Arthritis and Rheumatic Diseases Flashcards Preview

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Flashcards in Arthritis and Rheumatic Diseases Deck (66):
1

osteoarthritis is inflammatory or degenerative

degenerative

2

risk factors for OA

>50 yo
joint injury
obesity
contact sport stress/job
hereditary

3

pathophys of OA

worn articular cartilage + bone
thickening of synovium
osteophytes at articular edges
mild inflammation of joint capsule and ligaments

4

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

OA symptoms

5

DIP joints and PIP joints
weight bearing: hip, knees, spine

OA pattern

6

PIP joints and MCP joints
symmetric pattern of small joints

RA pattern

7

30-50 yo
F>M
chronic with acute flare-ups
morning stiffness lasts 45-60 minutes
systemic features
inflammatory features

RA symptoms

8

fever + chills + one joint

septic arthritis

9

weight loss

mets to bone
RA
SLE

10

HA + loss of vision + scalp tenderness + jaw claudication

temporal arteritis (giant cell)

11

skin and/or nail changes

psoriasis
scleroderma
SLE
Reiter syndrome
Lyme disease (erythema migrans)

12

multiorgan system signs + symptoms

SLE
collagen vascular disorder

13

cutaneous/subq nodules

gout
RA

14

conjunctivits
uveitis
dry eyes

RA
sjogren syndrome
Reiter syndrome

15

chest pain + cough + SOB

RA
SLE

16

diarrhea + ab pain

slceroderma
RA
reactive arthritis
arthritis of IBD

17

dsyuria + urethra discharge

reactive arthritis

18

crepitus: cracking heard or felt with movement of joint

OA

19

effusion (soft swelling) of large joint with redness/warmth (inflammation)
bone spurs (hard swelling)

OA

20

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)

OA

21

diagnostic test for reactive arthritis

HLA-B27

22

diagnostic test for anklylosing spondylitis

HLA-B27

23

diagnostic test for RA

rheumatoid factor
ANA

24

diagnostic test for SLE, sjogren syndrome, scleroderma

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