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Lecture 10: Arthritis Part 2 Flashcards

1
Q

Juvenile idiopathic arthritis (JIA), is characterized by chronic arthritis in () joints for at least () weeks

A

1 or more joints for 6+ weeks.

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2
Q

Enthesis is…

A

Where bone and tendons interface

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3
Q

The MC type of JIA is () type, which is characterized by arthritis affecting () or fewer joints. It often affects medium to large joints and is (symmetrical/asymmetrical)

A
  • Oligoarticular type
  • 4 or less joints
  • Asymmetrical
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4
Q

Usually, the only S/S seen for oligoarticular JIA is a () discrepancy and inflammation in the ()

A
  • Leg-length discrepancy
  • Inflammation of the eye (Anterior uveitis i think)
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5
Q

Once 5 or more joints are affected in JIA, its type changes to (), and it typically is symmetrical

A

Polyarticular

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6
Q

Polyarticular JIA can be RF+ or RF-. The worse one that resembles adult RA is..

A

RF positive

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7
Q

Systemic JIA is rare, but it has 2 key features, which are:

  • High () 1-2x a day
  • () on pressure areas
A
  • High fever
  • Evanescent, salmon-pink macular rash
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8
Q

Enthesitis-associated JIA mainly affects () older than (), and typically only affects (lower/upper) extremity large joints.

A

Boys older than 10 in their LE large joints.

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9
Q

Hallmark sign of enthesitis-associated JIA is…

A

Inflammation of tendinous insertion (enthesopathy), such as tibial tubercle or the heel

LBP + sacroilitis are common too.

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10
Q

The diagnostic test for JIA is…

A

No diagnostic test :)

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11
Q

The two tests that may help detect RF+ JIA are…

A
  • Anti-CCP antibody
  • Positive ANA
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12
Q

Carrying the HLAB27 antigen increases the risk of developing (subtype) JIA

A

Enthesitis-associated

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13
Q

JIA joint fluid analysis typically shows () WBCs, primarily (). The glucose is usually ()

A
  • 5-60k WBCs, mainly neutrophils.
  • Normal to slightly low glucose
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14
Q

The initial imaging study for JIA is…

A

Radiographs

May only show soft tissue swelling

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15
Q

First line therapy for JIA is…
2nd line therapy for JIA is…

A
  1. NSAIDs (Naproxen, advil, meloxicam w/ food)
  2. MTX

TNF inhibitors are after MTX

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16
Q

You should only use corticosteroids for JIA in children with ()

A

Severe involvement/systemic JIA

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17
Q

Uveitis is primarily treated with () and ()

A
  • Steroid eye drops
  • Dilating agents
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18
Q

The best rate of clinical remission among the JIAs is (), and the worst for chronic arthritis into adulthood is ()

A
  • Best: Oligoarticular
  • Worst: RF+ JIA
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19
Q

Seronegative for spondyloarthritis means they are negative for ()

A

RF

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20
Q

Generally, the biggest association for seronegative spondyloarthritis is the () gene, especially with ankylosing spondylitis.

A

HLA B27

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21
Q

Seronegative spondyloarthritis are characterized by (symm/asymm) oligoarthritis of large peripheral joints and ()pathy

A
  • Asymmetrical
  • Enthesopathy
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22
Q

The biggest risk of developing reactive arthritis is those with HLA B27 + infection with… (3 bacteria)

A
  • Salmonella
  • Shigella
  • Enteric organisms

I feel like this could be a question…

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23
Q

The fusion of bones in ankylosing spondylitis is sometimes referred to as a () spine

A

Bamboo spine

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24
Q

Ankylosing spondylitis typically occurs in (age) and affects mainly (sex)

A
  • Late teens/early 20s
  • Males
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25
Back pain **worse in the morning and stiffness for hours that improves with activity** in a **20M** + **Flattening of the lumbar and exaggeration of the thoracic** is suggestive of...
Ankylosing spondylitis
26
Ankylosing spondylitis causes the lumbar spine to () while the thoracic spine ()
* Lumbar turns into a Line * Thoracic Curves (Chest Curves)
27
Ankylosing spondylitis can be differentiated from RA because () symptoms are not present.
Constitutional symptoms
28
Transient acute arthritis of the peripheral joints, turning them into sausages, is known as...
Dactylitis
29
What are the lab findings associated with ankylosing spondylitis? * Elevated (ESR vs CRP) in 85% * RF and anti-CCP antibodies are () * () gene in 90% of white pts
* Elevated ESR * NEGATIVE RF and anti-CCP antibodies * HLA B27 gene
30
* Bilateral and symmetrical erosion/sclerosis of sacroiliac joints. * Shiny corner sign * Bamboo spine All describe what spondyloarthritis?
Ankylosing spondylitis
31
* First-line tx for ankylosing spondylitis: () * 2nd-line tx: * () should not be used
* First-line: NSAIDs * 2nd-line: TNF inhibitors * DO NOT USE corticosteroids | I think this is the only one that TNF is 2nd-line instead of MTX
32
The development of () within the first 2 years of ankylosing spondylitis onset is a worse prognosis
Hip disease
33
In psoriatic arthritis, what comes first: the psoriasis or arthritis?
Psoriasis first usually
34
# Psoriatic arthritis subtypes 1. Symmetric polyarthritis can resemble (), but fewer joint involvement. 2. Oligoarticular form may lead to () of affected joints 3. () joints are primarily affected + pitting of the () 4. Arthritis mutilans is () deforming arthritis 5. Spondylotic form affects () and (), usually HLAB27 positive.
1. Resembles RA 2. Destruction of affect joints 3. DIP joints + pitting of nails 4. Severe deforming arthritis 5. Sacroilitis and spinal involvement
35
Lab findings in psoriatic arthritis: * Elevated (inflammatory marker) * RF is () * Elevated (acid)
* Elevated ESR * RF negative * Elevated uric acid | but no gouty attacks
36
* **Sharpened pencil fingers** on XR * Asymmetric sacroilitis and coarse syndesmophytes Most suggestive of...
Psoriatic arthritis
37
* First-line tx for psoriatic arthritis () * 2nd-line ()
* First-line: NSAIDs! (if mild) * 2nd-line: Methotrexate * Can add to TNF inhibitors to MTX if refractory
38
In the triad of: * Arthritis * Conjunctivitis/uveitis * **Urethritis** And HLA-B27 Positive The underlying condition could be...
Reactive arthritis
39
A patient that develops arthritis symptoms 1-4 weeks after a GI or STD infection might have...
Reactive arthritis
40
Reactive arthritis is (symm/asymm) and frequently involves () joints. It is also characterized by () and () at the onset of the disease.
* Asymmetrical * Large wt-bearing joints (knee/ankle) * Fever and Wt loss
41
Very low yield slide but if you really want to for reactive arthritis
42
* First line tx of reactive arthritis is () * 2nd line tx is ()
* First-line: NSAIDs * 2nd line: MTX or Sulfasalazine * anti-TNF for refractory | Also treat STDs
43
Which IBD is more common with arthritis?
Crohn's disease
44
In peripheral arthritis, the severity of IBD () the activity of the joint disease. In spondylitis arthritis, the severity of IBD () the activity of the joint disease.
* Peripheral Parallels * Spondylitis Single (independent) | IBD spondylitis is basically ankylosing spondylitis
45
* First-line tx of Peripheral arthritis () * First-line tx of spondylitis arthritis ()
* Peripheral: tx the IBD * Spondylitis: NSAIDs | Also DMARDs and corticosteroids can help
46
Septic arthritis is an acute onset of inflammatory arthritis in () joint
Monoarticular! | Usually the big ones
47
4 biggest RFs for septic arthritis are: * () in the blood * () joints * () immunity * Loss of () integrity
* Bacteremia * Damaged/prosthetic joints due to RA * Compromised immunity * Loss of skin integrity
48
The MC affected joint in septic arthritis is...
Knee
49
You need to get a () to diagnose septic arthritis, showing () WBCs, and primarily () cells
* Synovial fluid analysis * More than 50k WBCs * 90% PMN cells
50
Generally, imaging is () in the diagnosis of septic arthiritis
Not very useful early on.
51
The recommended initial tx for septic arthritis is (abx) + (abx) and ()
* Rocephin * Vanco (if MRSA sus) * Drainage of infected joint | Always admit!
52
Gonococcal arthritis is more common in (men/women)
Women | Common during menses and pregnancy only
53
Gonococcal arthritis has two distinct patterns after the initial 4 days of migraty polyarthralgias. Pattern 1 is similar to (), affecting wrists, fingers, ankles, or toes. 60% of pts. Pattern 2 is a purulent () affect the knees, wrist, ankle or elbow. 40% of pts.
* Pattern 1: tenosynovitis * Pattern 2: Purulent monoarthritis
54
The characteristic skin lesiosn seen in gonococcal arthritis are usually over the () and (), presenting as small, necrotic pustules
* Palms * Soles
55
You should order cultures of (4 orifices) in all gonococcal arthritis pts.
* Urethra * Throat * Cervical * Rectal
56
Synovial fluid analysis is not super diagnostic of gonococcal arthritis because gonorrhea is not a very () disease
Not a very virulent disease | It can be just inflammatory levels.
57
ABX therapy for gonococcal arthritis is one dose of () orally and ()
* Oral azithromycin * Rocephin | IV therapy for 7-10 days and admit ## Footnote No need to drain joint typically.
58
Leflunomide/Arava is used to treat RA, but is contraindicated in (2)
Liver failure and pregnancy
59
Entanercept is nice because you can still use () or () with it. | TNF inhibitor
MTX or NSAIDs can still be continued.
60
In order to take bisphosphonates, a patient must take it on an () stomach, drink (), and (position) themselves for 30 minutes.
* Empty stomach * Little water with it * Must remain upright for 30 mins after taking it. | -dronates
61
The alternative to bisphosphonates is...
Teriparatide/Forteo
62
The Boxed warnings for Raloxifene/Evista in osteoporosis use for postmenopausal females is...
VTE and CVD
63
Muscle relaxers are on Beer's List of bad drugs because they can cause () and ()
* Somnolence * Anticholinergic effects | Also they are mostly hepatically metabolized ## Footnote Flexeril/cyclobenzaprine Robaxin Soma Skelaxin Zanaflex/Tizanidine
64
Prolia/denosumab is mainly indicated for...
Osteoporosis

MSK (17 decks)

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