Lec 5: Arthritides

Question 1

Most common rheumatic disease

Answer 1

osteoarthritis

Question 2

Osteoarthritis pathogenesis

Answer 2

Abnormal biomechanics leading to:
sclerosis, cysts, osteophytes, inflammation
**Asymmetric distribution

Question 3

OA Clinical presentation

Answer 3

1. Gradual onset of pain
2. Deep achy pain
3. Pain after activity, relieved by rest
4. Morning stiffness that resolves after 30min
5. Damp weather?

Question 4

Damp weather and OA

Answer 4

No link made yet, barometric pressure?

Question 5

OA-Spondylosis

Answer 5

Degeneration of facets, discs, vertebral bodies

Question 6

Degenerative Disc Disease

Answer 6

Back pain due to IVD degeneration

Question 7

Spinal OA management

Answer 7

CMT
PT
Weight loss if indicated
Exercise
Traction help with stenosis

Question 8

Seronegative Arthritides

Answer 8

Group of musculoskeletal syndromes similar to common clinical symptoms and mechanisms
*Absent rheumatoid factor

Question 9

Common clinical features of Seronegative arthritides

Answer 9

1. Male predominant
2. **Spontaneous exacerbations and remission
3. other issues: IBD, urethritis, eye disease

Question 10

Ankylosing Spondylitis presentation

Answer 10

• *3mos

* *relief with mild to moderate activity

Question 11

AS

Answer 11

**progressive spinal stiffening and fusion
usually affects SIJ
inflammatory arthritis
Loss of lordosis, increase kyphosis
Peripheral joint involvement

Question 12

AS evaluation

Answer 12

Normal neuro/ortho exams
decrease Lumbar ROM
**Primary radiographic diagnosis

Question 13

Amoss Sign

Answer 13

Instruct pt to get up from side lying position

Pos finding= pt places hands far from body and/or thoracic or thoracolumbar pain

Question 14

AS Radiograph

Answer 14

• *Bilateral asymmetric widening, erosion of SIJ
• *trolley track/bamboo spine seen
• *Changes may not be visible for 4-6yrs

Question 15

AS management

Answer 15

**Unpredictable remission/relapse
CMT to maintain mobility
Monitor for cardiac, pulmonary involvement

Question 16

Reiters Syndrome/Reactive Arthritis presentation

Answer 16

Young male

**Urethritis, conjunctivitis, skin lesions

Question 17

Reactive Arthritis

Answer 17

Diagnostic Triad-

• *Polyarthritis-knees, ankles, SIJ
• *Urethritis
• *Conjunctivitis
• *Lesion

Question 18

Reactive Arthritis evaluation

Answer 18

Hx of infection present (STD)
HLA-B27 marker
**Mechanical testing of SIJ=pain
change in film unilaterally (space narrowing, erosion)

Question 19

Reactive arthritis management

Answer 19

AB used to treat infection
CMT cautioned-could aggravate
Nonarticular symptoms resolve in days to weeks

Question 20

Psoriatic Arthritis

Answer 20

Precedes arthritis
**Can develop n absence of detectable psoriasis
MC in whites 35-55yo

Question 21

Psoriatic Arthritis with spondylitis

Answer 21

Occurs in 5% patients
Male predominance
**Sacroilitis if present is asymmetric
**vertebrae affected asymmetric

Question 22

Red flags are

Answer 22

Tumor, infection, spinal fx, nuero compromise (cauda equine)

**History is everything-be specific and ask lots of questions..weight loss, fever, numbness, weakness, etc

Question 23

abdominal aortic aneurysm (AAA) cause

Answer 23

Atherosclerosis MCC

Question 24

Location of AAA

Answer 24

MC L2-L4

**Most asymptomatic until rupture/bleed

Question 25

AAA facts

Answer 25

**life threatening **MC in white males 65-75yo M>F

Question 26

AAA presentation

Answer 26

Mild to severe Abdominal pain or LBP | Possibly leg pain due to claudication

Question 27

AAA radiograph

Answer 27

**>3.8cm=diagnostic **10-20% survival rate for ruptures >6cm needs surgical consult

Question 28

Cauda Equina Syndrome presentation

Answer 28

``` LBP sciatica **bladder/bowel dysfunction **Bowel dysfunction= most sensitive/specific indicator of Cauda equine **could be fatal ```

Question 29

Metastatic Disease

Answer 29

Most common site=Spine Not relieved with bed rest **May become symptomatic after trauma due to vertebral weakness **Immediate referral to oncologist

Question 30

Systemic Cancer

Answer 30

**Presents as initial spinal metastasis in 10% of pop | 60-70% of systemic cancer patients will have spinal metastasis

Question 31

Primary sources for metastatic disease

Answer 31

Lung-31% Breast-24% GI-9%

Question 32

Multiple Myeloma

Answer 32

MC primary malignant tumor of bone 70% patients experience bone pain **Lumbar spine most common site of pain

Question 33

Multiple Myeloma presentation

Answer 33

hypercalcemia renal disease **Bence jones proteins found **Osteopenia found on film

Question 34

Infectious Spondylitis

Answer 34

**History of recent respiratory tract , urinary, skin infection

Question 35

2 types of infectious spondylitis

Answer 35

1. Pyogenic- staph (90%), strep, gram neg organsims (could involve more than one vertebra) 2. Nonpyogenic- TB, fungi, brucella (centered around L1) * *REFER OUT

Question 36

Mechanical BP

Answer 36

Relief by rest 1 or more pain free positions sleep possible able to reproduce cc

Question 37

Non mechanical BP

Answer 37

No relief of symptoms no pain free positions may be worse at night unable to reproduce pain