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Flashcards in arthritis Deck (34):
1

osteoarthritis

noninflammatory - mechanical wear and tear of joints leads to destruction of articular cartilage
subchondral cysts
scerlsosis
osteophytes (bone spurs)
eburnations (polished, ivory-like appearance of bone)
heberden's nodes = DIP joints
Bouchard's nodes = PIP joints

2

osteoarthritis risk factors

age
obesity
joint deformity

3

osteoarthritis presentation

pain in weight-bearing joints after use (@ end of the day)
improves with rest
knees - cartilage loss begins on medial aspect (bowlegged)
no systemic symptoms (non-inflammatory)

4

x-rays for osteoarthritis

joint space narrowing
sclerosis
osteophytes (bone spurs)

5

Rheumatoid arthritis signs

auto-immune inflammatory disorder affecting synovial joints with pannus formation in joints (MCP and PIP)
subcutaneous rheumatoid nodules (fibrinoid necrosis surrounded by palisading histiocytes)
ulnar deviation
subluxation
Baker's cyst - behind the knee

6

RA etiology

Females > males
strong association with HLA-DR4

7

RA pathophysiology

Type III hypersensitivity - damage due to immune complex formation
histology: hyperplasia and hypertrophy of the synovium

8

RA Lab values

80% have positive rheumatoid factor (anti-IgG antibodies) - not specific for RA
anti-CCP antibody (less sensitive but more specific)

9

RA presentation

morning stiffness lasting > 30 minutes and improves with use
symmetric joint involvement

10

RA systemic manifestations

Fever
Fatigue
Pleuritis
Pericarditis
interstitial lung disease
vasculitis

11

treatment

NSAIDs, COX-2 inhibitors
glucocorticoids
disease modifying drugs (methotrexate, sulfasalazine, hydroxycholorquine)

12

Felty's syndrome

Felty's syndrome = RA, splenomegaly, neutropenia

13

characteristic lesions

ulnar deviation
Boutonnier deformity = PIP joint effected
Swan Neck deformity = PIP joint bent in wrong direction
Z-thumb deformity

14

Gout Findings

precipitation of monosodium irate crystals into joints due to hyperuricemia
IgG-mediated inflammation
crystals = needle shaped & negatively birefringent = yellow crystals under parallel light
more common in men

15

Causes of Gout

Lesch-Nyhan syndrome (defect in purine salvage - HGPRT enzyme)
PRPP excess
decreased excretion of uric acid (ex: thiazide diuretics) = 90%
increased cell turnover (leukemias)
von Gierk's disease
10% due to overproduction

16

Gout symptoms

asymmetric joint distribution
swollen, red, painful joint
painful MTP joint of big toes (podagra)
tophus formation (external ear, elbow - olecranon bursa, achilles tendon)

17

Acute Gouty attack

occur after large protein meals
alcohol binges = alcohol metabolites compete for same excretion sites in kidney as uric acid
thiazide diuretics

18

Gout tophi

painful granulomatous foreign body reaction occurring near a joint space
-external ear
-olecranon bursa
-Achilles tendon

19

Lesch-Nyhan syndrome

purine salvage deficiency (HGPRT enzyme)
purines are degraded into uric acid
patients develop gout at an early age

20

Gout Treatment Acute Attack

NSAIDs (indomethacin), colchicine

21

Chronic Gout Treatment

ALlopurinol, febuxostat, uricosurics (probenecid)

22

pseudogout

calcium pyrophosphate crystals deposit in the joints

23

pseudogout histology

POSITIVELY birefringent = crystals turn BLUE under parallel light
Yellow under perpendicular light
basophilic, rhomboid shapedcrystals

24

pseudo gout signs/symptoms

affects large joints (knee)
> 50 YO (M=F)
pain, erythema and inflammation

25

pseudogout treatment

acute = NSAIDs, colchicine

26

infectious arthritis

etiology:
staph aureus
streptococcus
Neisseria gonorrhoeae

27

gonococcal arthritis

co-symptom of urethritis
migratory, asymmetrical, large joints
synovitis = inflammation of synovium
tenosynovitis = inflammation of ligaments in hand
dermatitis (pustules)

28

tenosynovitis

inflammation of fluid filled sheath that surrounds the synovium and covers the tendons
seen in gonococcal arthritis

29

chronic infectious arthritis causes

TB - from mycobacterial dissemination
Lyme disease (untreated infection- targetoid lesion = erythema migrans)

30

seronegative spondyloarthropathies

arthritis without rheumatoid factor
strong HLA-B27 association (gene encodes HLA MHC I)
more in males

31

psoriatic arthritis

joint pain and stiffness ass with psoriasis
asymmetric and patchy involvement
dactylitis (sausage fingers)
X-RAY = "pencil-in-cup" deformity
< 1/3 of patients with psoriasis

32

ankylosing spondylitis

inflammation of spine and sacroiliac joint
typically affects young men
signs/symp: morning stiffness, difficulty bending forward
x-ray = bamboo spine due to joint fusion
associated: uveitis, aortic regurgitation, IBD (Crohn's or ulcerative colitis)

33

reactive arthritis

autoimmune reaction to pathogen
-GI (Campylobacter)
-GU (Chlamydia)

34

reactive arthritis symptoms

conjunctivitis and ureitis
urethritis
arthritis
"CAN'T SEE, CAN'T PEE, CAN'T CLIMB A TREE"
ass with HLA-B27 = prone to developing uveitis