Arthritis Flashcards

(35 cards)

1
Q

Stiffness rarely lasting longer than 15 minutes

Pain on motion worse with activity or weight bearing, relieved with rest

Flexion contracture, varus/valgus deformity, Heberden/Bouchard nodes

Crepitus

A

osteoarthritis

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2
Q

RF for osteoarthritis

A

90% have this by age 40
Hereditary, mechanical factors, obesity, contact sports, jobs w/ frequent bending/carrying

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3
Q

Loss of articular cartilage leading to pain and deformity + hypertrophy of bone at articular margin in weight bearing joints

Primary = DIP/PIP joints, CMC joint, hip, knee, cervical/lumbar

Secondary = injury to the joint from trauma or overuse or metabolic disease

A

osteoarthritis

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4
Q

XR: loss of joint space, sclerosis, subchondral cysts, osteophytic/lipping of marginal bone

Labs: lack of inflammatory markers

A

osteoarthritis

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5
Q

How do you tx osteoarthritis

A

Activity modification/splinting, exercise, weight reduction, NSAIDs, topical or otherwise
Intra-articular injections (steroid, hyaluronate, PRP), duloxetine (cymbalta), PT

Joint arthroplasty

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6
Q

Sudden onset, frequently nocturnal

MCJ = metatarsophalangeal joint (podagra) or ankle, tarsal, knee

Severe pain, redness, swelling, with maximum severity reached over several hours
Fever is common

A

gout

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7
Q

What are RFs for gout

A

Alcohol excess, med changes, hospitalization, fasting before procedures

Mostly adult men

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8
Q

Elevated levels of uric acid deposition due to overproduction or underexcretion of renal uric acid
– excess monosodium urate crystals depositing in tissue
Causing recurrent attacks of acute inflammatory arthritis, usually monoarticular

Tophi = masses from this with associated foreign body reaction

A

gout

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9
Q

What are triggers for gout

A

Triggers = thiazide/loop diuretics, ACEI, pyrazinamide, ethambutol, aspirin, purine rich foods

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10
Q

PE: Marked tenderness to palpation, swelling, erythema, limited ROM

Arthrocentesis → monosodium urate crystals in synovial fluid (birefringent needle shaped)

Labs: elevated ESR, WBC

XR: normal early, joint destruction later (punched-out erosions”mouse bite” w/ overhanging rim of cortical bone)

A

gout

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11
Q

How do you treat gout acutely

A

NSAIDs first line (indomethacin and naproxen)
Oral steroids (intra-articular injection for monoarticular)
Colchicine if symptoms <36 hours

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12
Q

How do you treat gout between attacks

A

Avoid alcohol (beer), purines (liver, seafood, yeasts), avoid diuretics, niacin, aspirin
Colchicine + canakinumab prophylaxis
Urate lowering = allopurinol + febuxostat (not acutely), probenecid (not in renal issues)

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13
Q

How do you treat gouts more severely?

A

Pegloticase in hospital setting

IL-1 inhibitors in hospitalization

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14
Q

Asymptomatic – generally acute and recurrent in one joint, knee MCJ, with wrists 2nd, more common in femeale/elderly

A

pseudogout

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15
Q

Calcium pyrophosphate deposition disease, causing precipitation of these crystals in connective tissues

A

pseudogout

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16
Q

PE: Marked tenderness to palpation, swelling, erythema, limited ROM

Presence of CPPD crystals (positive, birefringent rhomboid-shaped) in synovial fluid (joint aspiration to distinguish)

– XR evidence of CPPD crystals (chondrocalcinosis) to differentiate; calcification of cartilage

No bony erosions

17
Q

psuedogout tx

A

Joint aspiration + intra-articular steroid injection

NSAIDs for acute attacks

Colchicine w/n 24 hours and for prophylaxis

Short term immobilization

18
Q

Stiffness, pain, swelling, worse in the morning >30 minutes, improves later in the day
Carpal tunnel common

Anemia, malaise, fatigue, vasculitis, scleritis, rheumatoid nodules, renal disease, pleuropericarditis, ocular symptoms, trigger finger from nodules

Symmetric

A

rheumatoid arthritis

19
Q

RF for rheumatoid arthritis

A

Women > men
Peak onset late 40s, early 50s
Hands, wrists, knees, feet, ankles MC

20
Q

Acute + chronic inflammation in synovium, causing proliferative + erosive joint changes – etiology unknown

– Genetic predisposition, hormonal changes, infectious agents

A

rheumatoid arthritis

21
Q

PE: pain and swelling, limited ROM, synovial hypertrophy with “BOGGY” feeling, joint aspiration = little fluid, reduced grip strength, extensor surface nodules
Ulnar drift of toes fingers
Knee = ligament laxity, effusion, genu valgum
Heel pain from retrocalcaneal bursitis

RF, anti-CCP, IgM antibody, CRP, ESR
Anemia of chronic disease is common
XR

A

rheumatoid arthritis

22
Q

rheumatoid arthritis tx

A

Steroids – bridge gap between slow acting DMARDs:
→ Methotrexate, but can add sulfasalazine (2nd), leflunomide, hydroxychloroquine

Refractory = janus kinase inhibitors

Biologics – TNF-alpha added to methotrexate (etanercept, infliximab, adalimumab), or nonTNF (abatacept)

Omega 3 supplements, analgesics, splints/therapy, custom shoes

Selective surgery

23
Q

PEAR-U Sero-negative spondyloarthropathies

A

Psoriatic arthritis
Enteropathic arthritis (IBD)
Ankylosing spondylitis
Reactive arthritis (reiter)
Undifferentiated spondyloarthropathy

24
Q

What are RFs for sero-negative spondyloarthropathies

A

Males
<40
spine/SI joints
Enthesopathy
Ocular formation

25
HLA-B27 genetic marker is often seen in
Sero-negative spondyloarthropathies
26
DIP joint with scaly, cutaneous lesions, commonly with nail disorders, pitting, ridging, onycholysis psorasis preceding onset XR: pencil in cup deformity
psoriatic arthritis
27
How do you treat psoratic arthritis
TNF inhibitor → methotrexate
28
Crohn’s and UC Peripheral – oligoarthritis of large joints, paralleling bowel disease Spondylitis – indistinguishable from ankylosing spondylitis, independent course of bowel disease
enteropathic arthritis
29
How do you treat enteropathic arthritis
Control intestinal inflammation = eliminate peripheral arthritis, can add NSAID (if not exacerbating)
30
Morning stiffness relieved by activity and leaning forward Late teens, early twenties, males > females Primarily affecting axial skeleton - sacroiliitis and kyphosis
ankylosing spondylitis
31
PE: limited spinal motion, progresses in cephalad direction FABER maneuver stresses SI joint Achilles enthesopathy, anterior uveitis XR: “shiny corner sign” where annulus attaches to vertebral body, “bamboo spine”
ankylosing spondylitis
32
How do you treat ankylosing spondylitis
NSAIDS, then TNF
33
Arthritis, urethritis, conjunctivitis, mucocutaneous lesions STI and dysenteric disease common Pain in large joints of lower extremity with enthesitis of achilles tendon, dactylitis, sacroiliitis, nongonococcal urethritis, anterior uveitis, cutaneous ulcerations
reactive arthritis
34
“Reiter syndrome” – acute spondyloarhtropathy precipitated by GI/GU infection “Can’t see, can’t pee, can’t climb a tree”
reactive arthritis
35
how do you tx reactive arthritis
NSAIDs, then sulfasalazine or methotrexate – may need to treat chlamydial infection