inflammatory joint diseases part 1 Flashcards by Rachael Beverage

what are some general assumptions you can make about inflammatory joint diseases?

produce pannus
increased ESR
must be Xrayed

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what are the seropositive types?

RA
SLE
Sceroderma
Jaccoud's
Sjorgren's

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what are the seronegative types?

AS
Reactive arthritis
Psoriatic arthritis
Enteropathic arthritis

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what is the most common seropositive type?

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what is the most common seronegative?

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RA generalizations

generalized CT autoimmune disease
IgM-anti-IgG
IgG-anti-IgG
involving synovial tissue resulting in polyarticular joint inflammation

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define pannus

inflammatory hyperplastic synovitis

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which gender is typically associated with RA?

female, 20-60

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other body systems involved in RA

heart
lungs
small blood vessels
NS
eyes
reticuloendothelial system

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clinical features of FA

young to middle aged
females 3:1
elevated ESR
70-80% +Rh
\+ANA
C reactive protein
normocytic normochromic anemia
bilateral symmetry and progressive nature leading to deformity

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terms associated with RA

arthritis mutilans
baker's cyst
boutonniere deformity
felty's syndrome
haygarth's nodes
jelling phenomena
rheumatoid nodule
swan neck deformity
dot-dash appearance
marginal erosion

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arthritis mutilans

severe joint deformity destruction

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baker’s cyst

englargement of the gastrocneumius bursa

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boutonniere deformity

PIP flexion

DIP extension

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felty’s syndrome

leukopenia, splenomegaly, RA

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haygarth’s nodes

soft tissue swelling at the MCP

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jelling phenomena

stiff joint after inactivity

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rheumatoid nodule

accumulation of inflammatory cells with necrotic area and fibrosis seen on extensor surfaces

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swan neck deformity

flexion of DIP and extension of PIP

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marginal erosion

rat bite, bocket erosions localized loss of intraarticular cortex adjacent to the casular insertion due to pannus erosion at the anatomical bare area

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pathological changes occur where in RA?

joints
bursa
tendon sheaths
they are distinct on a radiograph

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what are some initial RA abnormalities?

acute synovitis with periarticular edema, effusion

juxta-articular hyperemia

what does proliferating pannus do in RA?

erodes and narrows the cartilage as the pannus releases chondrolytic collagenase enzymes and interferes with nutrition

intrusion of pannus into subchondral area produces___

cysts

when joints are entirely filled with proliferating pannus, what happens?

undergoes progressive fibrosis, fibrous ankylosis and possibly bony ankylosis

radiographic signs of RA

``` soft tissue swelling subcutaneous soft tissue mass uniform loss of joint space marginal erosions (bare area) subchondral cysts juxtaarticular osteoporosis ankylosis deformity ```

signs and symptoms of RA usually occur when?

insidiously, may be proceeded by emotional or physical stress

what are the signs and symptoms of RA?

``` articular complaints (pain, tenderness, swelling, stiffness especially in morning (jelling phenomenon)), particularly in the PIP and MCP joint fatigue, muscle weakness, fever ```

what are some other clinical abnormalities that can be found with RA?

raynaud's osteopenia cervical spine subluxations/dislocations

rheumatoid nodules

firm, non-tender nodules found in 20% in patients

what are some extra-articular manifestations of RA?

lacrimal gland atrophy leading to dry eyes | vasculitis leading to skin ulcerations

what are the signs and symptoms that you have to have at least 4 of to have an RA diagnosis

morning stiffness for at least 6 weeks pain on joint motion for at least 6 weeks swelling of at least one joint for at least 6 weeks swelling in at lelast one other joint for more than 6 weeks bilateral symmetrical joint swelling subcutaneous nodules radiographic changes labratory

RA principally involves what joints of the hands and wrist?

MCP PIPs ulnar aspect of the wrist

boutonniere deformity

flexion of PIP and extension of DIPs

swan neck deformity

extension of PIPs and flexion of DIPs

where do erosions and swelling occur on the ulna in RA?

inferior radioulnar compartment prestyloid recess extensor carpi ulnaris tendon sheath

what happens when the elbows get RA?

joint effusion

what happens when shoulders get RA?

glenohumeral and AC joint get it | resorption of clavicle

what happens when hips get RA?

axial migration | acetabular protrusion

what happens when knees get RA?

tricompartmental involvement | baker's cyst

what do you see in a radiograph of someone who has RA of the shoulder?

no osteophytes | licked candy stick appearance of the clavicle

if there is an enthesopathic change of the calcaneous, how can you tell if it is RA or Reiter's?

RA- there will be a "fluffy" proliferative change

50% of RA patients will get RA where within 10 years?

cervical spine

what happens to the bones if there is RA of the cervical spine?

they can have a big ADI dens erosions subaxial subluxations atlanto-axial impaction

what are some basic features of RA of the cervical spine?

``` apophyseal joint disease decreased disc height spinous process erosions subluxation osteoporosis ``` could also have: occ-C1 or C1-2 facet erosions, basilar invagination, potential neurological compromise

where do the erosions of the dens occur specifically?

between dens and anterior arch between dense and transverse ligament at the tip of the dens

when is the onset of JRA?

less than 16 years of age

what is the poorest prognosis for JRA?

seropositive (10% of patients have this)

what is the most common diganosis of JRA?

seronegative

20% of people with JRA have what other disease?

Still's

What are some classic signs and symptoms of JRA?

polyarticular involvement (50%) pauciarticular (30%) pronounced systemic involvement

What are signs and symptoms involved in JRA?

``` acute intermittent fever lymphadenopathy hepatosplenomegaly carditis anemia pale erythematous rash on trunk, face or etremities (fleeting and migratory) ```

what are some radiographic signs of JRA?

``` soft tissue swelling osteoporosis loss of joint space articular erosions subluxations growth disturbances periostitis ankylosis ballooning of the metaphysis acetabular protursion cervical erosions and posterior joint ankylosis, vertebral body and disc hypoplasia ```