Clinical Classification Flashcards
(22 cards)
What is the culprit for causing lyme disease?
- Borrelia burgdorferi carried by the ixodes scapularis deer tick.
How do we classify rheumatic diseases?
- MONOARTICULAR= 1 joint (crystal or infection induced)
- POLYARTICULAR= 5 or more joints (connective tissue diseases or seronegative spondyloarthropathy).
- NON-ARTICULAR= fibromyalgia
- ENDOCRINE and METABOLIC
- DEGENERATIVE= osteoarthritis
- METABOLIC
What is the most common cause of septic arthritis (monarticular)?
- Staph aureus
What is seronegative spondyloarthropathy (polyarticular)?
- seronegative rheumatoid factor negative (aka it doesn’t show up in blood)= predilection for inflammation of the spine.
What is the most common NONinflammatory arthritis seen in the U.S.?
- osteoarthritis (degenerative joint disease; DJD)
How do we approach a pt with joint pain?
- Hx= ask “how long are your joints stiff in the morning?”
- PE
- Labs
- x-ray
- tissue diagnosis
What is the most common INFLAMMATORY arthritis seen in the U.S.?
- gout (monoarticular)
How does RA differ from OA (DJD)?
- morning stiffness= much longer in RA vs. maybe only 30 mins for OA.
- Age of onset= 25-40 for RA vs. older than 40 for OA.
- symmetry= RA (symmetry bilateral), OA (asymmetric)
- constitutional symptoms= RA (yes), OA (no systemic component)
What does oligoarticular mean?
- 2-4 joints involved
What is important to know about gonococcal dermatitis-arthritis syndrome?
- infection with Neisseria gonorrhoeae causing the classic triad of dermatitis, tenosynovitis, and migratory polyarthritis
What is the difference between arthralgia and arthritis?
- arthralgia= symptom (complaint of pain in and around the joints).
- arthritis= sign (objective evidence of a joint abnormality).
What are the rheumatology terms for heat, redness, swelling, pain, and loss of function, respectively?
- heat= warmth
- redness= erythema
- swelling= joint effusion
- pain= pain/dolar
- loss of function= flexion contracture or ankylosis
What do we call swelling of the joints?
- synovitis or synovial proliferation (often MCPs; metacarpophalangeal joints in RA)
Inflammation of the first carpometacarpal joint?
- osteoarthritis
Are swan neck deformities specific to RA?
- NO bc they can be seen in lupus, psoriatic arthritis, and reactive arthritis.
What are the 6 lab screening tests for connective tissue diseases?
- CBC
- UA
- CMP
- ANA (sensitive to SLE; not specific)
- RA-Latex
- ESR (nonspecific marker of inflammation in the blood).
** What is the difference between sensitivity and specificity?
- seNsitivity= few false Negatives (100 lupus pts in a room; 90 female, 10 male. You would expect 98% of these pts to have a positive ANA; aka good screening test.
- sPecificity= few false Positives (if they have the antibody they have the disease; for lupus the best specific test is anti-smith antibody). However, it is not sensitive, bc this antibody is only found in 30% of lupus pts. So, we don’t use it to screen, bc we would be missing 70% of pts with lupus.
** RULE OF THUMB in RHEUMATOLOGY: If your pt has a joint effusion, and you do NOT yet have a diagnosis, what should you do?
- aspirate the joint and do a synovial fluid analysis.
What will you have in a synovial fluid analysis?
- WBC count
- culture
- crystal
- glucose (low= infection)
What is the radiographic hallmark of RA?
- erosion (looks like someone took a bite out of the bone).
What is the most common organism in septic bursitis?
- Staph aureus
What are the types of MONOarticular arthritis?
- gout
- pseudogout
- septic arthritis
- traumatic arthritis
- mechanical derangement
- bursitis/tendinitis
