Arthritis & Arthropathies

Question 1

Progressive and irreversible condition involving loss of articular cartilage that leads to pain and sometimes deformity.

• Degeneration of Cartilage and Hypertrophy of Bone at Articular Margin

Most Common form of Joint Disease

Answer 1

Osteoarthritis

Question 2

Symptoms of Osteoarthritis

Answer 2

Stiffness (rarely more than 15 minutes)
Pain with motion
Crepitus
Flexion contracture
Varus + Valgus
Heberden + Bouchard Nodes

Question 3

Osteoarthritis X-Ray Findings

Answer 3

Loss of Joint Space
Sclerosis
Subchondral Cysts
Osteophytes

Question 4

Osteoarthritis Treatment

Answer 4

Exercise
Weight Reduction
NSAIDs
Duloxetine

Question 5

Elevated levels of uric acid due to overproduction or under-excretion of the uric acid.

Excess monosodium urate crystals deposit in the tissue.

Answer 5

Gout

Question 6

Masses from uric acid crystal deposition with associated foreign body reaction.
- noted several years after the onset of gout

Answer 6

Tophi

Question 7

Symptoms of Gout

Answer 7

Sudden Onset
- Frequently Nocturnal
Fever

Metatarsophalageal Joint of Great Toe is Most Commonly affected
(Podagra)

Question 8

Disease caused by the precipitation of calcium pyrophosphate dehydrate crystals in connective tissues.

Knee is most affected.

Answer 8

Pseudo-gout

Question 9

What is the distinguishing characteristic between Pseduogout and Osteoarthritis?

Answer 9

No Bony Erosions in Pseduogout

Question 10

Negatively birefringent needle-shaped urate crystals

Answer 10

Gout

Question 11

Positive birefringent rhomboid-shaped crystals

Answer 11

Pseduogout

Question 12

Acute Gout Attack Treatment

Answer 12

NSAIDs
- Indomethacin

Colchicine
- if symptoms less than 36 hours

Interleukin 1 Inhibitors
- if hospitalized

Question 13

Gout Management - Between Attacks

Answer 13

Diet
- Avoid Alcohol
- Avoid Purines (Liver, Seafood, Yeast)
Avoid Thiazide and Loop Diuretics

Colchicine Prophylaxis
Allopurinol → decrease uric acid
Probenecid → increases uric acid excretion via urination

Question 14

Therapeutic and diagnostic treatment for pseduo-gout

Answer 14

Joint Aspiration

Question 15

What medication is given during acute attacks of pseudo-gout?

Answer 15

NSAIDs

Question 16

What medication is given within the first 24 hours of pseudo-gout for prophylaxis?

Answer 16

Colchicine

Question 17

Systemic autoimmune disorder characterized by acute and chronic inflammation in the synovium, causing proliferative and erosive joint changes.

Answer 17

Rheumatoid Arthritis

Question 18

Signs and Symptoms of Rheumatoid Arthritis

Answer 18

Symmetric pain
- Hands, Wrists, Knees and Feet and Ankles

Morning Stiffness for more than 30 minutes

Carpal Tunnel Syndrome is Common

Can Affect the Neck
- usually spares the rest of spine and SI joints.

Question 19

Major Exam finding of Rheumatoid Arthritis

Answer 19

Boggy Feeling in Swollen Joints
- synovial hypertrophy

Question 20

What is the most sensitive and specific blood test for Rheumatoid Arthritis?

Answer 20

anti-CCP
(anti-cyclic citrullinated peptides)

Question 21

What drug therapies are used to treat Rheumatoid Arthritis?

Answer 21

Steroids
DMARDS
- Methotrexate
- Sulfasalazine
- JAK inhibitors

Question 22

Seronegative Spondyloarthropathies

(PEAR - U)

Answer 22

Psoriatic Arthritis
Enteropathic Arthritis
Ankylosing Spondylitis
Reactive Arthritis
Undifferentiated Spondylarthropathy

Question 23

General Manifestations of Sero-negative Spondyloarthropathies

Answer 23

Male Predominance
Spine
SI Joints
Enthesopathy
Ocular Inflammation

Axial Skeleton Commonly Involved

HLA-B27 GENETIC MARKER
- 90% of pts. with Ankylosing Spondylitis

Question 24

Preceded by Psoriasis
- arthritis
- dactlylitis (sausage fingers)
- nail disorders

Answer 24

Psoriatic Arthritis

Question 25

X-Ray finding of Psoriatic Arthritis

Answer 25

Arthritis Mutilans PENCIL IN A CUP DEFORMITY

Question 26

Arthritis associated with: - Chron's Disease - Ulcerative Colitis

Answer 26

Enteropathic Arthritis

Question 27

What are the two distinct forms of Enteropathic Arthritis?

Answer 27

Peripheral Arthritis - oiligoarthritis of large joints (4 or fewer joints) - Joint disease parallels the bowel disease Spondylitis - indistinguishable from ankylosing spondylitis

Question 28

How do you treat Enteropathic Arthritis?

Answer 28

Controlling intestinal inflammation will eliminate peripheral arthritis

Question 29

Sero-negative spondyloarthropathy that primarily affects the axial skeleton and causes sacroiliitis and kyphosis. 90% have HLA-B27 Gene

Answer 29

Ankylosing Spondylitis

Question 30

Symptoms of Ankylosing Spondylitis

Answer 30

Morning Stiffness relieved by activity and leaning forward Limited spinal motion - progresses towards the head FABER maneuver stresses SI Joint

Question 31

X-Ray findings of Ankylosing Spondylitis

Answer 31

Bamboo Spine Shiny Corner Sign

Question 32

Acute Spondyloarthropathy precipitated by GI or GU Infection (especially STI)

Answer 32

Reactive Arthritis

Question 33

3 Major Symptoms of Reactive Arthritis

Answer 33

Can't See, Can't Pee, Can't Climb a Tree 1. Arthritis 2. Urethritis 3. Conjunctivitis + mucocutaneous lesions

Question 34

Psoriatic Arthritis Treatment

Answer 34

TNF inhibitor Methotrexate

Question 35

Enteropathic Arthritis Treatment

Answer 35

Control IBD - may add NSAID

Question 36

Ankylosing Spondylitis Treatment

Answer 36

NSAIDs TNF

Question 37

Reactive Arthritis Treatment

Answer 37

Methotrexate Sulfasalazine NSAIDs - may need to treat for Chlamydia