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Flashcards in Arthritis Deck (82):
1

What is the definition of arthritis?

Inflammation of joints

2

What is the most frequent cause of disability in the US?

Arthritis

3

What fraction of the US is affected by arthritis?

Half of all adults

4

What are the three major types of joints?

-Synarthroses
-Amphiarthroses
-Diarthroses

5

What are synarthroses? Are they moveable?

Skull sutures, which are immovable

6

What are amphiarthroses? Are they moveable?

Pubis symphysis, sacroiliac, and spine

Limited movement

7

What are diarthroses? Are they moveable?

Moveable joints

8

What are the moveable joints?

Diarthroses

9

What is the synovium? What is the role of this?

-Single cell layer that lines the joint capsule
-Secretes thick viscous fluid

10

What is cortical bone?

Outer, denser layer of bone

11

What is trabecular bone?

Inner, highly vascularized bone

12

How is cortical bone arranged?

Along lines of stress

13

True or false: almost none of the labs that are available in rheumatology are 100% specific

True

14

What are the components of the history taking that are specifically important to rheumatic diseases? (5)

-Location
-Symmetry
-Onset
-Chronology
-Inflammation and weakness

15

What is the difference in the affected areas of the hand with RA vs OA?

RA affects MCPs
OA affects DIPs

16

Which affects the PIPs: OA or RA?

Both

17

What is the difference between acute, subacute, and chronic in terms of rheumatological diseases?

Acute = hours
Subacute = days
Chronic = weeks (6+ weeks)

18

What is the infectious diseases that causes RA-like symptoms in adults, but is self limited?

5th's disease (parvovirus B19)

19

How common are fevers with rheumatologic diseases?

Common

20

What are four features that should be elicited with the joint exam on every joint?

-Signs of inflammation
-ROM
-Deformities
-Condition of surrounding structures

21

Why is acute monoarticular arthritis a red flag?

If a bacterial infection of the joint, can cause necrosis of the joint in a few days

22

Why are cranial symptoms in elderly patients with muscle pain a red flag?

Giant cell arteritis leading to blindness

23

Why is morning stiffness lasting over an hour in patients with back pain a red flag?

Suspicious for ankylosing spondylitis

24

What are the three major purposes of lab testing?

-Screening
-Confirming a dx
-Monitoring treatment

25

What are the acute phase reactants? (6)

ESR
CRP
Serum amyloid A
Ferritin
Fibrinogen
Haptoglobin

26

What is the general use of measuring acute phase reactants?

Reflect the intensity of inflammation (regardless of etiology)

27

What is the role of measuring acute phase reactants in rheumatic disease?

Sensitive, but very non-specific

28

What is the role of CRP in anemia?

Will be higher

29

What, generally, is an ESR? How is it performed?

The rate at which red blood cells sediment in a period of one hour.

To perform the test, anticoagulated blood was traditionally placed in an upright tube, known as a Westergren tube, and the rate at which the red blood cells fall was measured and reported in mm/h.

30

Which produces a much faster change with inflammation: CRP or ESR

CRP

31

True or false: you should never order both an ESR and CRP

False--should do together

32

What happens to ESR with age?

Elevates

33

Which gender usually has a higher sde rate?

Women

34

Which has a wider range of variance: CRP or ESR?

CRP

35

What is anti-CCP?

Relatively specific (but not sensitive) factor for RA, but not as sensitive as RF

36

What is rheumatoid factor?

IgM Antibody to the Fc portion of IgG molecule, that is present in 80% of RA pts

37

What is the problem with testing for rheumatoid factor?

Many false positives

38

True or false: rheumatoid factor levels correlate with disease activity

False

39

True or false: rheumatoid factor alone can diagnose RA

False

40

What is the infectious disease that often causes high levels of rheumatoid factor?

Hep C

41

What are some of the autoimmune diseases where RF will be falsely elevated?

Sjogren's syndrome
SLE

42

What is the autoantibody in MG? (pg 210 of FA)

Anti-ACh receptor

43

What is the autoantibody in: Goodpasture syndrome?

Anti-BM

44

What is the autoantibody in: antiphospholipid syndrome?

Anti-cardiolipin

45

What is the autoantibody in: CREST syndrome?

Anticentromere

46

What is the autoantibody in: pemphigus vulgaris?

Anti-desmoglein

47

What are the 3 autoantibodies in: SLE

Anti dsDNA
Anti-smith
ANA

48

What is the autoantibody in: DM 1

Anti glutamate hydroxylase

49

What is the autoantibody in: Bullous pemphigoid?

Anti-hemidesmosomes

50

What is the autoantibody in: Drug induced lupus?

Antihistone

51

What is the autoantibody in: Polymyositis and dermatomyositis?

Anti-Jo1
Anti-SRP
Anti Mi-2

52

What is the autoantibody in: hashimoto's thyroiditis

Antimicrosomal
Antithyroglobulin

53

What is the autoantibody in: primary biliary cirrhosis

Antimitochondrial

54

What is the autoantibody in: Scleroderma?

Anti-SCl-70 (anti topoisomerase I)

55

What is the autoantibody in: autoimmune hepatitis

Anti-smooth muscle

56

What is the autoantibody in: Sjogren's syndrome?

Anti-SSA (Ro)
Anti-SSB (La)

57

What is the autoantibody in: Grave's disease

Anti-TSH

58

What is the autoantibody in: mixed connective tissue disease?

Anti-U1 RNP

59

What is the autoantibody in: Wegener's granulomatosis

c-ANCA

60

What are the 2 autoantibodies in: Celiac disease?

IgA antiendomysial
IgA anti tissue transglutaminase

61

What is the autoantibody in: microscopic polyangiitis and Churg-Strauss disease

pANCA

62

What is the one antibody that can actually track the course of an autoimmune disease?

Anti-dsDNA in SLE flares

63

What is the problem with Anti ss-A and ss-B in pregnancy?

Can cross the placenta and cause complete heart block in the fetus

64

What is the sensitivity of ANA in SLE?

95%

65

What is the role of ANA antibodies?

Is sensitive for autoimmune disease, but is not at all specific

66

What is the general PPV of ANA for SLE?

Not good

67

Centromere pattern of ANA suggests what syndrome?

CREST

68

nucleolar pattern of ANA suggests what?

Systemic scleroderma

69

What are the three major components of complement that are measured in autoimmune diseases?

C3
C4
CH50

70

Which complement is depleted by the alternative pathway?

C3 only

71

Which complements are depleted by the classic pathway?

C3
C4
CH50

72

What drug class makes uric acid levels go up?

Diuretics

73

Are uric acid levels sensitive or specific for gout?

Neither

74

True or false: high uric acid levels + joint pain = gout

False--many times this is not true

75

What is the only way to confirm a diagnosis of gout?

Synovial fluid analysis

76

What is the difference in crystals appearance between uric acid crystals in gout, and Calcium phosphate crystals in pseudogout?

CaPO4 are shorter, and blue

77

What is the treatment for septic joint 2/2 staph?

-Hospitalization
-IV abx
-Drainage
-Ortho and infx dz consult

78

Are there long term residual symptoms with 5th's disease arthralgias?

No

79

What is the treatment for arthralgias with 5th's disease?

Symptomatic only--is self limited

80

What is the treatment for OA?

-Analgesics (NSAIDs)
-Total knee replacement (maybe)

81

The treatment for SLE is largely dependent on what?

Internal organ involvement

82

What are the drugs that are commonly used in treating SLE?

-Hydroxychloroquine
-Prednisone
-Immunosuppressants