution, erosions, soft tisssue swelling
79
Reducible vs nonreducible subluxations; dislocations?
reducible: SLE, Jaccoud Nonreducible: rheumatoid --> dislocations
80
Diffuse osteopenia arthropathy?
RA
81
periarticular osteopenia
RA, early inflammatory arthritis
82
osteophytes arthropathy
OA, CPPD, hemochromatosis
83
periosteal bone formation, arthropathy?
psoriatic arthritis, reactive arthropathy
84
bone ankylosis in wrist/cervical spine?
JIA
85
ankylosis of DIPs
psoriatic arthritis
86
ankylosis of wrist?
JIA, advanced RA

CORE: MSK (13 decks)

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