arthritis (needs reviewal)

Question 1

JIA/JRA (childhood arthritis)

Answer 1

juvenile idiopathic arthritis

Question 2

3 major subtypes

Answer 2

Systemic, oligoarticular, polyarticular

Question 3

all JIA symptoms include

Answer 3

joint pain, swelling, and inactivity stiffness
last at least 6 weeks
younger than 16

Question 4

systemic JIA etiology + epidemiology

Answer 4

idiopathic, autoimmune
least common

Question 5

systemic JIA presentation

Answer 5

fever - high spiking, intermittent fever
rash - salmon pink, axilla/around waist. worse with heat
arthritis - wrists, knee, ankles but also any joints
systemic - hepatospenomegaly, lymphandenopathy, serositis. uveitis is rare

Question 6

systemic JIA diagnosis

Answer 6

fever must be present for 2 weeks, arthritis for 6 weeks

Question 7

systemic JIA labs

Answer 7

leukocytosis, thrombocytosis, anemia, ESR and CRP elevation
ANA and RF always negative

Question 8

systemic JIA treatment

Answer 8

NSAIDs, oral glucocorticoids, DMARDS (nonbiologic or biologic), peds rheum referral

Question 9

DMARDS

Answer 9

suppress bodys overactive immune system
take weeks to months to become effective

Question 10

systemic JIA complications

Answer 10

destructive damage
macrophage activation syndrome
severe growth retardation

Question 11

oligoarticular JIA etiology + epidemiology

Answer 11

idiopathic, autoimmune
most common, F>M

Question 12

oligoarticular JIA presentaiton

Answer 12

arthritis - usually asymmetrical, large joints (knees, ankles, wrists, elbows)
limping w/o pain that improves throughout day

Question 13

oligoarticular JIA diagnosis

Answer 13

less than 5 joints during first 6 months

Question 14

oligoarticular JIA labs

Answer 14

ANA - might be positive
ESR - normal/mildly elevated

Question 15

oligoarticular JIA treatment

Answer 15

NSAIDs, glucocorticoids
regular eye exams

Question 16

oligoarticular JIA complications

Answer 16

uveitis - 20%
leg length discrepancy

Question 17

polyarticular JIA etiology + epidemiology

Answer 17

idiopathic, autoimmune
bimodal distribution (2-5, and 10-14)

Question 18

polyarticular JIA presentation

Answer 18

arthritis - symmetric
<10 years - 1-2 joints, epreads rapidly
older children - rapid onset in multiple joints

Question 19

polyarticular JIA diagnosis

Answer 19

arthritis in 4+ joints in first 6 months

Question 20

polyarticular JIA labs

Answer 20

ANA +, ESR elevtaed, mild anemia
+ RF in older than 10 maybe

Question 21

polyarticular JIA treatment

Answer 21

NSAIDs, DMARDS, oral glucocorticoids
eye exams if positive ANA

Question 22

polyarticular JIA complications

Answer 22

may cause destructive damage, uveitis, osteoporosis

Question 23

reactive arthritis

Answer 23

conjunctivitis, urethritis, arthritis
arthritis following an infection
seronegaitve

Question 24

seronegative

Answer 24

neg RF and ANA

Question 25

reactive arthritis etiology

Answer 25

GU or GI infections chlamydia trachomatis, campylobacter

Question 26

reactive arthritis presentation

Answer 26

arthritis, enthesitis, dactylitis, back pain extraarticular manifestations - conjunctivitis, urethritis

Question 27

reactive arthritis labs

Answer 27

HLA-B27 leukocytosis - maybe genital swab, stool cultures

Question 28

reactive arthritis treatments

Answer 28

NSAIDs, intraarticular glucocorticoid injections, ABX for chlamydia

Question 29

RA

Answer 29

chronic, systemic, inflammatory disease that involves joints

Question 30

RA etiology

Answer 30

unknown, autoimmune F 2-3 times more often

Question 31

RA presentation

Answer 31

morning stiffness 30-60 minutes symmetric joint swelling arthritis - peripheral joints. DIP joint spared

Question 32

RA symptoms

Answer 32

fatigure, weight loss, malaise, anemia, splenomegaly, sjogrens

Question 33

RA PE findings

Answer 33

tenderness to palpation, swelling, bogginess, decreased ROM, joint deformities

Question 34

common joint deformities RA

Answer 34

ulnar drift, swan neck, boutonneire, subcutaneous rheumatoid nodules on UE extensor surfaces, foot mirrors

Question 35

RA diagnosis criteria

Answer 35

inflammatory arthritis in 3 or more joints RF, anti-CCP, ESR, CRP elevation +ANA duration of sxs > 6 weeks

Question 36

RA imaging

Answer 36

joint erosions, displacement on xray

Question 37

RA treatment

Answer 37

refer to rheum education, PT/OT DMARDS, NSAIDs, glucocorticoids (PO or injection) consider surgery if advanced

Question 38

RA prognosis + complications

Answer 38

joint damage is irreversible if untreated - destruction

Question 39

OA risk factors

Answer 39

advanced age, obesity, female gender, occupation

Question 40

OA presentation

Answer 40

arthritis - pain, stiffness less than 30 min, weight bearing joints

Question 41

OA PE

Answer 41

tenderness to palpation along joint line bony enlargments decreased ROM crepitus joint deformities

Question 42

OA joint deformities

Answer 42

heberden and bouchard nodes bony enlargements of knees - varus/valgus

Question 43

OA diagnosis

Answer 43

clinical persistent joint pain age >45 morning stiffness <30min

Question 44

OA imaging

Answer 44

joint space narrowing, sclerosis of joint line, subchondral cysts, osteophytes

Question 45

OA lab findings

Answer 45

normal

Question 46

OA treatment

Answer 46

education, weight loss, exercise, PT/OT topical and oral NSAIDs, topical capsaicin, duloxetine, intra-atricular glucocorticoids surgical if failed conservative