Arthritis

Question 1

Asymmetrical/unilateral joint involvement-DIPJ

• erosion->new bone
• sausage toes
• acro-osteolitis
• pencil in cup
• ivory phalanx

Answer 1

Psoriatic

Question 2

-Diarrhea/sex->conjunctivitis, urethritis, polyarthritis, mucocutaneous lesions

• asymmetrical/unilateral joint involvment-feet
• symmetrical joint space loss
• fluffy heel spur-BILATERAL
• edema at insertion of tendo achilles
• large heel spur
• symptoms in feet only

Answer 2

Reactive Arthritis

Question 3

Bilateral/Symmetrical joint involvement-SI Joint

• bamboo spine
• syndesmophytes-long ligaments connecting adjacent vertebrae
• dagger/trolley track sign
• early shiny corner sign

Answer 3

Ankylosing spondylitis

Question 4

Gi dz

-bilateral sacro-ilitis, spondylitis, linear periostitis, wt loss

Answer 4

enteropathic arthropathies

Question 5

• Asymmetric joint involvment
• Preservation of joint space
• inborn error in purine metabolism
• elevated serum uric acid

Answer 5

GOUT

Question 6

how do you get primary gout?

Answer 6

hormonal/genetic

Question 7

how do you get secondary gout?

Answer 7

drug therapy or medical condition

SPEED:salicylates, pyrazinamide, ethambutol, ethanol, diuretics
Hyperparathyroidism

Question 8

condition where: joints are stiff, enlarged, deformed, joint/bone destruction, presence of tophi

Answer 8

chronic gout

Question 9

sign: overhanging margin of new bone to wall off soft tissue tophus

Answer 9

martel’s sign

Question 10

Gout like with CPPD (calcium pyrophosphate crystals)

-due to overactivity of enzymes
-Usually Bilateral in Knee
-affects meniscus
assoc with hyperparathyroidism, acromegaly, DJD, DM

Answer 10

chondrocalcinosis

Question 11

AKA osteoarthritis

• Asymmetric/unilateral joint involv
• Asymmetric joint space narrowing
• NO EROSIONS
• Eburnation
• Osteophyte formation
• Subchondral cysts
• Joint Mice

Answer 11

DJD

Question 12

which stage of the DJD regnauld classification is this?

flattening of 1st met head, small dorsal exostosis

pain at end of rom
passive nwb rom can be limited

Answer 12

stage 2

Question 13

which stage of the DJD regnauld classification is this?

Obliteration
-joint mice

rom < 10degrees

Answer 13

stage 4

Question 14

which stage of the DJD regnauld classification is this?

severe flattening, asymmetric joint space narrowing

crepitus, pain on full rom, passive/nwb rom limited

Answer 14

stage 3

Question 15

Bony outgrowths at PIPJ of fingers and seen in DJD

Answer 15

Bouchards Nodes

Question 16

Bony outgrowth at DIPJ of fingers and seen in DJD

Answer 16

Heberden’s nodes

Question 17

Where do you see joint mice?

loose osteocartilagenous bodies within joint

Answer 17

DJD-stage 4

Question 18

Clinical variant of DJD

symmetrical bilateral joint involvement
asymmetrical narrowing of joint space

worse than DJD; more inflammation + erosion

Answer 18

Erosive arthritis

Question 19

sign:

central erosions flanked by raised lips of bone

Answer 19

gull wing sign

seen in erosive arthritis

Question 20

Bilateral joint involvement
Symmetrical joint space narrowing
+ for ACCP
seropositive for RH factor ab

• licked candy stick
• erosive->ankylosis
• swan neck
• boutinneire
• opera glass hand
• fibular deviation
• most common in Forefoot
• smaller joints affected more freq
• pseudo cysts
• late stage subluxations of MPJ

Answer 20

Rheumatoid

Question 21

what joint is spared in Rheumatoid

Answer 21

calcaneal cuboid

Question 22

what stage is the PANNUS formed?

Answer 22

stage 2

Question 23

what does the pannus do?

Answer 23

envelope hyaline cartilage and erode bone at joint margins where it is not protected by cartilage

Question 24

is there new bone formation in Rheumatoid?

Answer 24

a little bit due to perisoteal lifting.

Question 25

is there a sclerotic border in Rheumatoid?

Answer 25

NO, its poorly outlined (unlike PA and gout)

Question 26

what radiographic sign is this? - flexion of the dipj - hyperextension of pipj

Answer 26

swan-neck deformity seen in rheumatoid

Question 27

what radiographic sign is this? - flexion of pipj - hyperextension of dipj

Answer 27

boutinneire deformity | seen in rheumatoid

Question 28

what radiographic sign is this? | -shortening of several proximal phalanges secondary to compressive erosions and destruction of bony ends

Answer 28

opera-glass hand deformity -seen in rheumatoid

Question 29

where do you see pencil in cup, ivory phalanx, ipj whiskering?

Answer 29

psoriatic

Question 30

what is the difference between psoriatic and rheumatoid?

Answer 30

bony proliferation in psoriatic

Question 31

where do you see shiney corner sign?

Answer 31

akylosing spondylitis

Question 32

what ligaments are ossified in the dagger sign?

Answer 32

posterior interspinous

Question 33

where do you see eburnation, joint mice, bouchards nodes, and heberdens nodes

Answer 33

DJD

Question 34

what are the stages of gout?

Answer 34

asymptomatic hyperuricemia acute monoarticular gout polyarticular gout chronic gout

Question 35

what are the two forms of neuropathic jt dz?

Answer 35

hypotrohpic-NWB joints | hypertrophic-WB joints

Question 36

what are the triad of symptoms of pulmonary hypertrophic osteoarthropathy?

Answer 36

digital clubbig symmetrical arthritis linear periostitis

Question 37

where do you see double stripe sign?

Answer 37

pulmonary hypertrophic osteoarthropathy

Question 38

which collagen vascular disorder presents with symmetric joint space narrowing with marginal erosions

Answer 38

scleroderma