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Inflammatory Flashcards

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1
Q

How do the number of joints affect your judgment of Inflammatory Joint diseases?

A

1 joint= infection

More than 1 joint= Rheumatoid arthritis or seronegatives like ankylosing spondylitis

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2
Q

What might you see in inflammatory joint diseases that you likely will not in degenerative diseases?

A

Erosions

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3
Q

How could you tell inflammatory from degenerative in a case of acetabular protrusion?

A

Inflammatory will not have osteophytes

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4
Q

What are the different types of Rheumatoid?

A

Seropositives

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5
Q

What are examples of seropositive rheumatoid types?

A

RA
Systemic lupus erythematosis
Scleroderma
Jaccoud’s

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6
Q

What are examples of Rheumatoid variants?

Seronegatives

A

Ankylosing spondylitis
Reactive arthritis/Reiter’s disease
Psoriatic arthritis
Enteropathic arthritis

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7
Q

What is Rheumatoid Arthritis?

A

Connective tissue autoimmune disease
IgM-anti-IgG
IgG-anti-IgG
Involves synovial tissue resulting in polyarticular joint inflammation

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8
Q

What is the Most common INFLAMMATORY arthritis?

A

Rheumatoid arthritis (1-2% population)

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9
Q

What are common sights of Rheumatiod arthritis?

A

Hands (PIPS), feet, and cervical spine

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10
Q

Who is more likely to have RA?

A

Females, 20-60

After 60, both genders equally

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11
Q

What are other body systems involved with RA?

A

Heart, lungs, small blood vessels, nervous, eyes, reticuloendothelial system.

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12
Q

What are some clinical features of RA?

A

Elevated ESR
Bilateral symmetry and progressive nature leading to deformity.
(Degenerative is asymmetric)

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13
Q

In RA, what are oversized PIP joints called?

A

Bouchard’s nodes

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14
Q

What is the Jelling Phenomena?

A

Joint stiffness after inactivity, seen in RA

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15
Q

What is a swan neck deformity seen in RA?

A

Flexion of DIP and extension of PIP

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16
Q

What is a dot-dash appearance seen on RA films?

A

Intermittent absence of articular cortex due to erosion

_____…….______…..____………..______

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17
Q

What is Boutonnière deformity seen in RA?

A

PIP Flexion, DIP extension

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18
Q

What is a rat bite in RA?

A

Marginal erosions/pocket erosions adjacent to the capsular insertion do to pan us at the bare area (no cartilage).

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19
Q

What is Felty’s syndrome?

A

Leukopenia, splenomegaly, and RA

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20
Q

What are Haygarth’s nodes?

A

Swelling of soft tissue at MCP

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21
Q

What is a baker’s cyst?

A

Enlargement of the gastrocnemius bursa

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22
Q

What is arthritis mutilans?

A

Sever joint deformity/destruction OFTEN SEEN in RA

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23
Q

What is hyper plastic synovitis?

A

Synovial proliferation that produces pannus, which erodes intraarticular surfaces of bone and cartilage.

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24
Q

What are the diagnostic criteria for RA?

A

Insidious onset leading to emotional or physical stress
Pain, tenderness, swelling, stiffness in the morning (jelling ph)
Start at PIP and MCP…spreading proximally
Fatigue, weakness, FEVER
RAYNAUD’s, osteopenia, cervical subluxations/dislocations

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25
What is important to know about RA in the cervical spine?
Pannus my erode transverse atl. Ligament, and odontoid process.
26
What are extra-articular manifestations that may be present with RA?
Ocular complications, lacrimal gland atrophy leads to dry eyes, vasculitis will produce skin ulceration
27
What is the Rheumatoid factor?
Measurement of the reactive IgM antibodies.
28
What is the prognosis for RA?
Minority will experience complete remission. | Signs of poor prognosis: subcutaneous nodules, high RF, onset before 30, longer than a year.
29
What are rat bites?
Erosion of the bare areas look like a rat took a bite out of them
30
Where is the principle involvement of RA in the hands and wrist?
MCP PIP's Ulnar aspect of wrist
31
What odd findings will you see in RA of the wrist?
Distal ulna has a LICKED LOLLIPOP look
32
What can carpal involvement of RA look like?
The carpals may be fused
33
With deformity of the digits in RA, which direction is deviation seen?
Ulnar deviation
34
Where will you see erosion in the wrist in RA?
At the ulnar and radial styloid | Progresses to entire joint
35
What is SLAC?
Scapholunate advanced collapse | Seen in RA of the wrist: distal row to proximal row
36
What does distribution of RA look like?
Elbows-joint effusion Shoulders- GH and AC RESORPTION OF DISTAL CLAVICAL Hips- axial migration, protrusion Knees-tricompartmental involvement, BAKER's CYST***
37
What does RA look like in the knees?
Symmetric loss of joint space (all compartments) Erosions Baker's Cyst's
38
What does RA look like in the hips?
Concentric loss of joint space | Acetabular protrusion
39
What does RA look like in the Elbow?
``` Joint effusion (visible fat pad) Demineralization ```
40
What does RA look like in the shoulder?
Wide AC joint space | Erosion
41
What does RA look like in the feet?
Same as the hands pretty much. | If you see erosion in the calcaneus, consider REITERS DISEASE
42
Who will you see RA of the cervical spine in?
50% within 10 years
43
What is a severe condition you should watch for with cervical RA?
Atlanta-axial impaction, MC cause of upper cervical neurological symptoms AKA BASILAR INVAGINATION****(mcgregors line)
44
What does erosion look like in the odontoid process?
Between dens and anterior arch Between the dens and transverse ligament At the tip of the dens
45
What is the most common cause of an increased ADI?
RA
46
What kind of views should be taken with Cervical RA?
Flexion and extension to evaluate the ADI
47
What should the ADI be?
should not exceed 3mm
48
where will you see the LICKED LOLLIPOP sign with RA?
The distal Ulna (wrist) | The odontoid process
49
When should you not do FLX/EXT films with cervical RA?
If the patient is neurocompromised
50
What is Jevenile Chronic Arthritis? | Juvenile RA
Onset of RA less than 16 years old
51
What are the 2 types of juvenile chronic arthritis?
Seropositive-RA adult type, poor prognosis 10% | Seronegative (MC)- Still's disease 20%, polyarticular 50%, 4 joints or less 30%
52
What is the most common type of seronegative JCA?
Polyarticular 50%
53
Who will you most likely see JCA in and what will you see?
FEMALES Bilateral and symmetrical Fever, lymphadenopathy, rash Mild systemic signs
54
What does JCA look like in the hands?
Same as RA with Periostitis and shortening of MC's
55
What does JCA look like in the knee?
Ballooning of metaphysis
56
What does JCA look like in the Hip?
Acetabular protrusion
57
What does JCA look like in the Cervical spine?
Erosions, and posterior joint ankylosis; vertebral body and disc hypoplasia
58
What is Periostitis in JCA?
Loosely attached periosteum in children and reacts with the hyperemia
59
What might you see in the hand of JCA?
Fusion of carpal-metacarpal joint | Carpal fusion
60
What is Systemic Lupus Erythematosis (SLE)?
Generalized connective tissue disorder involving multiple organs
61
What type of Rheumatoid is SLE?
Seropositive
62
What lab findings will be present in SLE?
Elevated ESR LE cells ANA positive Marked subluxation although the joints integrity is normal
63
What are symptoms you will see with SLE?
Fever, malaise, anorexia, weight loss, polyarthralgia, and skins rash with sun exposure. Damage to joints, skin, KIDNEYS, and serosal membranes(immunoreactive)
64
Who will you see SLE in?
Females 20-40
65
What do patients with SLE complain of 90% of the time?
Articular complaints, although not seen on radiograph
66
What locations do you see SLE?
Hands Feet Wrists Knees
67
What is the most frequent and serious feature of SLE?
Kidney involvement leading to nephropathy and renal failure Raynauds Bilateral, symmetric in hands, wrist, and shoulder Reversed, but resilent joint deformities
68
How do you treat SLE?
Steroids, but could lead to osteoporosis, ACN, spinal fractures, and gastric ulcerations.
69
What will there be an increase incidence of in SLE?
A vascular necrosis (AVN)
70
What does SLE distribution look like in the hands?
MCP and PIP Swan neck and boutonnière deformity reversible, non erosive ulnar deviation 50% (don't confuse with RA, with same deviation but not reversible, or Jaccoud's with same deviate and reversible)
71
What does distribution of SLE in the spine look like?
Increased ADI of 8.5% of patients
72
SLE looks like RA sometimes, how do you differentiate?
Associate signs with a malar rash | See if it's reversible
73
What is Jaccoud's arthropathy?
Non-erosive, reversible joint deformity that isn't actively corrected by patient, but examiner.
74
What does Jaccoud's arthropathy follow?
Rheumatic fever, and multiple connective tissue disorders
75
What will you see with Jaccoud's arthropathy?
Transitory and migratory arthrosis, myalgia, weight loss, and residual mitral valve disease. Patients demonstrate little pain or functional limitations
76
What will you see in the feet of Jaccoud's arthropathy?
Fibular deviations of the MTP joints
77
What does Jaccoud's of the hands and feet follow?
Strep | Fever
78
Is Jaccoud's arthropathy of the hands and feet erosive?
No, it is non erosive with reversible joint deformity
79
What is Scleroderma? | Progressive systemic sclerosis
``` Generalized CT disorder involving: Skin Lungs GI tract Kidneys Musculoskeletal system ```
80
What causes scleroderma?
Unknown etiology
81
What problems does scleroderma cause?
Small vessel disease | Fibrosis in multiple organ systems
82
How is scleroderma manifest?
Cutaneous
83
What are the three progression stages of scleroderma?
Edema Induration or hardening Atrophy
84
What will some signs of scleroderma be?
Puffy and painful swelling of the extremities
85
Is raynaud's associated with scleroderma?
Yes, it's one of the signs. | Peri vascular tissue inflammation with atrophy and fibrosis
86
When scleroderma progresses to thickening what is the sign?
Adherence to underlying structures becoming "HINDBOUND"
87
What are other later signs of scleroderma?
Muscle weakness Dysphagia/heartburn Sluggish bowel/constipation/distention
88
What is CREST syndrome are the 5 main signs of scleroderma, what are they?
``` Calcinosis of soft tissue Raynaud's phenomenon Esophageal dysmotility Sclerodactyly Telangiectasia ```
89
Scleroderma distribution?
Hands- soft tissue atrophy, osseous resorption (term. Tuffs, and subcutaneous calcification (sheet like calcification) Chest- Interstitial fibrosis GI- smooth muscle dysfx. Esophageal aperistalsis, reduced sphincter pressure.
90
Who are you most likely to see scleroderma in?
Females 30-50
91
Scleroderma clinical information?
elevated ESR ANA increased RF positive
92
What does scleroderma look like on film?
Acral tapering of the soft tissues Subcutaneous soft tissue calcification Flexion contractures
93
What is acro-osteolysis in scleroderma?
AKA hajdu-Cheney syndrome. Acquired acroosteolysis causes of which are burns, frostbite, electric shock, ADR, etc...
94
What is a COMMON rheumatoid variant?
Ankylosing Spondylitis, a seronegative inflammatory disease.
95
What is Ankylosing Spondylitis? | AS
Chronic, inflammatory | Articular ankylosis, ligamentous ossification and enthesopathic changes.
96
How do you categorize AS?
Seronegative, MOST COMMON spondyloarthropathy
97
Who will you most likely see AS in?
Young adult Males, and in the axial skeleton | Common symptom is low back pain.
98
What percentage of AS patients will have peripheral disease of the hips and shoulders?
50%
99
What is it called when you have AS in the hips and shoulders?
Spondylitis Rhizomelique
100
What is the distribution of AS?
Axial: SI and spine Appendicular: proximal large joints of extremities Enthesis Erosions, bony proliferation so, fusion; bilateral and symmetrical
101
Clinical features of AS?
``` Males, 13-35 3 months physician observing pain and stiffness Sacroilitis Conjunctivitis HLA B27, ESR Neg RA, neg ANA Aortic insufficiency, pulmonary fibrosis ```
102
How should you manage AS?
Long-term plan to prevent, decrease, or delay joint and postural deformities NSAIDS Rheumatology consult
103
What is a classic initial site of AS skeletal involvement?
Sacroiliac (sacroiliitis) 50% will progress to fusion Hazy loss of subchondral bone
104
What are the characteristics of Sacroiliitis?
Bilateral and symmetrical Loss of subchondral bone Osteitis (sclerosis) Joint widening
105
What is Osteitis Condensans Ilii?
Confused with AS Postpartum females Sclerosis at the inferior aspect of the SI joint, especially at the iliac aspect
106
What the AS of the spine look like?
In the thoracolumbar, and lumbosacral areas Discovertebral, apophyseal, costovertebral, atlantoaxial SI joint involvement 100% of the time initially, then thoracolumbar, then lumbosacral, then ascending

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