Introduction to Rheumatology

Question 1

Cartilage collagen fibers are anchored in…

Answer 1

Subchondral bone

Question 2

Purpose of the cartilage collagen fibers?

Answer 2

They form a meshwork that entraps the larger proteoglycan aggregates

Question 3

What are cartilage proteoglycan aggregates?

Answer 3

Very large, hydrophilic molecules. They are made of glycosaminoglycans. The pressure of the bound water gives cartilage its elasticity.

Question 4

Vascularity of Cartilage?

Answer 4

Its avascular.

Question 5

All components of articular cartilage are produced by…

Answer 5

chondrocytes

Question 6

Nutrition for chondrocytes come from…

Answer 6

Synovial fluid

Question 7

Where is synovial fluid generated

Answer 7

Synovial membrane

Question 8

How big is a normal synovial membrane?

Answer 8

1-3 cells thick with an underlying delicate connective tissue network (adipose, capillaries, fibrous parenchyma)

Question 9

Name the rheumatic disease associated with the joint site.

Joint Space

Answer 9

Joint Infection
Microcrystaline arthritis (Gout)

Question 10

Name the rheumatic disease associated with the joint site.

Muscle

Answer 10

Myositis

Question 11

Name the rheumatic disease associated with the joint site

Synovial Membrane

Answer 11

RA/Synovitis

Question 12

Name the rheumatic disease associated with the joint site.

Enthesis

Answer 12

Enthesopathy

Ankylosing spondylitis

Question 13

Name the rheumatic disease associated with the joint site.

Cartilage

Answer 13

Cartilage Degeneraion

Osteoarthritis

Question 14

Name the rheumatic disease associated with the joint site.

Bony End-Plate

Answer 14

Avascular Necrosis

Question 15

Five details important to gather in a rheumatology patient history

Answer 15

1. Time, Rapidity of Onset
2. Determine # of joints
3. Constitutional Symptoms
4. Response to Therapy
5. Functional Status

Question 16

Typically few joints are involved in…(3)

Answer 16

Gout
Seronegative spondyloarthropathies
OA

Question 17

Typically many joints are involved in…(4)

Answer 17

RA
SLE
Seronegative spondyloarthropathies
Fibromyalgia

Question 18

Gout responds remarkably well to…

Answer 18

NSAIDs

Question 19

Fibromyalgia responds very well to…

Answer 19

Exercise

Question 20

What three things did he recommend to score in the physical exam?

Answer 20

Swelling 0-3
Tenderness 0-4
Limitation 0-4

Question 21

Four Types of Labs one might ask for as a rheumatologist

Answer 21

Routiene CBC/Chemistries
ESR/CRP/Hemoglobin/Albumin (Acute Phase Reactants)
Rheumatoid Factor + Antinuclear Antibodies
Joint Aspiration

Question 22

Why look at ESR, CRP, Hemoglobin, etc.?

Answer 22

To assess systemic inflammation

Question 23

When should you do a Joint Aspiration

Answer 23

Monoarthritis
Undiagnosed Polyarthritis
One joint swelling out of proportion with the others

Question 24

What are you looking for on an X ray

Answer 24

Ankylosing spondylitis, Calcium pyrophosphate deposition disease, OA

Question 25

What does he mean when he says rheumatism?

Answer 25

Pain around the joint but not in the joint

Question 26

Common Rheumatology treatments

Answer 26

- Exercise - Physical Therapy, Occupational Therapy - NSAIDS - Corticosteroids - DMARDS

Question 27

Risks of chronic NSAID use?

Answer 27

GI bleeds, Renal Insufficiency, High BP, Stroke

Question 28

How are corticosteroids delivered?

Answer 28

Intraarticular injections in arthritis | Can be used systemically in inflamm. arthritis and autoimmune conditions

Question 29

What are DMARDS?

Answer 29

Disease Modifying Anti-Rheumatic Drugs | These drugs try to treat underlying immune defect in many of the autoimunes.

Question 30

Examples of DMARDS

Answer 30

Hydrocychloroquin Gold Methotrexate

Question 31

Musculoskeletal complaints that are nonarticular include...

Answer 31

Trauma | Rheumatism -- Bursitis, Tendonitis, Fibromyalgia

Question 32

Musculoskeletal complaints in a joint less than 6 weeks old

Answer 32

Crystal induced arthritis Septic arthritis Viral arthritis Early chronic arthritis presentation

Question 33

Musculoskeletal complaints in a joint over 6 weeks old with NO INFLAMMATION

Answer 33

Osteoarthritis | Internal Derangement

Question 34

Musculoskeletal complaints in a joint over 6 weeks old with Inflammation of many joints

Answer 34

RA SLE PA

Question 35

Musculoskeletal complaints in a joint over 6 weeks old with Inflammation of few joints

Answer 35

``` Seronegative spondyloathropathy (AS, Reiter's, Psor.) Juvenile Rheumatoid Crystal Induced Septic Early Polyarthritis ```