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Flashcards in Joint disease Deck (16):

Joint findings in Osteoarthritis

narrowed joint space, bone spurs, DIP and PIP involvement, subchondryl cysts, eburnation (polished, ivory-like appearance of bone). no MCP invovlement
(Heberden nodes on DIP and Bouchard nodes on PIP)


Etiology of rheumatoid arthritis

inflammatory. mediated by cytokines and type III and IV hypersensitivity rxns


Joint findings in RA

pannus formation in joints (abnormal granulation tissue d/t irritation of the synovium. granulation tissue will contract), subcutaneous rheumatoid noducles, ulnar deviation, baker cyst in popliteal fossa. no DIP involvment


Antibodies in RA

80% of rheumatoid factor (IgM ab against IgG antibody (Fc portion)). anti-cyclic citrullinated peptide is more speicifc


What the systemic symptoms of RA?

fever, fatigue, pleuritis, pericarditis. can cause anemia of chronic disease and secondary amyloidosis


Tx for RA?

NSAIDs, glucocorticoids, and disease modifying agents ike methotrexate, sulfasalazine, and TNF-alpha inhibitors


Causes of gout

1. undersecretion of uric acid. usually idiopathic, but may be worse with thiazide diuretics
2. overproduction of uric acid (only 10%). Seen in incr. cell turnover from leukemia or myeloproliferative disorders, Lesch-Nyhan syndrome (X-linked dificiency of HGPRT; also have self-mutilation and intellectual disability), or renal insufficency, (or Von Gierke glycogen storage disease)


What crystals are found in joints in gout? characteristics?

MSU (monosodium urate crystals) in tissues. needle shaped crystals w/ negative bifuringence under polarized light (yellow when parallel, blue when perpendicular)


Classic manifestation of gout. complications of gout

painful MTP join of the big toe- podagra.
tophi, and renal failure


What might precipitate a gout attack?

large meal, EtOH (alcohol metabolites compete for the same excretion sites in the kidney. decr. uric acid secretion and buildup in blood


Treatment of gout

acute: NSAIDs (indomethicin), glucocorticoids, colchicine
chronic: xanthine oxidase inhibitors like allopurinol or febuxostat.


pseudogout: findings, classic presentation

deposition of calcium pyrophosphate crystals. chondrocalcinosis on X ray. basophilic, rhomboid crystals. usually affects the large joints (like knee)


predisposing conditions for pseudogout

hemochromatosis, hyperparathyroidism, hypoparathyroidism
tx: NSAIDs, steroids, colchicine


Common causes of infectious arthritis

s aureus, streptococcus, and Neisseria gonorrhoea.
gonorrhea presents with synovitis, tenosynovitis (hand), and dermatitis (pustules)


Features of seronegative spondyloarthropathies

no rheumatoid factor. associated with HLA-B27 and more common in males.


biochem of gout

break down of purines (AMP and GMP) AMP to hypoxanthine, GMP to guanine. both go to xanthine, which is converted to uric acid by xanthine oxidase.
hypoxanthine and guanine may be salvaged by HGPRT. if no HGPRN (Leish nyhan syndrome), pt has excess uric acid

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