Flashcards in Arthritis Deck (82):
What is the definition of arthritis?
Inflammation of joints
What is the most frequent cause of disability in the US?
What fraction of the US is affected by arthritis?
Half of all adults
What are the three major types of joints?
What are synarthroses? Are they moveable?
Skull sutures, which are immovable
What are amphiarthroses? Are they moveable?
Pubis symphysis, sacroiliac, and spine
What are diarthroses? Are they moveable?
What are the moveable joints?
What is the synovium? What is the role of this?
-Single cell layer that lines the joint capsule
-Secretes thick viscous fluid
What is cortical bone?
Outer, denser layer of bone
What is trabecular bone?
Inner, highly vascularized bone
How is cortical bone arranged?
Along lines of stress
True or false: almost none of the labs that are available in rheumatology are 100% specific
What are the components of the history taking that are specifically important to rheumatic diseases? (5)
-Inflammation and weakness
What is the difference in the affected areas of the hand with RA vs OA?
RA affects MCPs
OA affects DIPs
Which affects the PIPs: OA or RA?
What is the difference between acute, subacute, and chronic in terms of rheumatological diseases?
Acute = hours
Subacute = days
Chronic = weeks (6+ weeks)
What is the infectious diseases that causes RA-like symptoms in adults, but is self limited?
5th's disease (parvovirus B19)
How common are fevers with rheumatologic diseases?
What are four features that should be elicited with the joint exam on every joint?
-Signs of inflammation
-Condition of surrounding structures
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
Why are cranial symptoms in elderly patients with muscle pain a red flag?
Giant cell arteritis leading to blindness
Why is morning stiffness lasting over an hour in patients with back pain a red flag?
Suspicious for ankylosing spondylitis
What are the three major purposes of lab testing?
-Confirming a dx
What are the acute phase reactants? (6)
Serum amyloid A
What is the general use of measuring acute phase reactants?
Reflect the intensity of inflammation (regardless of etiology)
What is the role of measuring acute phase reactants in rheumatic disease?
Sensitive, but very non-specific
What is the role of CRP in anemia?
Will be higher
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.
Which produces a much faster change with inflammation: CRP or ESR
True or false: you should never order both an ESR and CRP
False--should do together
What happens to ESR with age?
Which gender usually has a higher sde rate?
Which has a wider range of variance: CRP or ESR?
What is anti-CCP?
Relatively specific (but not sensitive) factor for RA, but not as sensitive as RF
What is rheumatoid factor?
IgM Antibody to the Fc portion of IgG molecule, that is present in 80% of RA pts
What is the problem with testing for rheumatoid factor?
Many false positives
True or false: rheumatoid factor levels correlate with disease activity
True or false: rheumatoid factor alone can diagnose RA
What is the infectious disease that often causes high levels of rheumatoid factor?
What are some of the autoimmune diseases where RF will be falsely elevated?
What is the autoantibody in MG? (pg 210 of FA)
What is the autoantibody in: Goodpasture syndrome?
What is the autoantibody in: antiphospholipid syndrome?
What is the autoantibody in: CREST syndrome?
What is the autoantibody in: pemphigus vulgaris?
What are the 3 autoantibodies in: SLE
What is the autoantibody in: DM 1
Anti glutamate hydroxylase
What is the autoantibody in: Bullous pemphigoid?
What is the autoantibody in: Drug induced lupus?
What is the autoantibody in: Polymyositis and dermatomyositis?
What is the autoantibody in: hashimoto's thyroiditis
What is the autoantibody in: primary biliary cirrhosis
What is the autoantibody in: Scleroderma?
Anti-SCl-70 (anti topoisomerase I)
What is the autoantibody in: autoimmune hepatitis
What is the autoantibody in: Sjogren's syndrome?
What is the autoantibody in: Grave's disease
What is the autoantibody in: mixed connective tissue disease?
What is the autoantibody in: Wegener's granulomatosis
What are the 2 autoantibodies in: Celiac disease?
IgA anti tissue transglutaminase
What is the autoantibody in: microscopic polyangiitis and Churg-Strauss disease
What is the one antibody that can actually track the course of an autoimmune disease?
Anti-dsDNA in SLE flares
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
What is the sensitivity of ANA in SLE?
What is the role of ANA antibodies?
Is sensitive for autoimmune disease, but is not at all specific
What is the general PPV of ANA for SLE?
Centromere pattern of ANA suggests what syndrome?
nucleolar pattern of ANA suggests what?
What are the three major components of complement that are measured in autoimmune diseases?
Which complement is depleted by the alternative pathway?
Which complements are depleted by the classic pathway?
What drug class makes uric acid levels go up?
Are uric acid levels sensitive or specific for gout?
True or false: high uric acid levels + joint pain = gout
False--many times this is not true
What is the only way to confirm a diagnosis of gout?
Synovial fluid analysis
What is the difference in crystals appearance between uric acid crystals in gout, and Calcium phosphate crystals in pseudogout?
CaPO4 are shorter, and blue
What is the treatment for septic joint 2/2 staph?
-Ortho and infx dz consult
Are there long term residual symptoms with 5th's disease arthralgias?
What is the treatment for arthralgias with 5th's disease?
Symptomatic only--is self limited
What is the treatment for OA?
-Total knee replacement (maybe)
The treatment for SLE is largely dependent on what?
Internal organ involvement