articles Flashcards
1
Q
predisposing factors for sepsis in unusual joints
A
(eg: sternoclavicular joint)
- IV drug use
- large vein catheterization
2
Q
most common type of nontraumatic acute monoarthritis in young, sexually active people in the US
A
- gonococcal arthritis (3-4 x more common in women than men)
3
Q
nongonocococal septic arthritis
A
- most destructive type of septic arthritis
- generally monoarticular (most often knees)
- S. aureus most common, also non group A beta hemolytic strep, gram negative, and S. pneuomoniae
(anaerobic and gram neg more common in IC people)
4
Q
common cause of inflammation of a single large joint?
A
Lyme disease (mycobaterial, fungal and viral infections are rare)
5
Q
what kinds of crystals can elicit acute monoarthritis?
A
- monosodium urate (gout)
- calcium pyrophosphate dihydrate (CPPD, pseudogout)
also: - calcium oxalate (renal dialysis)
- apatite
- lipid crystals
6
Q
risk factors for spontaneous osteonecrosis
A
alcoholism
chronic corticosteroid use
7
Q
clue: sudden onset of pain in seconds or minutes
A
potential dx: fracture, internal derangement, trauma, loose body
8
Q
clue: onset of pain over several hours or one to two days
A
potential dx: infection, crystal deposition disease, other inflammatory arthritic condition
9
Q
clue: insidious onset of pain over days to weeks
A
potential dx: indolent infection, osteoarthritis, infiltrative disease, tumor
10
Q
clue: IV drug use, immunosuppression
A
potential dx: septi arthritis
11
Q
clue: previous acute attacks in any joint, with spontaneous resolution
A
potential dx: crystal deposition disease, other inflammatory arthritic condition
12
Q
recent prolonged course of corticosteroids
A
potential dx: infection, avascular necrosis
13
Q
clue: coagulopathy, use of anticoagulants
A
potential dx: hemarthrosis
14
Q
clue: urethritis, conjunctivitis, diarrhea, and rash
A
potential dx: reactive arthritis
15
Q
clue: psoriatic patches or nail changes such as potting
A
potential dx: psoriatic arthritis
16
Q
clue: use of diuretics, presence of tophi, history of renal stones or alcoholic binges
A
potential dx: gout
17
Q
clue: eye inflammation, low back pain
A
potential dx: ankylosing spondylitis
18
Q
clue: young adulthood, migratory polarthralgias, inflammation of the tendon sheaths of hands and feet, dermatitis
A
potential dx: gonococcal arthritis
19
Q
clue: hilar adenopathy, erythema nodosum
A
potential dx: sarcoidosis
20
Q
bulge sign
A
- the medial or lateral compartment is stroked and the fluid moves through the suprapatellar area into the opposite compartment, resulting in a visible bulge (indicates small effusion)
21
Q
types of noninflammatory arthritis
A
( less than 2000 WBC)
- osteoarthritis, trauma, avascular necrosis, Charcot’s arthropathy, hemochromatosis, pigmented villonodular synovitis
22
Q
types of inflammatory arthritis
A
( >2000 WBC)
- septic arthritis (>90% PMNs), crystal-induced monoarthritis (gout, pseudogout), RA, spondyloarthropathy, SLE, juvenile RA, lyme,
23
Q
can crystals be present in a septic joint?
A
yes
24
Q
is fever helpful in distinguishing infectious arthritis from others?
A
fever may be absent in patients with infectious monoarthritis but can be a presenting feature in acute attacks of gout or pseudogout
- fever may occur for other reasons in certain patients (eg: the IC)
25
does a normal serum uric acid level make gout less likely?
no, serum uric acid levels often are lowered in patents with acute gout
- conversely, there may be unrelated hyperuricemia in patients with other conditions
26
are gram staining and culture of synovial fluid sufficient to exclude infection?
no, cultures of blood, urine or another primary site of infection (eg: abscess) must be obtained and repeated as necessary if infection is strongly suspected clinically.
- culture results may be negative in early infection
27
definition of polyarticular joint pain
pain in more than 4 joints
28
differential diagnosis of polyarticular joint pain (general)
viral infection, indirect bacterial infection (reactive arthritis), direct bacterial infection, other infections, crystal-induced synovitis, systemic rheumatic disease, systemic vasculitis disease, spondyloarthropathies, endocrine disorders, malinancy
29
types of polyarticular joint pain that can cause viral infection
parovirus b19, enterovirus, adenovirus, epstein-barr, coxsackievirus, cytomegalovirus, rubella, mumps, hep B, VZV, HIV
30
types of indirect bacterial infections that can cause polyarticular joint pain
eg: reactive arthritis
| gonorrhea, bacterial endocarditis, campylobacter, chlamydia, salmonella, shigella, yersinia, whipple's, group A strep
31
types of direct bacterial infections that can cause polyarticular joint pain
gonorrhea, s. aureus, gram negative bacilli, bacterial endocarditis
32
other types of infections that can cause polyarticular joint pain
lyme (borrelia burgdorferi), tuberculosis, fungi
33
crystal-induced synovitis that can cause polyarticular joint pain
gout, pseudogout, hydroxyapatite
34
types of systemic rheumatic disease that can cause polyarticular joint pain
rheumatoid arthritis, SLE, polymyositis/dermatomyositis, juvenile RA, scleroderma, Sjogren's, Behcet's, polymyalgia rheumatica
35
types of systemic vasculitis disease that can cause polyarticular joint pain
schlonlein-henoch purpura, hypersensitivity vasculitis, polyarteritis nodosa, Wegener's granulomatosis, giant cell arteritis
36
types of spondyloarthropathies that can cause polyarticular joint pain
ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease, reactive arthritis
37
types of endocrine disorders that can cause polyarticular joint pain
hyperparathyroidism, hyperthyroidism, hypothyroidism
38
types of malignancies that can cause polyarticular joint pain
metastatic cancer, multiple myeloma
39
other types of diseases that can cause polyarticular joint pain
osteoarthritis, hyperrmobility syndromes, sarcoidosis, fibromyalgia, osteomalacia, sweet's syndrome, serum sickness
40
parvovirus b19 polyarticular infection
| chronology, inflammation, distribution, other signs, gender ratio
```
acute
yes
small joints, symmetrical, no axial involvement
lacy rash, malar rash
3:1 (F:M)
```
41
rheumatoid arthritis
| chronology, inflammation, distribution, other signs, ratio
chronic
yes
small and large joints, symmetrical, cervical axial involvement
subcutaneous nodules, carpal tunnel syndrome
3:1
42
SLE
| chronology, inflammation, distribution, other signs, ratio
chronic
yes
small joints, symmetrical, no axial involvement
malar rash, oral ulcers, serositis (pleuritis or pericarditis)
9:1
43
osteoarthritis
| chronology, inflammation, distribution, other signs, ratio
```
chronic
no
lower extremity joints, proximal and distal IP joints, first carpometacarpal joint, sometimes symmetrical, cervical and lumbar involvement
none
1:1
```
44
fibromyalgia
| chronology, inflammation, distribution, other signs, ratio
chronic
no
diffuse pattern, symmetrical, axial involvement
myalgias, tender points, irritable bowel syndrome
9:1
45
ankylosing spondylitis
| chronology, inflammation, distribution, other signs, ratio
```
chronic
yes
large joints, symmetrical, axial involvement
iritis, tendonitis, aortic insuficiency
1:1 to 1:5
```
46
psoriatic arthritis
| chronology, inflammation, distribution, other signs, ratio
chronic
inflammation
large and small joints, sometimes symmetrical + axial involvement
psoriasis, dactylitis (sausage digits), tendonitis, onychodystrophy
1:1
47
arthritis vs arthralgia
```
arthritis = joint pain w/ inflammation
arthralgia = joint pain w/o inflammation
```
48
signs of inflammation
erythema, warmth, pain and swelling
fatigue, weight loss, fever
morning stiffness lasting longer than 1 hr
49
reticulated (lacy) rash, facial exanthem (slapped cheek)
parvovirus B19
50
malar rash
SLE, parvo b19, lyme, rosacea, seborrhea, dermatomyositis
51
plaques (scalp, navel, gluteal cleft)
psoriasis
52
heliotrope
dermatomyositis
53
erythema chronicum migrans
lyme
54
erythema marginatum rheumaticum
rheumatic fever
55
erythema nodosum
sarcoidosis, Crohns
56
pyoderma gangrenosum
IBD, RA, SLE, ankylosing spondylitis, sarcoidosis, Wegener's granulomatosis
57
palpable purpura
hypersensitivity vasculitis, Schonlein-Henoch purpura, PAN
58
livedo reticularis
antiphospholipidd antibody syndrome, vasculitis, cholesterol emboli
59
keratoderma blennorrhagicum
reactive arthritis, psoriatic arthritis
60
discoid skin lesions
discoid lupus, SLE, sarcoidosis
61
Gottron's papules or plaques
dermatomyositis
62
vesicopustule on erythematous base
gonococcal arthritis
63
iritis or uveitis
spondyloarthropathies, sarcoidosis, Wegener's
64
conjunctivitis
spondyloarthropathies, SLE, Wegener's
65
cytoid bodies (retinal exudates)
SLE
66
scleritis
RA, relapsing polychondritis
67
ischemic optic neuritis
GCA, Wegener's
68
oral ulcers
SLE, Behcet's, reactive arthritis, Wegener's
69
parotid enlargement
Sjogrens, sarcoidosis
70
macroglossia
amyloidosis
71
scalp tenderness
GCA
72
bloody or severe sinusitis
Wegener's
73
inflammation of ear lobe
relapsing polychondirits
74
onycholysis
psoriatic arthritis, hyperthyroidism
75
pitting nails
psoriatic arthritis
76
nail clubbing
IBD, whipple's, hyperthyroidism
77
nodules
RA, gout, whipple's, rheumatic fever, amyloidosis, sarcoidosis
78
tophi
gout
79
jaundice
hepatitis, hemochromatosis
80
hyperpigmentation
whipple's, hemochromatosis
81
telangiectasia
scleroderma
82
thickened skin
scleroderma, amyloidosis, eosinophilic fasciitis
83
hair thinning
hypothyroidism, SLE
84
tender points
fibromyalgia
85
tender points
fibromyalgia
86
heberden's nodes
DIP joints
| OA
87
Bouchard's nodes
PIP joints
| OA
88
Boutonniere and swan-neck deformities
RA SLE, Ehlers-Danlos
89
dactylitis
spondyloarthropathies
90
bursitis and enthesitis
spondyloarthropathies
91
mitral regurg and stenosis
rheumatic fever
92
aortic regurg
anklosing spondylitis, rheumatic fever, relapsing polychondritis, reactive arthritis, Marfan syndrome, Takayasu's arteritis
93
cardiomyopathies
viral infection, amyloidosis, sarcoidosis, SLE, polymyositis
94
new murmur, fever
bacterial endocarditis, rheumatic fever
95
diminished peripheral pulses
GCA, Takayasu's arteritis
96
hepatomegaly
whipple's, hemochromatosis, amyloidosis, Wilson's
97
positive fecal occult blood test
IBD
98
prostatitis
reactive arthritis, ankylosing spondylitis
99
urethritis or cervicitis
reactive arthritis, gonococcal arthritis
100
scrotal or vulvar ulcers
Behcet's
101
hypogonadism
hemochromatosis
102
balanitis circinata
reactive arthritis
103
entrapment neuropathies
RA, hypothyroidism, hyperparathyroidism
104
facial palsy
lyme
105
peripheral neuropathy
SLE, amyloidosis
106
chorea
antiphospholipid antibody syndrome, SL, rheumatic fever
107
mononeuritis multiplex
RA, SLE, lyme, vasculitis
108
seizures
SLE
109
most important risk factors for septic arthritis
- prosthetic hip or knee joint
- skin infection
- joint surgery
- rheumatoid arthritis
- age >80 yrs
- diabetes mellitus
110
examples of large vessel vasculitis
takayasu arteritis
| giant cell arteritis
111
examples of medium vessel vasculitis
polyarteritis nodosa
| kawasaki disease
112
examples of ANCA-associated small vessel vasculitis
microscopic polyangiitis
granulomatosis with polyangitis (wegener's)
eosinophilic granulomatosis (churg-strauss)
113
examples of immune complex small vessel vasculitis
cryoglobulinemia vasculitis
IgA vasculitis (Henoch-Schonlein)
hypocomplemenemic urticarial vasculitis (anti-C1q vasculitis)
anti-GBM disease
114
examples of variable vessel vasculitis
Behcet's disease
| Cogan's syndrome
115
examples of vasculitis associated w/ systemic disease
lupus vasculitis
rheumatoid vasculitis
sarcoid vasculitis
116
Takayasu arteritis
often granulomatous
affects aorta and/or major branches
onset usually
117
GCA
```
often granulomatous
affects aorta/or major branches, usually carotid and vertebral arteries
often involves temporal artery
onset usually >50 yrs
often ass. w/ polymyalgia rheumatica
```
118
polyarteritis nodosa
necrotizing arterities of medium or small arteries w/o glomerulonephritis. not ass/ with ANCA
119
Kawasaki disease
arteritis ass. w/ mucocutaneous LN syndrome and predominately affecting medium and small arteries.
coronary arteries often involved.
usually affects children
120
ANCA-associated vasculitis
necrotizing vasculitis affecting small vessels.
| ass. w/ MPO, ANCA or proteinase 3
121
microscopic polyangiitis
necrotizing vasculitis affecting small vessels.
necrotizing glomerulonephritis very common
pulmonary capillaritis often occurs
122
granulomatosis w/ polyangiitis (wegener's, GPA)
necrotizing granulomatous inflammation usually involving upper + lower resp tract (small vessels)
necrotizing glomerulonephritis is common
123
eosinophilic granulomatosis w/ polyangiitis (Churg Strauss)
eosinophil-rich and necrotizing granulomatous inflammation often involving resp tract
ass. w/ asthma and eosinophilia
ANCA more frequent when glomerulonephritis is present
124
immune complex vasculitis
small vessels
| glomerulonephritis is frequent
125
anti-glomerular basement membrane disease
affects glomerular capillaries (glomerulonephritis) and pulmonary capillaries (pulmonary hemorrhage)
126
cryoglobulinemic vasculitis
ass. w/ serum cryoglobulins
| skin, glomeruli and peripheral nerves often involved
127
IgA vasculitis (henoch-schonlein)
small vessels
often involves skin and GI tract
often causes arthritis
128
hypocomplementemic urticarial vasculitis (anti-C1Q vasculitis)
urticaria, hypocomplementemia
| glomerulonephritis, arthritis, obstructive pulmonary disease and ocular inflammation are common
129
Behcet's disease
recurrent oral and/or genital aphthous ulcers, w/ cutaneous, ocular, articular, GI and/or CNS inflammatory lesions
130
Cogan's syndrome
ocular inflammatory lesions (interstitial keratitis, uveitis, episcleritis), and inner ear disease (sensorineural hearing loss, vestibular dysfunction)
vasculitic signs: arteritis, aortitis, aortic aneurysms, and aortic and mitral valvulitis
