Flashcards in Exam 1 -- Rheumatology #5 Deck (83):
What is another name for osteoarthritis?
Degenerative Joint Disease (DJD)
True or false: osteoarthritis is the most common type of arthritis
Which gender has a higher prevalence of osteoarthritis?
True or false: osteoarthritis is the second most common cause of diability
False; it is the most common cause of diability
Osteoarthritis is uncommon below what age?
Fact: Osteoarthritis is related to aging.
What are some risk factors for osteoarthritis?
Obesity, trauma, estrogen, smoking
Focal erosion of cartilage occurs in osteoarthritis, leading to bone rubbing on bone. What is the name for the bone overgrowth that occurs as the bone attempts to repair itself?
Osteoarthritis normally affects which joints?
Knees, hips, fingers, spine
Imbalances in which factors contribute to the degeneration of tissue in osteoarthritis?
MMPs, IL's, TNF-alpha, and VEGF all increase, IGF decreases
True or false: symptoms of osteoporosis improve with use and are worse with rest
False; symptoms are exacerbated by use and reduced by rest
What is the term for the crackling of joints that can sometimes be heard in a patient with osteoarthritis?
Which joints in the hand can become affected in osteoarthritis?
CMC (proximal joint of thumb) and DIP and PIP (two most distal joints of the other fingers)
What is the name for the bony spurs that can occur in the DIP joint?
What is the name for the bony spurs that can occur in the PIP joint?
What manifestation can osteoarthritis have in the feet?
Hallux valgus (big toe points toward second toe)
True or false: spinal stenosis (narrowing of spinal column) can occur in osteoarthritis
What is the name for the pockets of synovial fluid that can occur in the back of the knee in osteoarthritis?
What sort of testing might help distinguish osteoarthritis?
X-rays (for osteophytes), MRIs (for cartilage injury)
What are some non-medical treatment options for osteoarthritis?
Weight loss, light exercise, alternating heat and ice packs, massages
What are some medical treatment options for osteoarthritis?
Acetominophen (drug of choice), low-dose NSAIDs, topical capsaicin (for pain relief), corticosteroid injections, surgery
What is most commonly the first sign of osteoporosis?
Fragility fracture (usually in the spine)
What are some risk factors for osteoporosis?
Low estrogen, female, light weight, smoking, age (over 80 years)
Secondary osteoporosis can be caused by what conditions?
Corticosteroids, hyperthyroidism, hyperparathyroidism
A DEXA scan is one way to measure bone density. A score of how many standard deviations below the norm indicates osteoporosis?
What supplements can be taken to help with osteoporosis?
Calcium (1,000-1,200 extra mg per day) and Vitamin D (800 IU per day)
What lifestyle changes can be made to help with osteoporosis?
Exercise, smoking cessation, fall prevention, alcohol avoidance
What medications can be used for osteoporosis?
Bisphosphonates (ibandronate q1mo, aldendronate q1week), estrogen therapy (raloxifene)
Relapsing polychondritis is an autoimmune mediated inflammation of what type of tissue?
Relapsing polychondritis is associated with what conditions?
Vasculitis and arthritis
What effects can relapsing polychondritis have in the ears?
Cauliflower ear, floppy ear, hearing loss
What effects can relapsing polychondritis have in the nose?
What effects can relapsing polychondritis have in the eyes?
Episcleritis, scleritis, proptosis
What effects can relapsing polychondritis have in the lungs?
True or false: relapsing polychondritis can feature non-erosive joint pain
What percentage of relapsing polychondritis patients get valvular disease?
Which gender has a higher prevalence of relapsing polychondritis?
Neither; prevalence is equal between the genders
What is the general age of onset for relapsing polychondritis?
Greater than 40 years
Which ethnicity has a higher prevalence of relapsing polychondritis?
What is the 5-year survival rate for relapsing polychondritis?
65-75% (45% if systemic vasculitis involved)
What are the medical treatment options available for relapsing polychondritis?
NSAIDs, oral steroids, DMARDs, TNF inhibitors (cyclophosphamide reserved for severe cases)
What is the main difference between gout and pseudogout?
Gout has sodium urate crystals, pseudogout has calcium crystals
What is another name for pseudogout?
Calcium pyrophosphate deposition (CPPD)
Patients with what conditions have an increased risk of gout?
Psoriasis and psoriatic arthritis
What is the main characterizing symptom of gout?
Podagra (pain, redness, and swelling in big toe at MTP)
Podagra affects what percentage of gout patients?
True or false: the pain of podagra usually begins at night
Attacks of gout may be separated by what length of time?
In addition to elevated uric acid levels, what else must occur to trigger gout?
Trauma or inflammation
True or false: patients with gout have a lower risk of CVD
False; they have a higher risk of CVD
Which gender has a higher prevalence of gout?
What is the usual age of onset for gout?
True or false: Pacific Islanders have a higher prevalence of gout
What is the prevalence of gout in the U.S.?
What are some common causes of gout?
Purine foods*, high saturated fats, fructose in drinks, alcohol, obesity, trauma
What medications can cause an attack of gout?
Cyclosporine, aspirin, diuretics
True or false: diabetes and renal failure can induce attacks of gout
List the stages of gout:
Hyperuricemia, urate deposition, trauma/inflammation, podagra, chronic tophaceous gout
Serum uric acid raised to what level is indicative of gout?
Higher than 6.8 mg/dL
Joint aspiration shows what shape of cystals in gout?
Tophaceous gout is characterized by very high levels of uric acid, as well as tophi. What are tophi and where can they be found?
They are white deposits which can ulcerate. They form on the ears, fingers, and ankles.
Tophaceous gout is caused by what?
Inflammation adjacent to urate crystalsin synovium
Tophaceous gout is associated with what conditions or medications?
Renal impairment and long-term diuretic use
75% of untreated gout patients develop tophi after how many years?
Renal failure is very common gout patients who also have what other conditions?
Diabetes, CKD, HTN, obesity
Uric acid stones cause what percentage of kidney stones?
What sort of dietary restriction can help with gout?
Reduce alcohol, reduce calories and cholesterol, reduce soft drinks, reduce offal/organ meats, increase water intake
By what percentage can dietary restriction reduce serum uric acid?
What medical options are available in acute gout?
High dose NSAIDs (naproxen, diclofenac, indomethacin, but not aspirin; aspirin can induce gout); low-dose colchicine, oral or injected corticosteroids
What are some side effects of colchicine?
Kidney failure, liver failure, GI upset in 80%
What medical options are available in chronic gout?
Allopurinol (blocks synthesis of uric acid, decreases purine synthesis), febuxostat, probenecid (increases excretion and stop resorption of uric acid)
What are some side effects of allopurinol?
Skin rash, GI upset, can induce acute gout
Febuxostat plays the same type of role as allopurinol in treating gout. When would it be preferred to allopurinol?
If patient has kidney failure, since it is less toxic to the kidney
What are some side effects of febuxostat?
Cardiovascular risk factors
What is a side effect of probenecid?
Which gender has a higher prevalence of pseudogout?
Which joints are affected in pseudogout
Knee*, elbow, ankle
What is the typical age of onset for pseudogout?
Above 65 years
True or false: pseudogout is more painful than gout
False; it is less painful
What can cause pseudogout?
Trauma or increased iron uptake
What testing can be done to test for pseudogout?
X-ray (to see calcium deposits), synovial fluid analysis (looking for calcium pyrophosphate)
Pseudogout crystals have what shape?
Triangular or rhomboid