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arthritis Flashcards

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1
Q

caused by joint wear and tear → destroys articular cartilage

A

osteoarthritis

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2
Q

joint findings:
osteophytes - bone spurs caused by bone-on-bone
eburnation - polished, ivory-like appearance caused by bone-on-bone
heberden nodes (DIP)
bouchard nodes (PIP)

A

osteoarthritis

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3
Q

heberden nodes

A

DIP in osteoarthritis

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4
Q

bouchard nodes

A

PIP (prOximal = bOuchard) in osteoarthritis

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5
Q

common locations of osteoarthritis

A 
fingers
weight bearing areas (especially in obese):
knees
hips
spine
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6
Q

risk factors for osteoarthritis

A

age - wear to articular cartilage
obesity
trauma.joint deformity - misaligned joint

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7
Q

pain in weight bearing joints AFTER USE/END OF DAY

improves with rest

A

osteoarthritis

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8
Q

localized, noninflammatory joint disease with no systemic symptoms

A

osteoarthritis

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9
Q

treatment of osteoarthritis

A

1) acetaminophen - scheduled
2) NSAIDs
3) intraarticular glucocorticoid - temporary relief (knee)
4) hyaluronic acid - in synovial fluid
5) opioids - relieve pain only
6) knee/hip replacement if can’t walk (obese)

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10
Q

joint space narrowing - no cartilage on xray

A

osteoarthritis

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11
Q

systemic, autoimmune joint disease involving inflammatory destruction of the synovial joints

A

rheumatoid arthritis

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12
Q

joint disease that is a type III hypersensitivity reaction

A

rheumatoid arthritis

autoantibodies bind to soluble antigen in blood → form immune complexes →IC deposit in tissue

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13
Q 
female with: 
pannus formation of MCP + PIP (no DIP)
subq rheumatoid nodules 
ulnar deviation of fingers at PIP
subluxation
Baker cyst in popliteal fossa (synovial cyst behind knee)
A

rheumatoid arthritis

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14
Q

rheumatoid factor

A

IgM against IgG (anti-IgG antibody)
high FP for RA (low specificity)
if positive RF → do ACPA (anti-citrullinated peptide antibody, more specific, confirms RA)

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15
Q

MORNING STIFFNESS >30 min
improves with use
symmetric joints + systemic symptoms (fever, fatigue, pleuritic effusion, pericarditis)

A

rheumatoid arthritis

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16
Q

swan neck deformity

A

advanced rheumatoid arthritis sign (opposite of Boutonneire)
extension of PIP
flexion of DIP

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17
Q

Boutonniere deformity

A

advanced rheumatoid arthritis sign
extensor tendon on back of finger splits so PIP pokes through
flexion of PIP
extension of DIP

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18
Q

treatment for acute exacerbation of rheumatoid arthritis

A

NSAID
cox-2 inhibitor
short course of steroids

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19
Q

long-term treatment for rheumatoid arthritis (disease modifying anti-rheumatic drugs = DMARDs)

A

longer you wait - more irreversible damage
low dose MTX
hydrochloroquine
sulfasalazine
TNFα inhibitor: etanercept, infliximab, adalimumab, golimumab, certolizumab

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20
Q

precipitation of monosodium urate crystals

A

gout

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21
Q

precipitation of calcium pyrophosphte crystals

A

Pseudogout (calcium Pyrophosphate crystals)

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22
Q

is hyperuricemia required for the diagnosis of gout

A

NO
can have gout without hyperuricemia or
hyperuricemia without gout

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23
Q

acute inflammatory monoarthritis caused by monosodium urate crystals in joints

24
Q

crystals are
needle shaped
negative birefingent under polarized light (yellow under parallel light, blue under perpendicular)

Study These Flashcards
A

gout (yeLLow = paraLLel)

25
conditions that cause underexcretion of uric acid → hyperuricemia → gout (most common cause)
usually idiopathic | loops or thiazide diuretics
26
drugs that can cause gout
loop or thiazide diuretics
27
conditions that can cause overproduction of uric acid → hyperuricemia → gout
purine-rich foods Lesch Nyhan syndrome treating leukemia, lymphoma: ↑ cell turnover (tumor lysis syndrome)
28
asymmetric joint distribution, monoarthritis (one joint at a time) cyclical attacks - comes and goes swollen, red, painful joint PODAGRA: painful MTP joint of big toe TOPHI formation: nonpainful, uric crystals in external ear (most common), olecranon bursa, achilles tendon
gout
29
arthritis that occurs after big meal or alcohol consumption
gout | alcohol metabolites compete for same excretion sites in kidney as uric acid →↓ uric acid excretion → hyperuricemia
30
treatment of acute gout attacks
1) NSAIDs (indomethacin) - DOC 2) colchicine 3) prednisone for 4-5 days
31
chronic treatment for gout (>1-2 attacks/year, control uric acid levels to prevent future attacks)
1) allopurinol - inhibit XO - DOC 2) probenecid 3) febuxostat - same MOA as allopurinol
32
crystals are rhomboid weakly positively birefringent (blue under parallel light, yellow to perpendicular light)
pseudogout | Positively birefringent + calcium Pyrophosphate crystals = Pseudogout
33
arthritis with chondrocalcinosis (calcification of articular cartilage - esp menisci) on xray
pseudogout
34
arthritis involving large joints (knee usually) | >50 yo
pseudogout
35
treatment of pseudogout
same as gout: sudden, severe attack: NSAIDs steroids: prednisone colchicine
36
what are the seronegative spondyloarthropathies
``` PAIR Psoriatic arthritis Ankylosing spondylitis Inflammatory bowel disease spondylitis Reactive arthritis (reiter syndrome) ```
37
syndrome that causes: conjuncitivitis (or uveitis): pink eye urtethritis (dysuria) arthritis
``` reactive arthritis (reiter syndrome) Can't see, can't pee, can't climb a tree ```
38
``` arthritis of spine with negative rheumatoid factor (no anti-IgG antibody) common in male with HLA-B27 (codes for HLA MHC class I) ```
seronegative spondyloarthropathies
39
asymmetric + patchy, inflammatory arthritis (sometimes symmetrical) involving DIP joints, spine, SI joint dactylitis ("sausage fingers", inflammed finger)
psoriatic arthritis may have psoriasis (asymmetric, patchy skin condition) without arthritis, both (1/3 psoriatic patients), or only psoriatic arthritis
40
"pencil-in-cup" deformity on xray
psoriatic arthritis
41
chronic inflammatory disease of spine + SI joints → ankylosis (stiff spine due to fusion of SI joints, intervertebral discss, and/or facet joints) + uveitis (vascular layer of eye) + aortic regurgitation/conduction abnormalities/PVD/CHF
ankylosing spondylitis
42
bamboo spine on xray
ankylosing spondylitis | calcification of bone outlining intervertebral discs
43
↓spine mobility (including SI joint) beginning in 20-30 yo | improves with exercise
ankylosing spondylitis
44
arthritis associated with IBD
IBD spondylitis chron's/UC may have ankylosing spondylitis or peripheral arthritis
45
arthritis after infection with: chlamydia GI infection: shigella (most common), salmonella, yersinia, campylobacter, clostridium)
reactive arthritis (reiter syndrome)
46
STD that can cause a migratory arthritis with asymmetric pattern (a type of septic arthritis)
``` Neisseria gonorrhoeae (can cause osteomyelitis too) called gonococcal arthritis STD Synovitis (knee) Tenosynovitis (hand) dermatitis (pustules) ```
47
young sexually active patient with red, swollen, painful knee
Gonoococcal arthritis (N. gonorrhoeae)
48
diagnosis of septic arthritis requires
arthrocentesis: ↑WBC, bacteria
49
treatment of septic arthritis
IV antibiotics + surgery to clean out otherwise destructive
50
organisms that can cause septic arthritis
S. aureus Streptococcus N. gonorrhoeae
51
treatment of seronegative spondyloarthropathies
NSAID steroids DMARDs (also used in RA) TNFα inhibitors (also used in RA)
52
arthritis begins
juvenile idiopathic arthritis
53
type of juvenile idiopathic arthritis characterized by: | severe symmetrical arthritis + dactylitis (inflammation of fingers)
polyarticular juvenile idiopathic arthritis
54
type of juvenile idiopathic arthritis characterized by: large joint involvement (doesn't start in hips) 20-25% have uveitis
pauciarticular (few joints) juvenile idiopathic arthritis
55
type of juvenile idiopathic arthritis characterized by: begins with systemic sx (fever, rash, ↑WBC, anemia, heaptosplenomegaly, LAD) - looks like leukemia/lymphoma arthritis presents later
systemic onset juvenile idiopathic arthritis (still's disease)

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