*Arthritis Flashcards
(75 cards)
1
Q
A
osteoarthritis
in the metatarsophalangeal joint of the big toe
2
Q
A
Psoriatic Arthritis
3
Q
A
Osteoarthritis
4
Q
A
Psoriatic Arthritis
(highlighting ivory phalanx); pencil-in-cup;
whittling of the distal tufts of the phalanges
5
Q
A
Psoriatic Arthritis:
- “pencil in cup” deformity of left 1st MTPJ
- bilateral erosion of the head of the first metatarsal, worse on the left where the head is almost completely destroyed. Corresponding but less florid erosion is present on the distal aspect of this joint, producing a characteristic deformity.
6
Q
A
Reactive Arthritis
7
Q
A
Reactive Arthritis
juxta- articular osteoporosis present in the third MTP joint. Periostitis is present along the shafts of the second, third, and fourth proximal phalanges and the neck of the third metatarsal
8
Q
A
Rheumatoid Arthritis
fibular dislocation of the toes; juxta-articular osteopenia metatarsal heads are washed out
9
Q
A
Rheumatoid Arthritis
10
Q
A
Septic Arthritis
poorly defined bony destruction with indistinct superficial marginal erosions may be evident along the articular surfaces. This may be accompanied by joint space narrowing, secondary to chondral destruction. Joint space ankylosis may occasionally occur in advanced cases.
11
Q
A
Septic Arthritis
a destructive erosive process involving the first metatarsophalangeal joint with associated subluxation of the joint. This patient has septic arthritis.
12
Q
A
Rheumatoid nodules
(assoc w/ RA)
13
Q
A
Boutonniere finger deformity
(assoc w/ Rheumatoid Arthritis)
14
Q
A
Swan neck deformity
(assoc w/ Rheumatoid Arthritis)
15
Q
A
Baker’s cyst
(assoc w/ Rheumatoid Arthritis)
16
Q
A
Felty Syndrome:
(assoc w/ Rheumatoid Arthritis)
17
Q
A
Pannus Formation
(assoc w/ Rheumatoid Arthritis)
18
Q
A
Heberden nodes
at DIPJs
(assoc w/ Osteoarthritis)
19
Q
A
Bouchards nodes
at PIPJ
(assoc w/ Osteoarthritis)
20
Q
Positive Schober Test
A
Ankylosing Spondylitis
(also poker spine, bamboo spine, kyphosis)
(+) result is a decrease in lumbar spine range of motion (flexion), most commonly as a result of ankylosing spondylitis
21
Q
A
Keratoderma Blennorrhagica
assoc. w/ Reiter’s/ Reactive Arthritis
22
Q
A
Ivory phalanx
assoc w/ Psoriatic arthritis
23
Q
A
Keratoderma blennorrhagica
(assoc w/ Reactive/Reiters arthritis)
24
Q
purpose of arthrocentesis
A
performed daily to BID
25
types of septic arthritis
* **Acute bacterial**
* nongonococcal
* gonococcal
* **Viral -**
* MC by _Hep B_, then mono \> rubella \> mumps …etc
* **Tuberculosis arthritis -**
* dx w/ synovial biopsies
* **Fungal arthritis** -
* MC _sporothrix schenckii_
* **Lyme disease**
* MC _borrelia burgdorferi_
26
compare Overproducers and Underexcretors of Gout
27
**overproducer** of uric acid
treatment
recall: overproducer = METAbolic gout
* **Allopurinol (**Xanthine oxidase inhibitor) - 300 mg QD
\**not as common; caused by genetic enzyme defect or tumor*
28
**underexcretor** of uric acid
treatment
recall: **under**excretor = **RENAL** gout (*more common)*
* **Probenecid**: competes w/ uric acid for reabsorption from the kidneys
* 250 mg BID x 1 week, then double dose, then inc. by 500 mg/d every 4 weeks (do not exceed 2 g/d)
29
how do diuretics affect gout?
increase osmolarity → increase risk of gout
30
pseudogout
chondrocalcinosis, calcium pyrophosphate dihydrate, CPPD
MC: Knee (50%) \> ankle, wrist, shoulder
associated w/ high-grade fever
rhomboid crystals
31
pseudogout radiographic findings
calcification of the articular cartilage or meniscus
(recall: MC in knee)
rhomboid-shaped crystals, positively birefringent, blue
32
drugs that can cause Drug-induced lupus
PCH PIG
* Procainamide
* Hydralazine
* Chlorpromazine
* Isoniazid
* Penicillamine
* Griseofulvin
33
proximal nail fold telangiectasias,
assoc. w/ which connective tissue disease
Systemic lupus erythematosus
34
systemic lupus erythematosus:
treatment
symptomatic:
* steroids
* antimalarials (chloroquine)
* immunosuppressants
* avoid sunlight
35
Scleroderma (progressive systemic sclerosis)
36
CREST syndrome
assoc. w/ scleroderma
* calcinosis cutis (calcifications in the skin)
* raynaud phenomenon
* esophageal dysfunction
* sclerodactyly - localized scleroderma of the digits
* telangiectasias
37
Scleroderma:
key words
* **mask facies**
* thick, hard **leathery** skin
* nails grow **claw-like** over shortened distal phalanges
* **matlike** telangiectasias
* **mouse-like** appearance due to skin around mouth having many furrows radiating outward
* (+) ANA
38
Dermatomyositis/Polymyositis
39
Dermatomyositis/Polymyositis:
key words
* **Gottron sign**
* Reddish-purplish (**heliotrope**) facial lesions
* **_proximal_ muscle weakness**
* **_proximal_ nail fold telangiectasias**
40
**Gottron sign**: (assoc w/ Dermatomyositis)
flat-topped violaceous papules over the dorsal aspect of the knuckles
41
Dermatomyositis/Polymyositis:
diagnosis & tx
tx: steroids
42
**Sjogren syndrome**:
define & key words
* assoc. w/ rheumatic disease
* **keratoconjuncitivitis sicca** (dry eyes) - *feels burning or itching*
* **xerostomia** (dry mouth)
* **dry vagina**
* **dysphagia**
* **dry skin**
* possible loss of taste/smell
* **parotid gland enlargement**
43
**Sjogren Syndrome**:
diagnosis
* W \> M (9:1), 40-60s
* mild anemia, **leukopenia**
* **(+) RA factor**
* **(+) Schirmer test** (tears)
* **Bx of saliva gland**
44
**Schirmer test:**
what is it, and what condition does it test for?
* measures quantity of tears
* litmus paper is placed in the eye for 5 minutes; if less then 5mm of wetness, test is (+) positive
Tests for Sjogrens Syndrome
45
Sxs of IBD-associated Arthritis
Crohn dz and Ulcerative colitis
* rheumatologic manifestations in 15-20% of patients
* asymmetric, nondestructive, transient arthritis
* arthritis flares tend to parallel flares of the underlying bowel disease
* commonly affects knees, ankles, elbows, wrists
46
what can positive ANA be seen with,
beyond the connective tissue diseases?
* aging
* HIV
* viral hepatitis
* interstitial lung disease
* Tuberculosis
* Malignancy (especially B-cell lymphomas)
47
connective tissue diseases
with positive (+) ANA
* **Sjogrens** - *dryness*
* **Systemic lupus erythematosus - photosensitivity**
* **Scleroderma**
* **Dermatomyositis**
48
Scleroderma:
subtypes
**Systemic sclerosis (scleroderma)** - increased risk of intersititial lung disease; organ involvement
**Limited/cutaneous scleroderma (CREST)** - skin is taut, no wrinkles, NO ORGAN INVOLVEMENT
49
most specific Rheum test for rheumatoid arthritis
CCP
**Anti-CCP Ab**: CCP is cyclic citrullinated peptide, a derivative of arginine
50
what might falsely INCREASE ESR
severe anemia
51
what might falsely DECREASE **ESR**
* advanced liver disease
* nephrotic syndrome
* protein-losing enteropathies/malnourishment
52
what distinguishes inflammatory from noninflammatory diseases
(i.e. synovial fluid aspiration)
**inflammatory** synovial fluid has **increased WBCs**
noninflammatory has WBCs WNL
53
episcleritis / scleritis
;
associated w/ Rhematoid arthritis
**Episcleritis** is **inflammation of the superficial, episcleral layer of the eye**. It is relatively common, benign and self-limiting.
**Scleritis** is inflammation involving the sclera. It is a severe ocular inflammation, often with ocular complications, which nearly always requires systemic treatment
54
HLA-DR4:
associated w/ what?
Rheumatoid arthritis,
esp in female gender
55
HLA-B27:
associated with what?
* Reactive Arthritis (Reiters)
* Ankylosing Spondylitis
* Psoriatic arthritis
56
raynaud disease:
color changes
**white → blue → red**
changes w/ cold exposure of fingers, ears, nose
57
organs that might be affected by Sjogren Syndrome
58
polymyositis:
signs and sxs
59
Dermatomyositis:
signs and sxs
60
guttate psoriasis
**a type of psoriasis that shows up on your skin as red, scaly, small, teardrop-shaped spots**
**gota = “drops”**
61
diruetics can contribute to decreased renal excretion of uric acid
can therefore contribute to gout
62
pathophysiology of hyperuricemia (gout)
63
synovial fluid cell count
and conditions
64
what factors contribute to gout attacks occurring at night?
extrinsic factors trigger crystal-induced inflammation
* **pH** - *breathing at slower rate, pH is going to be more acidic*
* **temperature** - *cooler at night, esp if toes are peeking out of sheets*
* **dehydration** - *haven't had fluid while sleeping*
65
crystal-induced inflammation:
pathophysiology
as urate crystals deposit in synovial tissues →
initial response w/ macrophages and monocytes →
recruitment of large # of neutrophils →
crystal-induced inflammation
66
tx for OVERPRODUCERS vs. UNDEREXCRETORS
* **Overproducers:**
* **acute**: NSAIDs, Colchicine, Systemic Steroids, Intra-articular steroids
* **chronic**: Allopurinol - to decrease uric acid production
* **Underexcretors:**
* probenecid or sulfinpyrazone
67
best tx for a gout attack in patients w/:
renal insufficiency
intra-articular steroid injection
68
risk factors for **Pseudogout**
* **elderly**
* **hyperparathyroidism**
* **too much iron**
* **too little phosphate or magnesium**
## Footnote
**asscociated w/ hemochromatosis**
69
pseudogout (CPPD):
xray
chondrocalcinosis
| (calcific deposits in the cartilage)
70
hemochromatosis
**causes your body to absorb too much iron from the food you eat**.
Excess iron is stored in your organs, especially your liver, heart and pancreas. Too much iron can lead to life-threatening conditions, such as liver disease, heart problems and diabetes
71
initial treatment algorithm for septic joint
gram positive cocci → vanc
gram negative rods → ceftriaxone
negative gram stain → vanc
72
case:
w/ HA, fever, recent camping trip
Lyme Disease
| (erythema chronica migrans)
73
Case:
29 y/o F, migratory polyarthralgias
gonococcal infections
| (disseminated gonococcal infections)
74
Case:
25 y/o M, recent diarrheal illness
Reactive (Reiter's) Arthritis
scleritis
75
Case:
Obese older M, w/ CKD
chronic tophaceous gout
