Arthritis and Rheumatic Diseases Flashcards
(66 cards)
1
Q
osteoarthritis is inflammatory or degenerative
A
degenerative
2
Q
risk factors for OA
A
>50 yo joint injury obesity contact sport stress/job hereditary
3
Q
pathophys of OA
A
worn articular cartilage + bone
thickening of synovium
osteophytes at articular edges
mild inflammation of joint capsule and ligaments
4
Q
mild, dull aching pain in joint
pain worse with activity + damp/cold weather, improves with rest
stiffness with inactivity, improves after 15 min of exercise
morning stiffness
A
OA symptoms
5
Q
DIP joints and PIP joints
weight bearing: hip, knees, spine
A
OA pattern
6
Q
PIP joints and MCP joints
symmetric pattern of small joints
A
RA pattern
7
Q
30-50 yo F>M chronic with acute flare-ups morning stiffness lasts 45-60 minutes systemic features inflammatory features
A
RA symptoms
8
Q
fever + chills + one joint
A
septic arthritis
9
Q
weight loss
A
mets to bone
RA
SLE
10
Q
HA + loss of vision + scalp tenderness + jaw claudication
A
temporal arteritis (giant cell)
11
Q
skin and/or nail changes
A
psoriasis scleroderma SLE Reiter syndrome Lyme disease (erythema migrans)
12
Q
multiorgan system signs + symptoms
A
SLE
collagen vascular disorder
13
Q
cutaneous/subq nodules
A
gout
RA
14
Q
conjunctivits
uveitis
dry eyes
A
RA
sjogren syndrome
Reiter syndrome
15
Q
chest pain + cough + SOB
A
RA
SLE
16
Q
diarrhea + ab pain
A
slceroderma
RA
reactive arthritis
arthritis of IBD
17
Q
dsyuria + urethra discharge
A
reactive arthritis
18
Q
crepitus: cracking heard or felt with movement of joint
A
OA
19
Q
effusion (soft swelling) of large joint with redness/warmth (inflammation) bone spurs (hard swelling)
A
OA
20
Q
disc degeneration
ostephytes (bone spurs) of facet joints can compress spinal nerve roots (weakness and sensory loss)
can lead to spinal stenosis (symptoms may mimic claudication)
A
OA
21
Q
diagnostic test for reactive arthritis
A
HLA-B27
22
Q
diagnostic test for anklylosing spondylitis
A
HLA-B27
23
Q
diagnostic test for RA
A
rheumatoid factor
ANA
24
Q
diagnostic test for SLE, sjogren syndrome, scleroderma
A
ANA
25
do you need xray to make diagnosis of OA
no
26
treatment of OA
twice-daily exercise, low impact aerobic exercise
exercise muscle group that support affect joints: quads for knees, ab muscles for lumbar spine
if obese: weight loss before surgery
pain: NSAID, topical capsaicin cream, intraarticular hyaluronate, IA steroid injection if effusion and inflammation of joint
27
synovial fluid:
PMN >95
positive culture or gram stain
WBC 50,000-100,000
septic arthritis
28
synovial fluid:
| pyrophosphate crystals
pseudogout
29
synovial fluid:
| urate crystals
gout
30
synovial fluid:
WBC 2,000-100,000
PMN >50
often xanthochromic
RA
31
synovial fluid:
WBC 2,000-15,000
PMN 50
acute rheumatic fever
32
osteopenia
subchondral bone cysts
joint surface erosions
RA
33
bone cysts
| punch out erosions on joint surface
gout
34
bilateral sacroiliitis
squaring of lumbar vertebrae
sclerosis of corners of vertebrae
joint fusion: bamboo spine
ankylosing spondylitis
35
```
joint space loss
osteophyte formation
cartilage calcification
cyst formation
subchondral sclerosis
```
OA
36
chronic inflammatory symmetric polyarthritis: *peripheral joints
* synovial membrane of joints - synovium forms pannus of granulomatous tissue that erodes cartilage, ligament, tendons, bone- most commonly affected
* these granulomas can form subq nodules (rheumatoid nodules) and cause vasculitis → peripheral neuropathy in legs/arms, cardiac arrhythmias, pericarditis, pleurisy, bowel, scleritis in eye
* nerve entrapement can cause peripheral neuropathy
* splenomegaly
RA
37
risk factors for RA
HLA-DR genetic susceptibility
| smoking
38
```
ulnar deviation
hammer fingers
boutonniere
swan neck
tendon rupture in extremities
flexion of toes
valgus (inward) of foot
fixed ankle joint
```
RA
39
RA associated with dry eyes, mouth
sjogren syndrome - 20% cases have this too
40
```
initially:
joint pain, swelling
early morning stiffness
myalgia
fatigue
low-grade fever
weight loss
```
RA
41
ACR criteria for RA
arthritis > 6 wks
+ RF
morning stiffness > 1 hr
one joint affected in wrist/MCP/PIP distribution
at least 3 joints in SYMMETRIC joint involvement: PIP, MCP, MTP
subq nodules or over bony points
hand/wrist xray shows erosions/decalcifications
42
ACR criteria for gout
```
monoarthritis
red over joint
first MTP involved or tarsal joint
tophus identified
hyperuricemia
urate crystals in joint fluid
subcortical cysts on xray
```
43
RA markers
RF: positive wks-mo after onset of RA, 25% with RA are seronegative
variable: ANA, ESR, CRP
44
RF + conditions
bacterial endocarditis
TB
sarcoidosis
malignancies
45
man > 40 yo with inflammatory arthritis
gout
46
risk factors for gout
> 40 yo
man
african american
genetic predisposition
47
MSU crystal deposition in and surrounding tissues of joints → local inflammation, necrosis, fibrosis, subchondral bone destruction
gout
48
defective metabolism of uric acid or
acquired hyperuricemia: multiple myeloma, polycythemia vera, chronic renal disease, psoriasis, alcoholism, thiazide or loop diuretic, cyclosporine, niacin
gout
49
```
+/- prodrome: arthralgia, fever, chills
acute attack, desquamation of skin over joint in few days
1-3 joints of fingers and/or toes
joint is swollen, red, tender, hot
#1: great toe
#2: knee, ankle
```
gout
50
urate deposits in soft and cartilaginous tissues of MTP joint, elbow, tendons of hands, ears
causes nodular swelling, may discharge white material
gout
51
hyperuricemia not specific to gout
```
renal diseae
blood disorders
lymphoma
diabetes
HTN
```
52
measurement of serum elevated urate 2 weeks or more after episode of acute arthritis can be diagnostic of
gout
53
definitive diagnosis of gout requires
MSU crystals in synovial fluid, needle-like
| tophus: negatively birefringent in polarized light, yellow
54
gout can be caused by foods
purine (block renal excretion of urate): seafood, red meat, alcohol: beer or liquor (not wine)
soft drinks
55
didn't go over
treatment of RA, gout
| soft tissue syndromes: fibromyalgia, somatic dysfunction, polymalgia rheumatica
56
red, hot joint + fever with extra-articular site of bacterial infection, think
septic arthritis
57
diagnosis of septic arthritis requires
arthrocentesis
58
risk factors for septic arthritis
```
diseased or prosthetic joint
>80 yo
DM
hemodialysis
immunocompromised
IVDU
```
59
causes of septic arthritis
s. aureus, s. pneumo
prosthetic joint: s. epidermidis
young, sexually active: N. gonorrhea
60
```
adult with polyarthritis +/- rash
symmetric joints - similar to RA distribution
morning stiffness
negative or low-titer RF
resolve spontaneously in 4-6 wks
```
parvovirus B19
61
lyme disease
early: bulls eye rash (erythema migrans)→ migratory polyarthritis, arthralgias
mo-yrs later: chronic monoarticular arthritis (knee most common)
62
diagnosis of lyme disease
enzyme-linked assay
| confirm: western blot
63
treatment of lyme disease
doxycycline if early disease - prevents progression and is curative
64
young men
HLA B27 positive or HIV +
arthritis following GI infection (shigella, salmonella, campylobacter) or GU (chlamydia)
reactive arthritis (reiter)
65
urethritis
conjunctivitis
arthritis (inflammation from immune complexes, asymmetric, oligo-articular of knee, ankle, small joint of LE)
papulosquamous rash - can coalesce to look like psoriasis
can't see, can't pee, can't climb a tree
reactive arthritis
66
synovial fluid
high inflammatory changes
negative culture results
reactive arthritis
