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MSK/Rheum > Arthritis > Flashcards

Arthritis Flashcards

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1
Q

arthritis is defined as

A

swelling and pain of a joint

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2
Q

ddx of acute monoarthritis

A

trauma
infection
crystals

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3
Q

what is the most common form of arthritis?

A

osteoarthritis

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4
Q

what is the most prominent symptom of OA

A

pain

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5
Q

definition of OA

A

progressive destruction of the cartilage in the joint, which is accompanied by new bone formation

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6
Q

3 things to consider when making the diagnosis of RA

A

clinical picture (classical joints)
radiographic
normal laboratory tests (ESR, serologies, uric acid)

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7
Q

classical joints of OA

A

knees
hip
hands
spine

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8
Q

3 radiographic features of OA

A

joint space narrowing
osteophyte formation
bone sclerosis

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9
Q

which node is associated with OA on the DIP joint?

A

Heberden’s nodes

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10
Q

which node is associated with OA on the PIP joint

A

Bouchard’s nodes

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11
Q

what happens to the first CMC joint in OA

A

squared due to the osteophytes at that joint

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12
Q

swan neck deformity is associated with

A

RA

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13
Q

is RA symmetric or asymmetric?

A

symmetric

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14
Q

sausage toes are prominent in

A

psoriatic arthritis

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15
Q

onchodystrophy is associated with

A

psoriatic arthritis

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16
Q

what’s the greatest risk factor for OA progression

A

age > 60

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17
Q

bow-legged

A

varus

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18
Q

knock-kneed

A

valgus

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19
Q

treatment for mild-to-moderate pain OA

A

simple analgesics, topical creams

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20
Q

treatment for moderate-to-severe pain OA

A

COX2 selective inhibitors

NSAIDs + gastroprotection

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21
Q

increased risk of OA conferred by

A

obesity, prior injury, family history

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22
Q

how is obesity related to OA

A

may exacerbate OA via chronic inflammatory state

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23
Q

two sources of uric acid

A

dietary

cellular nucleotides and nucleoproteins

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24
Q

how much uric acid is excreted through the gut

A

⅓- not adjustable

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25
how much uric acid is excreted through the kidneys
⅔- adjustable
26
what food increases the risk of gout
meat | fructose
27
what food decreases the risk of gout
dairy
28
what converts ribose-5-P to purines
PRPP synthase, which is inhibited by excess purines (ATP, ADP, AMP)
29
what converts xanthine to uric acid
xanthine oxidase
30
purine salvage enzyme
HGPR transferase
31
what converts uric acid to allantoic acid (that humans don't have)
uricase
32
mechanisms of abnormal purine metabolism
increased production- PRPP synthase up decreased salvage- HGPRT down
33
increased cell (and purine) turnover conditions
myelo- and lymphoproliferative malignancies hemolytic anemias chemotherapy with tumor lysis
34
how much of urate is filtered in the glomerulus
100%
35
dysfunction of urate secreting transporters promotes
hyperuricemia
36
dysfunction of urate transporters (or inhibitors of them) promotes
urate excretion
37
how much of urate is excreted
90% of filtered loads
38
important urate transporters
URAT1 | ABCG2
39
2 conditions promoting uric acid retention
lactic acid and ketoacidosis drugs
40
drugs causing hyperuricemia
``` alcohol diuretics ethambutol pyrazinamide nicotinic acid salicylates ```
41
serum urate concentration for a gouty attack
>8.9 mg/dL
42
how to crystals initiate inflammation
activation of complement and other serum factors activation of synovial macrophages
43
activation of synovial macrophages produces
IL1, TNF-alpha, IL8
44
chemoattractants activate
integrins
45
ICAMs upregulated and activated by
cytokines
46
phagocytosis of crystals results in
degranulation, O2- generation
47
what happens to ESR in gout
elevated
48
what happens to WBC in gout
elevated
49
what happens to uric acid levels in gout
may be elevated. but maybe not
50
short, squat, positively birefringent crystal is likely to be
calcium pyrophosphate
51
release of PPi from the chondrocyte
Ank transporter- releases PPi, binds with extracellular Ca++
52
colchicine action
diminishes stimulated endothelial adhesiveness for leukocytes
53
anakinra
IL1 receptor antagonist
54
rilonacept
IL1 trap
55
canakinumab
anti-IL1 Ig
56
drugs that block urate production
allopurinol, febuxostat
57
drugs that promote urate excretion
probenecid, lesinurad
58
drugs that prevent gout attacks
colchicine, NSAIDs, low-dose steroids
59
allopurinol, febuxostat block
xanthine oxidase
60
probenecid and lesinurad inhibit
URAT1 | **only works if renal filtration is adequate
61
pegloticase is used for treating
chronic tophaceous gout- reducing tophi
62
chondrocalcinosis results from
calcium pyrophosphate deposition in cartilage
63
peak age of RA onset
40-60 years
64
MCP involvement in OA or RA
RA
65
presentation of advanced RA
ulnar deviation volar subluxation interosseous wasting
66
marginal erosions of the bone present in
RA
67
RA effects on the eyes
scleritis | keratoconjunctivitis
68
RA effects on the lungs
fibrosis, nodules, pleuritis, pleural effusions
69
cardiovascular manifestations of RA
atherosclerosis vasculitis increased MI risk 2-3X
70
#1 cause of death in RA
CV related
71
RA increases which hematologic malignancy
B-cell non-hodgkin's lymphoma increased 2-3X increased systemic inflammation
72
RA susceptibility to which MHC gene
MHC II DRb1
73
characteristic lab abnormalities of RA
``` RF anti-citrullinated protein antibody (ACPA, CCP) elevated ESR elevated CRP anemia of chronic disease ```
74
which RF's do we usually test for
IgM-RF
75
3 Ddx for RF
SLE Hepatitis B, C malignancies: lymphoma, plasma cell dyscriasis
76
what accomplishes citrullination
PADI's higher specificity for RA associated with progression and worse prognosis
77
3 cytokines promoting damage to RA joints
TNF-alpha IL1 IL6
78
tofacitinib
selective inhibitor of janus kinases- modulates cytokines important in pathogenesis of RA
79
HLA_B27 contributes to susceptibility to what
ankylosing spondylitis
80
sacroiliitis is a hallmark of
ankylosing spondylitis
81
chief complaint of AS
low back pain and morning stiffness
82
acute anterior uveitis is a systemic feature of
AS
83
IBD is a feature of
AS
84
lung involvement in AS
pulmonary fibrosis | costovertebral joint fusion--> restrictive lung disease
85
cardiac involvement in AS
valvular insufficiency and variable degrees of AV block in ~5% of patients
86
what is used to treat spine symptoms in AS
TNF antagonists (etanercept)
87
nail changes seen in
psoriatic arthritis
88
achilles tendonitis seen in
psoriatic arthritis

MSK/Rheum (5 decks)

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