Exam 6 arthridities Flashcards Preview

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Flashcards in Exam 6 arthridities Deck (92):
1

What is a type of non-inflammatory arthritis?

Osteoarthrits

2

What are the inflammatory arthridities?

Rheumatoid arthritis, Juvenile idiopathic arthritis, System lupus erythematosus, Crystal induced arthritis, sponydloarthropathies (ankylosing spondy, psoriatic, reactive)

3

What is the distribution of osteoarthritis?

Knees, hips, spine (cervical and lumbar), hands (DIP, PIP), feet (first metatarsophalangeal)

4

How does osteoarthritis advance?

progressive loss of articular cartilage

5

What is the clinical presentation of osteoarthritis?

>50 yo, Gradual onset, initially intermittent and self-limited, Use-related pain (knees and hips worse w/ weight bearing, hands worse w/ over use), Relieved by rest, morning stiffness less than 30 mins

6

What are risk factors for osteoarthritis?

Increasing age, major joint trauma, obesity (knees), repetitive activities, genetic predisposition, congenital/developmental defects, females

7

What is most common arthritis?

Osteoarthritis

8

What arthritis do you think when you hear "bone on bone"?

Osteoarthritis

9

How long is the stiffness for osteoarthritis?

only 30 minutes

10

What does the physical exam of osteoarthritis look like?

Localized pain, limited ROM, bony enlargement, soft tissue swelling

11

T/F: Osteoarthritis patients have heat in their affect joints?

False

12

What are x-rays of osteoarthritis?

new bone formation in subchondral trebeculae, osteophyte formation at joint margins, loss of cartilage

13

How do you treat osteoarthritis (non-drug treatments)?

Weight reduction, exercise helps a lot, physical therapy for ROM, assistive devices, joint replacement

14

What are the drugs to treat osteoarthritis?

Acetaminophen, NSAIDs, alagesics, some topical agents, joint injections, hyaluronic derivative injections

15

When is the onset of rheumatoid arthritis?

30-50 years old

16

T/F: more women have rheumatoid arthritis than men?

True, 3:1

17

what are the risk factors of rheumatoid arthritis?

smoking, periodontal disease

18

What does rheumatoid arthritis present as?

symmetric inflammation (insidious and erosive), chronic and progressive, positive rheumatoid factor, positive anti-CCP Ab, systemic factors

19

What are some extra-articular manifestations of rheumatoid arthritis?

subcutaneous nodes, pericarditis, pulmonary nodules, interstitial fibrosis, inflammatory eye disease, vasculitis

20

T/F: stiffness of rheumatoid arthritis in the AM lasts longer than osteoarthritis?

True, lasts at least 1 hour

21

What is the classification criteria of rheumatoid arthritis?

Morning stiffness for 1 hour, swelling in 3+ joints, swelling in hands, symmetric joint swelling, erosions/decalcification of hand on x-ray, rheumatoid nodules, + rheumatoid factor

22

What joints are affected by rheumatoid arthritis?

Wrists, MCP, PIP, MTP, ankles, knees, elbows, shoulders

23

What are the treatments of rheumatoid arthritis?

patient education, PT/OT, exercise/rest, medications (NSAIDs, steroids, DMARD's (disease modifying anti-rheumatic drugs))

24

What are some DMARD options for rheumatoid arthritis pts?

Hydroxychloroquine, minocycline, gold, slfasalazine, TNF-blockers, B-cell blockers, T-cell costimulators, anti-interleukins

25

What are differential subtypes of juvenile idiopathic arthritis?

systemic onset, polyarticular onset, pauciarticular onset

26

When is the onset of juvenile idiopathic arthritis?

typically 1-6 years old

27

What are systemic features of juvenile idiopathic arthritis systemic onset?

lymphadenopathy, hepatosplenomegaly, pericardial/pleural effusions, fatigue, muscle atrophy, weight loss, leukocytosis, anemia

28

T/F: juvenile idiopathic arthritis polyarticular onset can be divided into rheumatoid factor positive/negative individuals?

true (mostly RF-negative)

29

What is the clinical feature of juvenile idiopathic arthritis polyarticular onset?

malaise, weight loss, low grade fever, lympadenopathy, anemia

30

T/F: juvenile idiopathic arthritis oligoarticular/pauciarticular onset has a positive ANA?

True

31

What joints does juvenile idiopathic arthritis oligoarticular/pauciarticular onset affect?

knees, ankles, wrists, elbows

32

What are the subgroups of juvenile idiopathic arthritis oligoarticular/pauciarticular onset?

Psoriatic (nail pitting, dactylitis, sacroiliitis), Enthesitis-related JIA (Negative RF and ANA, older than 6 males, Positive HLA-B27, ocular inflammation, sacroiliitis), Undifferentiated

33

What is the treatment of juvenile idiopathic arthritis oligoarticular/pauciarticular onset?

Pt/parent education, PT/OT, NSAIDs, Steroids (intra-articular/oral), DMARDS (methotrexate, sulfasalazine, leflunomide), Biological DMARDS (anti-TNF, anti-IL-1)

34

What is systemic lupus erythematosus?

autoimmune disease with ANA

35

T/F: systemic lupus erythematosus affects more females than males?

True

36

What are clinical features of systemic lupus erythematosus?

Butterfly rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, POSITIVE ANA

37

What are the genetic links of systemic lupus erythematosus?

most cases are sporadic, strong familial aggregation, can strong link in twins (especially monozygotic)

38

What is the treatment of systemic lupus erythematosus?

NSAIDs, corticosteroids, antimalarials (hydroxychloroquine), methotrexate, leflunomide, cyclophosphamide, dapsone, sunscreen

39

What are the clinical presentations of drug-induced SLE?

fever, malaise, arthritis/arthalgias, serositis, rash

40

What is the therapy for drug-induced SLE?

stop the medication

41

What medications is drug-induced SLE associated with?

procainamide, hydralazine, methyldopa, chlorpromazine, isoniazid, quinidine, minocycline

42

What are the two forms of crystal-induced arthritis?

Gout (uric acid), pseudogout (calcium pyrophsophate deposition)

43

What does gout cause when it deposits in the joints, skin and kidneys?

Joints: acute imflammatory arthritis, Skin: accumulation of crystals (tophi), Kidney: uric acid urolithiasis, nephropathy

44

What are the stages of gout?

asymptomatic hyperuricemia, acute intermittent gout, chronic tophaceous gout

45

What are the causes of gout

Uric acid overproduction (HGRT, PRPP synthetase overacticity, psoriasis, alcohol), Uric acid underexcretion (90%) (hypertension, obesity, lead, low dose aspirin)

46

What does acute intermittent gout usually start?

between fourth and sixth decade of life

47

T/F: women have a later onset of acute intermittent gout?

True (after menopause)

48

What is the clinical story or a pt with acute gouty arthritis?

Often occurs at night, pain escalates very highly in 8-10 hours, may subside in 3-10 days, fever, chills, malaise

49

What structures are involved in acute gouty arthritis?

Pariarticular structure (bursa, tendons), Joints

50

Where does acute gouty arthritis affect individuals?

Lower extremeties (podagra first MTP), usually monoarticular but may be polyarticular, can involve other MTPs, midfoot, ankles, wrist, fingers

51

How do you diagnose gout?

Serum uric acid levels (not often specific enough for an acute attack), HISTORY AND PHYSICAL for clinical manifestations. SYNOVIAL FLUID ANALYSIS IS GOLD STANDARD

52

What is the cut off of leukocytes when you are looking at a joint effusion for non-inflammatory and inflammatory joints?

2000

53

What are triggering factors of gout?

Alcohol ingestion, trauma, sever illness, IV hydration, Medications (thiazide diuretics, low dose aspirin, cyclosporine), Dietary excess (high purine foods like red meat), IV contrast dye

54

What can advanced gout lead to?

Chronic arthritis leading to joint destruction that is polyarticular (both upper and lower extremities)

55

What are tophi?

Solid uric acid deposits (white chalky material) that are a result of advanced gout

56

How do you decrease the levels of uric acid in a patient to prevent the formation of tophi?

xanthine oxidase inhibitor

57

Where are tophi usually found?

helix of ear, periarticular regions (fingers, wrist, olecranon bursa)

58

What are the pearls of Gout arthritis?

can have NORMAL uric acid levels, hyperuricemia results from diuretic therapy, allopurinol is NOT appropriate initial therapy during acute attack of gout, try to keep uric acids levels below 6

59

What should acute gout be treated with (pharma)?

NSAIDs and steroids

60

Should you treat acute gout with allopurinol?

NO

61

What is the treatment of gout?

Aspiration of joint/analysis of fluid, dietary counseling (alcohol and obesity), NSAIDs, colchicine, allopurinol, glucocorticoids, analgesics

62

Where do you find calcium pyrophosphate dihydrate?

Psuedogout patients

63

What can pseudogout be confused with?

gout, OA, RA

64

If a person is 95 years old, are they most likely to have gout or pseudogout?

pseudogout

65

Where is pseudogout most likely to affect patients?

knees (most common), wrists, hips, shoulders, ankles

66

What will x-rays of a pseudogout joint show?

chondrocalcinosis (wrist, knees, symphisis pubis)

67

What is the largest risk factor for pseudogout?

aging

68

What is pseudogout associated with?

hyperparathyroidism, hemochromatosis, hypothyroidism, prior trauma

69

T/F: Gout has more men than women, while pseudogout has more women than men?

False, Gout: Men>>Women, psuedogout men=women

70

What joints is gout most likely to affect?

1st MTP, instep, ankles, knees

71

Does gout and pseudogout have renal complications?

only gout does

72

What is the differences of x-ray for gout and pseudogout?

Gout: soft tissue swelling/erosions, pseudogout: chondrocalcinosis, osteoarthritis

73

What are the treatments (pharma) for pseudogout?

NSAIDs, colchicine is kinda effective, not preventative drug, intra-articular steroids

74

What are spondyloarthropathies?

Multisystem inflammatory disorder

75

What do spondyloarthropathies usually affect?

spine, sacroiliitis, peripheral joints, periarticular structures

76

T/F: spondyloarthropathies are HLA B27 positive?

true

77

What are non-vertebral symptoms of spondyloarthropathies?

Plantar fasciitis, inflammatory eye disease, mucocutaneous lesions, asymmetric peripheral arthritis, sausage digits, achilles tenosynovitis

78

What are subcatagories of spondyloarthropathies?

ankylosing spondylitis, psoriatic arthritis, reactive arthritis (Reiter's syndrome), arthritis associated with inflammatory bowel disease

79

What disease are associated with HLA B27 positive gene?

ankylosing spondylitis (90%), Reactive arthritis (Reiter's sydrome) (85%), Psoriatic arthritis (spondylitis, peripheral arthritis), Inflammatory bowel disease (50%)

80

What is ankylosing spondylitis?

NOT mechanical back pain, inflammatory back pain

81

What does ankylosing spondylitis present with?

Back pain with onset before 40, gradual pain that progresses, indidious, >3 mos, Morning stiffness, pain decreases with exercise

82

What other arthritises/problems does ankylosing spondylitis present with?

Axial arthritis, sacroiliitis, peripheral arthritis (swollen knee/foot), aortitis, cardiac arrhythmias

83

What joints does psoriatic arthritis affect?

Peripheral arthritis at DIP joints

84

What can psoriatic arthritis patients present with?

psoriasis, arthritis at DIP joints, sausage toes, achilles tendinitis, plantar fasciitis, sacroiliitis, pits in finger nails

85

When does reactive arthritis develop?

after an infection (bowel with compylobacter, salmonella, shigella, yersinia), or genital (chlamydia)

86

Are pts who develop reactive arthritis usually HLA B27+?

Yes

87

Is reactive arthritis also an infection of the joint?

No, just triggers inflammation

88

What joints does reactive arthritis affect? When does it occur?

usually large joints of lower extremity (knees and ankles), usually within 1 month of infection

89

What are extra-articular manifestations of reactive arthritis?

conjuctivitis, urethritis or cervicitis, genital ulcers, rash on palms of soles

90

What is the treatment of spondyloarthropathies?

PT/ROM/good postures, Meds: NSAIDs, for peripheral arthritis: sulfasalazine, methotrexate, for axial arthritis: biologics (TNF blockers), Abx for chlamydia

91

Give an overview of osteoarthritis (clinical, lab, radiographic)

92