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.