Joint Disorders 2

Question 1

Juvenile Idiopathic Arthritis definition

Answer 1

heterogeneous group of
arthritides of unknown cause beginning in
children up to 18 years of age and occurring for 6 weeks

Question 2

JIA pain is often _____ and (more/less) severe

Answer 2

aching and less severe

Question 3

Subcategories of JIA (4 main ones)

Answer 3

❑ Pauciarticular JIA (oligoarthritis)
❑ Polyarthritis JIA (RF+)
❑ Polyarthritis JIA (RF−)
❑ Systemic-onset JIA (SOJAI)

(less important)
❑ Psoriatic JIA
❑ Enthesitis-related arthritis
❑ Other (undefined)

Question 4

what is the most common type of JIA

Answer 4

pauciarticular (oligoarticular)

Question 5

pauciarticular JIA commonly involves the…

Answer 5

knees, elbows, wrists, and ankles.

Question 6

Pauciarticular (oligoarticular) JIA generally affects how many joints during the first ___ months of the disease?

Answer 6

4 or fewer joints during the first 6 months

Question 7

swollen joint, limp, abnormal gait, leg-length discrepancy are all typical of what type of JIA?

Answer 7

pauciarticular

Question 8

Oligoarticular JIA affects (girls/boys) more, ages ___ and ___

Answer 8

girls; ages 1 and 5

Question 9

polyarticular JIA affects how many joints?

Answer 9

five or more joints, most commonly including large and small joints

Question 10

polyarticular JIA affects which gender more?

Answer 10

girls

Question 11

polyarticular is usually (symmetric/asymmetric) and has the potential for …..?

Answer 11

symmetric; has potential for severe, destructive arthropathy

Question 12

2 subtypes of HIA

Answer 12

Rheumatoid factor–positive (RF+)
Rheumatoid factor–negative (RF-)

Question 13

Rheumatoid factor–positive (RF+) characteristics

Answer 13

presence of a rheumatoid factor
Subcutaneous nodules, cervical spine fusion, chronic uveitis, and destructive hip disease

Question 14

Rheumatoid factor–negative (RF-) characteristics

Answer 14

Joint involvement usually less severe
Morning stiffness and fatigue with possible low-grade fever are common.

Question 15

Systemic-onset JIA is also called?

Answer 15

Still Disease

Question 16

Systemic-onset JIA affects which gender more?

Answer 16

affects boys and girls equally

Question 17

systemic-onset JIA has the most severe _______?

Answer 17

extraarticular manifestations

Question 18

__% of children will systemic-onset JIA have joint symptoms within __ year(s) of the initial

Answer 18

95%; 1 year

Question 19

approximately _____ of the children recover almost entirely from systemic-onset JIA; ____ of children remain ill

Answer 19

1/2 (half)
1/3 (one-third)

Question 20

Treatment goals of JIA

Answer 20

• control pain
• preserve joint motion and function
• minimize systemic complications
• assist in normal growth and development

Question 21

spondyloarthropathies (SpAs) definiton

Answer 21

A group of disorders with similar features affecting the spine (used to be considered variants of RA before science kicked in)

Question 22

types of SpAs (5)

Answer 22

• Ankylosing Spondylitis (AS)
• Sjögren syndrome
• Psoriatic arthritis
• Reactive arthritis including arthritides that accompany inflammatory bowel disease (known as enteric arthritides)
• Reiter syndrome

Question 23

which gender is most affected by SpAs

Answer 23

young male; in late teens, early adulthood

Question 24

SpAs results in (acute/chronic) inflammation of which areas?

Answer 24

chronic; axial skeleton and sacroiliac joints

Question 25

SpAs presentation is symmetric or asymmetric?

Answer 25

asymmetric involvement of a small number of peripheral joints

Question 26

T/F SpAs have a familial predisposition

Answer 26

True

Question 27

Extraarticular involvement of SpAs

Answer 27

eyes, skin, genitourinary tract, cardiac system

Question 28

Ankylosing Spondylitis is also called

Answer 28

Marie-Strümpell disease

Question 29

ankylosing spondylitis definition

Answer 29

inflammatory arthropathy of the axial skeleton

Question 30

joints affected by ankylosing spondylitis

Answer 30

sacroiliac joint intervertebral disk articulations apophyseal joints costovertebral joints

Question 31

______ of individuals with AS have (symmetric/asymmetric) involvement of large, peripheral joints

Answer 31

1/3; asymmetric

Question 32

how many people in the US have ankylosing spondylitis

Answer 32

2 million people; almost as common RA

Question 33

what age group does ankylosing spondylitis typically affect

Answer 33

young people, age 15-30, rarely after age 40

Question 34

(Men/women) are ___ times more affected.

Answer 34

men; 2-3x more affected than women

Question 35

what is the enthesis

Answer 35

where the ligaments attach to the vertebrae

Question 36

ankylosing spondylitis results in chronic nongranulomatous inflammation where?

Answer 36

enthesis

Question 37

in ankylosing spondylitis, disruption of the ligamentous-osseous junction results in ....?

Answer 37

reactive bone formation

Question 38

characteristic of end-stage ankylosing spondylitis (AS)

Answer 38

fused, rigid, 'bamboo' spine

Question 39

AS has ______ onset

Answer 39

insidious

Question 40

Pain characteristics of AS

Answer 40

- at first, pain is 'dull ache' & poorly localized - over time, pain becomes more severe and constant - tenderness over spinous processes/SI areas

Question 41

with AS, morning stiffness lasts how long?

Answer 41

> 1 hour

Question 42

Patients with AS typically have early loss of lumbar ______ accompanied by increased _________ of the thoracic spine

Answer 42

lordosis; kyphosis

Question 43

T/F: AS results in loss of spine mobility in only the transverse and sagittal planes

Answer 43

FALSE; loss of spine mobility/flexibility in ALL 3 planes

Question 44

Can AS compromise breathing?

Answer 44

Yes, if costovertebral junctions ossify

Question 45

Complications of AS

Answer 45

osteoporosis fracture atlantoaxial subluxation spinal stenosis

Question 46

Common compensations of AS

Answer 46

Flexed knees to stay upright; flexion contractures; rigid gait

Question 47

what clinical features distinguish AS from mechanical pain

Answer 47

accompanied by: - inflammatory bowel syndrome with fever - fatigue - loss of appetite (weight loss)

Question 48

most common extraarticular manifestation of AS

Answer 48

uveitis (20-30% of affected individuals)

Question 49

T/F pulmonary problems occur in mid-stage AS

Answer 49

FALSE; late stage AS

Question 50

__% of people with AS experience daily pain

Answer 50

80%

Question 51

what does DISH stand for?

Answer 51

diffuse idiopathic skeletal hyperostosis

Question 52

what is DISH

Answer 52

idiopathic variant of OA where ligaments ossify (especially longitudinal ligaments of the spine)

Question 53

DISH is also called what?

Answer 53

Forestier disease

Question 54

DISH most commonly affects which region of the spine

Answer 54

thoracic

Question 55

DISH affects which gender more?

Answer 55

men > women (2:1); ages of 50 and 70 years

Question 56

DISH manifests with bony outgrowths attached to ligaments that are called ______________

Answer 56

syndesmophytes

Question 57

how is DISH differentiated from ankylosing spondylitis?

Answer 57

age (DISH = older) location (DISH is more cervical/thoracic) morphology (loosely flowing ossification on lateral view)

Question 58

DISH during the early stages is often _______________ and identified inadvertently from _______________

Answer 58

asymptomatic; radiographs

Question 59

Sjögren Syndrome definition

Answer 59

chronic autoimmune disease that causes arthritis-related effects in several organs

Question 60

Sjögren Syndrome most commonly affects the ________________

Answer 60

moisture-producing glands; joints; lungs; kidneys; liver

Question 61

Sjögren Syndrome most commonly affects _______

Answer 61

women, specifically postmenopausal women

Question 62

hallmark sign of Sjögren Syndrome

Answer 62

dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia)