Joint Diseases Flashcards
(129 cards)
1
Q
What is Osteoarthritis (OA)?
A
Degenerative Joint Disease (DJD): chronic, slowly progressive erosive damage to joint surfaces
2
Q
What causes pain in OA?
A
The loss of articular cartilage causes increasing pain with minimal to no inflammation
3
Q
What is the incidence of OA directly proportional to?
A
Increasing age and trauma to the joint
4
Q
What are common risk factors for OA?
A
Contact sports with trauma, obesity and developmental deformities
5
Q
What joints are most commonly affected by OA?
A
Weight-bearing joint: Knee, hip, ankle
Hand is affected but not a major cause of diasability
6
Q
What joints of the hand are affected by OA?
A
DIP, PIP and MCP
7
Q
What is DIP joint enlargement in OA called?
A
Heberden Nodes
8
Q
What is PIP joint enlargement in OA called?
A
Bouchard Nodes
9
Q
How long is stiffness in OA?
A
Brief <15 minutes
10
Q
What is the most common cause of joint disease?
A
Osteoarthritis (OA)
11
Q
What lab value does Osteoarthritis (OA) falsely elevate?
A
T-Score on DEXA scan
12
Q
What is the most accurate diagnostic test for OA?
A
X-ray of the affected joint
13
Q
What does x-ray show in OA?
A
Joint space narrowing
Osteophytes
Dense Subchondral bone
Bone cysts
14
Q
What is the best initial therapy for Osteoarthritis (OA)?
A
NSAIDs alone or with Acetaminophen
15
Q
What are other treatment options for OA?
A
Weight loss and moderate exercise
Acetaminophen
Capsaicin cream
Intraarticular steroids: if other therapy does not control pain
Joint replacement if function is compromised
Duloxetine for knee pain
16
Q
What form of NSAIDs can be used in OA to avoid systemic toxicity?
A
Topical NSAIDS
17
Q
What is Rheumatoid Arthritis (RA)?
A
Autoimmune disorder mainly affecting the Joints: but does have systemic manifestations of chronic inflammation
18
Q
What is the key to diagnosing RA?
A
Morning stiffness of multiple, small inflamed joints
19
Q
How does RA typically affect Joints?
A
Bilateral, Symmetrical joint involvement: typically of PIP joints, MCP joints, wrists, knees and ankles for 6 weeks
20
Q
How long does stiffness last in RA?
A
At least 30 minutes: often much longer
21
Q
What is the most common-extra articular feature of RA?
A
Rheumatoid Nodules: most often over bony prominences
22
Q
How can RA affect the eye?
A
Episcleritis
23
Q
How can RA affect the lungs?
A
Pleural effusions with low glucose and nodules in the lung parenchyma
24
Q
How can RA affect the C-Spine?
A
C1 and C2: risk of subluxation
25
What can happen if a Baker Cyst ruptures in RA?
It can mimic a DVT
26
What are options for diagnostic testing in RA?
Rheumatoid Factor (RF): nonspecific
Anti-CCP Ab: Sensitive and specific
X-ray
Elevated ESR or CRP
Normocytic Anemia
Arthrocentesis: r/o crystal disease
27
What type of anemia does RA present with?
Normocytic Anemia
28
What is seen on X-ray in RA?
Erosion of joints and osteopenia
29
What Ab is most sensitive and specific for RA?
Anti-Cyclic Citrullinated Peptide (anti-CCP)
30
How are diagnostic Criteria assessed for RA?
Points: 6 or more points diagnoses RA: you don't need an abnormal x-ray
31
What are points given for to diagnose RA?
Joint Involvement: up to 5 points
ESR or CRP: 1 point
Duration >6 weeks: 1 point
RF or Anti-CCP: 1-3 points
32
What is the most common cause of death in RA?
Coronary Artery Disease
33
How does Sicca Syndrome Present?
Dry eyes, mouth and other mucous membranes
34
How Does Felty Syndrome present?
Ra, Splenomegaly and Neutropenia
35
How does Caplan syndrome Present?
RA, Pneumoconiosis and Lung Nodules
36
What is the goal of RA treatment?
Stop progression of Disease
37
What is the mainstay of treatment for all patients with erosive RA?
Disease-modifying antirheumatic drugs (DMARDS)
38
What DMARD is used first for treatment of RA?
Methotrexate
39
What are common adverse effects of Methotrexate?
Liver toxicity, pulmonary toxicity and bone marrow suppression
40
If RA does not respond to Methotrexate what drug class can be added?
Tumor Necrosis Factor (TNF) Inhibitors
41
What are some commonly used TNF-Inhibitor Drugs?
Infliximab
Adalimumab
Etanercept
Golimumab
Certolizumab
42
What are common adverse effects of TNF-inhibtiors?
Infection and reactivation of TB
43
What must you screen for before starting a TNF-Inhibitor?
TB
44
What drug provides excellent long-term control of RA?
Rituximab
45
What is the mechanism of Rituximab?
removes CD20 (+) Lymphocytes from circulation
46
When do you consider using Rituximab for RA?
Added to Methotrexate if no response after anti-TNF has been added
47
What drug can be used for Mild RA that doesn't require the strength of Methotrexate?
Hydroxychloroquine
48
What are common adverse effects of Hydroxychloroquine?
Toxicity to the retina
49
What must you perform prior to using Hydroxychloroquine?
Dilated Eye exam
50
Is Hydroxychloroquine safe to use in pregnant patients?
Yes
51
What is an alternative to Methotrexate if the patient experiences toxicity?
Leflunomide
52
What are alternative DMARDs that can be used in RA?
Sulfasalazine, Abatacept, and Anakinra
53
What are common side effects of Sulfasalazine use?
BM toxicity, hemolysis in G6PD Deficiency, oligospermia and rash
54
What does "erosive" RA mean?
Joint space narrowing
Physical deformity of joints
X-ray abnormalities
55
What must an RA patient have done prior to surgery?
C-Spine x-ray to assess for risk of injury with intubation
56
What is the best initial treatment for Pain in RA?
NSAIDS; work immediately to improve inflammation
57
What is used in RA to bridge the pain from inflammation while waiting for DMARDs to take effect?
Steroids: much faster onset of action than DMARDs
58
What is the common side effect of ANTI-TNF drugs?
Reactivation of TB
59
What is the common side effect of Hydroxychloroquine?
Ocular effects
60
What are the common side effects of Sulfasalazine?
Rash and Hemolysis
61
What is the common side effect of Rituximab?
Infection
62
What are the common side effects of Methotrexate?
Liver, lung and bone marrow toxicity
63
What is Gout?
Gouty Arthritis; overproduction or underexcretion or uric acid
64
What are common causes of uric acid Overproduction?
Idiopathic
Increased Cell Turnover: Cancer, hemolysis, psoriasis, chemotherapy
Enzyme Deficiency: Lesch-Nyhan, Glycogen storage disorder
Ethanol
65
What are common causes of uric acid Underexcretion?
Renal Insufficiency
Ketoacidosis or lactic acidosis
Thiazides and aspirin
66
How does Gout classically present?
Sudden, excruciating pain, redness and tenderness of the big toe after a night binge drinking
67
What is the most commonly affected joint in gout?
Metatarasal Phalangeal (MTP) joint of the great toe
68
What can result from chronic gout?
Tophi and uric acid kidney stones
69
What are tophi?
Tissue deposits of urate crystals that create a foreign body reaction
-occur in cartilage, subq tissue, bone and kidney
70
What is the most accurate diagnostic test for gout?
Aspiration of the joint
71
What is seen on joint aspiration in gout?
Needle-shaped crystals with negative birefringence on polarized light microscopy
Elevated WBC: predominantly Neutrophilic
72
What does X-ray show in Gout?
Normal in early disease: erosion of cortical bone in later stage
73
What is the best initial treatment for an acute attack of gout?
NSAIDs
74
What is the 2nd line treatment for an acute gout attack if NSAIDs cannot be used/don't work?
Corticosteroids: Triamcinolone
Injection for single joint, PO for multiple joints
75
What is 3rd line for an acute gout attack if NSAIDs and Steroids cannot be used?
Colchicine
76
What drugs do you avoid starting during an acute gout attack?
Uricosuric agents or Allopurinol
77
How do you manage Chronic Gout between attacks?
Reduce alcohol, weight and high-purine foods
Stop Thiazides, aspirin and niacin
Medications
78
What drug do you use first for hypertension in chronic gout patients?
Losartan
79
What medications are used to manage chronic gout between attacks?
Colchicine
Allopurinol
Febuxostat
Pegloticase
Probenecid
Anakinra
80
What is the role of Colchicine for chronic gout?
Prevents 2nd attacks and attacks brought on by sudden fluctuations in uric acid caused by probenecid or allopurinol
81
How does Allopurinol work?
Decreases production of Uric acid
82
How does Febuxostat work?
Xanthine-Oxidase Inhibitor: Used if allopurinol is contraindicated
83
How does Pegloticase work?
Dissolves uric acid: accelerates uric acid metabolism
84
What disease is Pegloticase contraindicated in?
G6PD deficiency
85
How does Probenecid work?
Increases uric acid excretion in the kidney "Uricosuric"
86
How does Anakinra work?
IL-1 Inhibitor used when multiple agents fail to control gout
87
What are common side effects of Uricosuric agents and allopurinol?
Hypersensitivity, TEN and SJS
88
What are common side effects of high dose Colchicine?
Diarrhea and BM suppression: Neutropenia
89
What drugs are contraindicated for Gout in Renal Insufficiency?
Probenecid and NSAIDs
90
Why is Losartan (ARB) the best drug for Hypertension in gout?
It also lowers uric acid
91
What is Calcium Pyrophosphate Deposition Disease (Pseudogout)?
Calcium-containing salts deposit in articular cartilage
92
What are the most common risk factors for Calcium Pyrophosphate Deposition Disease (Pseudogout)?
Hemochromatosis and Hyperparathyroidism
93
What other conditions are associated with Calcium Pyrophosphate Deposition Disease (Pseudogout)?
Diabetes, Hypthyroidism and Wilson Disease
94
How does Calcium Pyrophosphate Deposition Disease (Pseudogout) typically affect joints?
Large joints: but not the first MCP of the foot unlike gout
Does not affect DIP and PIP joints: separates from OA
95
What is the most accurate test for Calcium Pyrophosphate Deposition Disease (Pseodugout)?
Arthrocentesis
96
What is shown on Arthrocentesis for Calcium Pyrophosphate Deposition Disease (Pseudogout)?
Positively birefringent rhomboid-shaped crystals
97
What is seen on X-ray for Calcium Pyrophosphate Deposition Disease (Pseudogout)?
Linear calcification or Chondrocalcinosis of the cartilaginous structures of the joint and DJD
98
What is seen on synovial fluid in Calcium Pyrophosphate Deposition Disease (Pseudogout)?
Elevated WBC between 2,000 and 50,000
99
What is the best initial treatment for Calcium Pyrophosphate Deposition Disease (Pseudogout)?
NSAIDs
100
what can be used for severe Disease if Pseudogout does not respond to NSAIDS?
Intraarticular steroids such as triamcinolone
101
What can be used for prophylaxis between pseudogout attacks?
Low Dose Colchicine
102
how does Septic Arthritis present?
High fever with very acute onset: single hot joint affected
103
What is seen on Synovial fluid analysis in Septic Arthritis?
>50,000 WBC: 80-90% PMNs
104
What Patient population are the Seronegative Spondyloarthropathies common in?
Men <40 years of age
105
What are common symptoms of Seronegative Spondyloarthropathies?
Involvement of the spine and large joints
Negative RF: hence the name
Enthesopathy
Uveitis
HLA-B27
106
What drug class is not helpful in treating Seronegative Spondyloarthropathies?
Corticosteroids
107
What is Enthesistis?
Inflammation of attachment of tendons and ligaments to bone
108
What is Dactylitis?
Swelling of the fingers and toes
109
How does Ankylosing Spondylitis commonly present?
Low backache, stiffness and pain that radiates to the buttocks
110
What spinal changes are seen in Ankylosing Spondylitis?
Flattening of the normal lumbar curvature and decreased chest expansion
111
Where does Enthesopathy classically occur in Ankylosing Spondylitis?
Achilles Tendon
112
What are other common findings seen in Ankylosing Spondylitis?
Transient peripheral arthritis: hips, knees and shoulders
Cardiac: AV block
Uveitis
Osteoporosis/Osteopenia: increases vulnerability to spine fractures
Bamboo spine: fusion of vertebral joints
113
What is the best initial test for Ankylosing Spondylitis?
X-ray of the SI joint
114
What is the most accurate test for Ankylosing Spondylitis?
MRI: detects abnormalities years before the x-ray becomes abnormal
115
How do you treat Ankylosing Spondylitis?
Exercise and NSAIDs
116
If ankylosing Spondylitis does not respond to exercise and NSAIDs, what is your next line of treatment?
Anti-TNF agents: etanercept, adalimumab or infliximab
117
If anti-TNF agents do not control ankylosing spondylitis what is your 3rd line of treatment?
Anti-IL17 drugs: Secukinumab
118
How does Psoriatic Arthritis commonly Present?
Psoriasis, Arthritis, Sausage digits from Enthesopathy, nail pitting
119
What is the best initial test for Psoriatic Arthritis?
X-ray of the joint
120
What is seen on joint x-ray in Psoriatic Arthritis?
"pencil in a cup deformity" + bony erosions and irregular bone destruction
121
What lab value is elevated in Psoriatic Arthritis?
Uric acid: due to increased skin turnover
122
What is the first line treatment for Psoriatic Arthritis?
Methotrexate
123
If methotrexate fails to control Psoriatic Arthritis what is the next step?
Anti-TNF agents
124
If Anti-TNF agents cannot be used in Psoriatic Arthritis what do you use?
Anti-IL17 medications: Secukinumab or Ixekizumab
125
What is Reactive Arthritis (Reiter Syndrome)?
Arthritis occurring secondary to Inflamamtory bowel disease (IBD), Sexually transmitted infection (STI) or gastrointestinal infection: Yersina, Salmonella, Campylobacter
126
What is the typical triad of presentation in Reactive Arthritis (Reiter Syndrome)?
Joint pain
Ocular findings: Uveitis, Conjunctivitis
Genital Abnormalities: Urethritis, Balantis
127
How do you diagnose Reactive Arthritis (Reiter Syndrome)?
Clinical dx based on presentation + tap hot swollen joints to rule out septic joint
128
What is the best initial treatment for Reactive Arthritis (Reiter Syndrome)?
NSAIDs
129
If Reactive Arthritis (reiter syndrome) does not respond to NSAIDs what do you use?
Sulfasalazine
