inflammatory joint diseases part 2

Question 1

what is SLE?

Answer 1

generalzed connective tissue disorder involving multiple organs

Question 2

what are positive signs of SLE?

Answer 2

seropositive (Rh+)
female
increased ESR
presence of LE cells
\+ANA
marked subluxation although joint integrity is relatively normal
butterfly rash

Question 3

what are some symptoms of SLE?

Answer 3

fever
malaise
anorexia
weight loss
polyarthralgia
skin rash with sunlight

Question 4

What are some secondary signs and symptoms of SLE due to excessive immunoreactivity?

Answer 4

damage to joints, skin, kidneys, serosal membranes

Question 5

who are more likely to get SLE?

Answer 5

females age 20-40

Question 6

are severe radiographic changes seen in people with SLE? where are the complaints seen?

Answer 6

no, 90% have an articular complaint, though

most common areas of complaint are: hands, feet, wrists, knees

Question 7

what is the most frequent and serious feature of SLE?

Answer 7

kidney involvement leading to nephropathy and renal failure

Question 8

what phenomenon is associated with SLE?

Answer 8

raynaud

Question 9

describe joints for SLE.

Answer 9

swelling, pain stiffness

easily reversed joint deformities

Question 10

administration of steroids to SLE patients can lead to what?

Answer 10

osteoporosis
ANV
spinal fracture
gastric ulcerations

Question 11

what lab results do you get for someone who has SLE?

Answer 11

normocytic normochromic anemia
elevated ESR
+ANA
+Rh

Question 12

deposition of immune complexes and fibrinoid material in tissues results in what for SLE patients?

Answer 12

vasculitis, synovitis, pleuritis, pericarditis

Question 13

what are radiographic changes for SLE?

Answer 13

bilateral, symmetric
reversible deformities
osteoporosis
soft tissue atrophy
minimal arthropathy
soft tissue calcification
increased incicence of AVN
MC involvement in the hand

Question 14

what are the signs of SLE in the hands?

Answer 14

MCP and PIP involvement
ligamentous laxity, which results in reversible nonserosive ulnar deviation of the digits
swan neck and boutonniere deformity

Question 15

ulnar deviation is involved in what disease?

Answer 15

SLE, RA, Jaccoud’s

Question 16

describe jaccoud’s arthropathy?

Answer 16

follows rheumatic fever and multiple connective tissue disorders

Question 17

jaccoud’s arthropathy patients have had many diagnoses of what?

Answer 17

streptococcal pharyngitis, rheumatic fever

Question 18

jaccoud’s arthropathy is marked by what?

Answer 18

non-erosive, reversible joint deformity

Question 19

what is the demographic for scleroderma?

Answer 19

females 30-50 years old

Question 20

what is scleroderma?

Answer 20

generalized inflammatory connective tissue disorder involving skin, lungs, GI tract, kidneys and musculoskeletal system

Question 21

what does scleroderma cause?

Answer 21

small vessel disease and fibrosis in multiple organ systems. Scleroderma is the cutaneous manifestation of the disease

Question 22

what is the most unique feature of scleroderma?

Answer 22

skin appearance: edema, induration (hardening), atrophy

Question 23

what usually exacerbates scleroderma?

Answer 23

exposure to cold or emotional upset that precipitates Raynaud’s phenomenon

Question 24

what is raynaud’s phenomenon?

Answer 24

sympathetic nervous system dysfunction characterized by cyclic vascular canges usually of the hands which is precipitated by the cold or emotional upset
an initial vasoconstriction followed by a vasodilation with severe pain and swelling

Question 25

what are some non joint related symptoms of scleroderma?

Answer 25

dysphagia and heartburn from decreased motility and dilation of esophagus bowel is sluggish, distention and constipation occurs muscle weakness and atrophy skin edema being replaced by thickening and becoming "hidebound"

Question 26

what pneumonic is associated with scleroderma?

Answer 26

CREST syndrome

Question 27

what does CREST stand for?

Answer 27

``` calcinosis raynaud phenomenon esophageal dysmotility sclerodactyly telangectasia ```

Question 28

what are the clinical features of scleroderma?

Answer 28

females, 30-50 years old, raynaud phenomenon, joint pain and stiffness, dysphagia, elevated ESR, +ANA, RF+

Question 29

what radiology can you see with scleroderma?

Answer 29

acral tapering of soft tissues extensive subcutaneous soft tissue calcification flexion contractures

Question 30

what are the segonegative arthropathies?

Answer 30

AS Psoriatic arthritis Reiter's disease enteropathic arthritis

Question 31

AS

Answer 31

chronic inflammatory disorder, predominately affecting young adult males primarily involves axial skeleton

Question 32

what are some characteristics for AS?

Answer 32

sequela of articular ankylosis, ligamentous ossification and enthesopathic changes chronic low back pain in young men aching, stiffness typically originate in low back ESPECIALLY IN SI JOINTS

Question 33

50% of AS patients will have a peripheral disease where?

Answer 33

in hips and shoulders

Question 34

clinical features of AS

Answer 34

``` MC seronegative spondyloarthropathy 1:1 to 1:10 female to male ratio male predominance 90% positive for HLA-B27 unknown etiology pannus ```

Question 35

skeletal distribution of AS

Answer 35

axial, SI and spine appendicular: proximal large joints of extremities enthesis erosions, bondy proliferation, fusion, bilatreal symmetrical

Question 36

clinical features of AS

Answer 36

``` male 15-35 years 3 months of physcian observed pain and stiffness limited spinal motion SACROILIITIS limited chest expansion presents as spinal pain and stiffness iritis, conjunctivitis +HLA B27, +ESR, -RA, -ANA usually no disability, sometimes severe aortic insufficiency, pulmonary fibrosis ```

Question 37

what is the management of AS?

Answer 37

long-term plan to prevent, decrease or delay joint and postural deformities NSAIDS to prevent inflammation and pain suggest rheumatological cosultation with any of the inflammatory joint diseases

Question 38

what are the discovertebral signs of AS?

Answer 38

corner erosions (romanus lesion) reactive sclerosis (shiny corner sign) loss of anterior concavity (vertebral squaring) thin syndesmophyytes (bamboo spine) disc calcification interspinous ligament ossification (dagger sign) trolley track sign (z capsular ossification) whiskering (ischial entheseopathy) endplate destruction (anderson lesion) spinal fracture (carrot stick fracture)

Question 39

spondylitis rhizomelique

Answer 39

a type of AS that looks like RA, but also has sacroiliitis

Question 40

enteropathic arthritis is radiographically similar to what?

Answer 40

AS

Question 41

is enteropathic arthritis HLA B27 positive or negative?

Answer 41

positive

Question 42

5-15% of ulcerative and granulomatous colitis patients progress to what?

Answer 42

enteropathic arthritis

Question 43

what are some clinical features of enteropathic arthritis?

Answer 43

``` abdominal complaint with joint pain HLA B27 + conservative management for arthropathy malaise, anorexia, weight loss in younger adults no gender association ```

Question 44

what can surgical bowel removal do for enteropathic arthritis?

Answer 44

can stop peripheral involvement of enteropathic arthritis, but not axial involvement

Question 45

how is enteropathic arthritis similar to AS?

Answer 45

SI joints bilateral, symmetrical, erosions, sclerosis, bony ankylosis discovertebral erosions, sclerosis, squaring, thin, bilateral, marginal syndesmophytes peripheral joints tend to be nonspecific swelling and periarticular osteoporosis

Question 46

what is the difference between an anderson lesion and a carrot stick fracture?

Answer 46

if the ankylosed spine is fractured only, then it is a carrot stick fracture it the ankylosed spine is fracture and hypermobile, it is an Andersson lesion