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MSK/RHEUM Flashcards

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1
Q

what is the most common arthropathy among adults and elderly

A

OA

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2
Q

how is OA defined

A

progressive loss of articular cartilage with reactive changes in the bone resulting in pain and destruction of the joint

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3
Q

Clinical features of OA

A

Decreased ROM, Joint crepitus and pain gradually worsening throughout the day and changes with weather
hard and bony joints

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4
Q

what are the common sites of involvement for OA

A

DIP (Heberden’s nodes)
PIP (Bouchards nodes)
Wrist, Hip, Knee, Spine

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5
Q

what do radiographs show with OA

A

asymmetric narrowing, subchondral sclerosis, cysts and marginal osteophytes

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6
Q

what is the treatment for OA

A

Weight reduction, moderate physical activity, Tylenol, NSAID are 1st line, Intra-articular steroids, viscuosupplement injection, bracing

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7
Q

what is rheumatoid arthritis

A

is a chronic disease with synovitis affecting multiple joints and other systemic extra-articulat manifestations

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8
Q

who is more affected by RA

A

females are more often affected than males with onset between 40-60 years of age.

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9
Q

what is the criteria for diagnosing RA

A

morning stiffness for >1hr for at least 6weeks
Arthritis and soft tissue swelling of >3joints and presents for at least 6 weeks
arthritis of hand joints for at least 6 weeks
symmetric arthritis for 6 weeks
subcutaneous nodules in specific places
Rheumatoid factor at a level above the 95th percentile
radiology changes of joint erosions or calcific changes

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10
Q

what lab findings are positive in RA

A

ESR and CRP are elevated
RF and Anti-CCP antibodies
radiographic findings show soft tissue swelling and juxta articular demineralization

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11
Q

what is the treatment for RA

A 
Consult rheumatologist 
PT/OT
NSAIDs with DMARDS
methotrexate initial DMARD used
Reconstructive surgery for severe cases
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12
Q

what serological test is most sensitive for RA

A

anti-CCP

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13
Q

what drugs are DMARDS that are used in RA

A

methotrexate, hydroxychloroquine, azothiprine

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14
Q

what are the symptoms of RA

A 
fever, fatigue, wt loss
joint stiffness
MCP, wrist, PIP, knee shoulder, ankle
worse in morning better with movement
swollen, tender, boggy, erythematous joints
Boutonniere deformity
Ulnar deviation at MCP
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15
Q

what is gout

A

inflammatory monoarticular arthritis caused by the crystallization of monosodium urate in joints
hyperurecemia is the hallmark of the disease

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16
Q

who is affected by gout

A

90% of patients are men over 30 and women are not affected until after menopause

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17
Q

what causes gout

A

increased production of uric acid
decreased excretion of uric acid
renal disease, NSAIDs, diuretics

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18
Q

what are the clinical features of gout

A

increased serum uric acid level
peak age of onset is between 40 to 60
sudden onset of exqusite pain where patient can not tolerate even a bed sheet on the toe
most often affects the big toe (podagra)
pain, erythema, swelling and warmth

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19
Q

what are tophi

where are they usually located

A

aggregations of urate crystals surrounded by giant cells in an inflammatory reaction

extensor surfaces of forearms, elbows, knees

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20
Q

how is gout diagnosed

A

joint aspirations under polarized light will show
needle shaped negatively shaped birefringent urate crystals
Serum uric acid is not helpful as it can be normal during an acute attack

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21
Q

what is the treatment for gout attack

A

bed rest,
NSAID (indomethacin)
Colchicine for pts who can not take NSAIDs
prednisone (7-10days)

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22
Q

what medication is used prophylactic therapy for gout

A

Allupurinol, probenecid,

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23
Q

what is pseudo gout

A

calcium pyrophosphate deposit in joints leading to inflammation

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24
Q

what are risk factors for pseudo gout

A

increases with age, and with OA of the joints
common in elderly with degenerative joint disease
hemochromatosis, hyperparathyroidism, hypothyroidism,

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25
what are the symptoms of pseudo gout
most common joints affected are knees and wrists | classically monoarticular
26
how is pseudo gout diagnosed
joint aspiration will show weakly positively birefringent rod shaped and rhomboidal crystals
27
what is the treatment for pseudo gout
treat underlying disorder | symptomatic managament of NSAIDs, colchicine, steroid injections
28
what Systemic lupus erythematosus
autoimmune disorder characterized by inflammation and positive ANAs and involvement of multiple organs
29
what are risk factors for SLE
``` Genetics Sun exposure Infections Hormonal estrogen drugs (procainamide, hydralazine, INH ```
30
SLE is most common in what patient
MC in young female | AA affected greater than whites
31
what are the clinical features of SLE
``` Joint pain, Fever, Malar/butter fly rash discoid lesions pericarditis renal disease pleuritis neurologic disease ```
32
what is the criteria for the diagnosis of SLE
Need 4 of these: Malar rash, Discoid skin lesions Photosensitivity, Oral ulcers, Arthritis, Serositis Renal Dz protein uria, Neuro Dz seizures, psychosis
33
Lab results in SLE
Positive ANA sensitive but not specific Anti-ds DNA and Anti-Sm are diagnostic of SLE but not very sensitice Anti-Histone Ab are present in 100% of cases of drug induced SLE
34
what is the treatment for SLE
avoid sun NSAID for MSK complaints Local or systemic steroids for acute exacerbations hydroxychloroquine
35
what is polymyositis
inflammatory disease of striated muscle affecting the proximal limbs, neck and pharynx
36
who is more commonly affected by polymyositis
women
37
what are the clinical features of polymyositis
proximal muscle weakness, dysphagia, over weeks Skin rash (malar) heliotrope (blue-purple) upper eyelid discoloration polyarthralgias and muscle atrophy
38
what are the laboratory findings in polymyositis
``` elevated CPK, aldolase muscle biopsy will show myopathic inflammation Anti-Jo-1 Anti-signal recognition particle Anti-Mi2 antibodies ```
39
what is the treatment for polymyositis
high dose steroids, methotrexate, azathioprine until symptoms resolve
40
what is polymyalgia rheumatic
idiopathic inflammatory condition causing synovitis, bursitis and tenosynovitis
41
what are the clinical features of polymyalgia rheumatica
aching/stiffness of proximal joints (shoulders, hips and neck) MC in Femal >50 Closely associated with temporal arteritis
42
what are the symptoms of Polymyalgia rheumatica
bilateral joint aching/stiffness >30min of the pelvic and shoulders with trouble combing hair, putting on coat and getting out of chair profound morning Stiffness
43
how is polymyalgia rheumatica diagnosed
clinical | elevated ESR
44
whats is TX for PMR
steroids
45
what is fibromyalgia
chronic nonprogressive course with waxing and waining in severity
46
what is the key to the diagnosis of fibromyalgia
multiple trigger points that are tender to palpation, symmetrical eighteen characteristic locations have identified
47
how is fibromyalgia diagnosed
point tenderness in 11 of the 18 trigger points for >3 months Biopsy will show moth eaten appearance
48
what is the Tx for fibromyalgia
exercise Pregabalin (lyrica) TCA,Cymbalata SSRI, Neurontin
49
what is reactive arthritis
is asymmetric inflammatory oligoarthritis of lower extremities that is preceded by an infectious process that is remote from the site of arthritis (1-4 weeks) prior
50
who commonly gets Reiters syndrome
HLA-B27 positive indiviuals
51
what organisms are associated with reiters
Salmonella, shigella, campylobacter, chalmydia, yersinia
52
what is the classic triad of reiters syndrome
arthritis, urethritis and ocular inflammation (conjuntivitis or uveitis cant see, cant pee and can't climb a tree
53
how is reactive arthritis diagnosed
``` synovial fluid for analysis WBC 10,000-20,000 elevated ESR Synovial fluid 1,000-8,000 cells/mm synovial fluid is bacterially negative ```
54
what is the treatment for reactive arthritis
NSAIDs first line if no response then try sulfasalazine or azathioprine Abx use is controversial
55
what is polyarteritis nodosa
small and medium artery inflammation involving the skin, kidney and peripheral nerves and gut
56
Who is affected by polyarteritis nodosa
Men generally between the ages of 40-60 | associated with hepatitis B&C
57
what are the clinical features of polyarteritis nodosa
fever, anorexia, weight loss, abdominal pain, peripheral neuropathy Skin lesions palpable purpura and livedo reticularis HTN, edema, oligouria and uremia
58
how is polyareritis nodosa diagnosed
vessel biopsy or angiography
59
Lab finding with polyarteritis nodosa
elevated ESR, CRP, proteinuria positive Hep B surface antigen
60
what is the treatment for polyarteritis nodosa
high doeses of steroids cytotoxic drugs and immunotherapy also may be used treat HTN
61
what is scleroderma
unknow cause and is characterized by deposition of collagen in the skin and less commonly in the kidney, heart and lungs
62
who is affected by scleroderma
women | ages 30 to 50
63
what are the clinical features of scleroderma
skin involvement affects 95% of the patients, changes most often start with the fingers swelling and the hands then the face Raynauds is seen in 75% of the patietns CREST Calcinosis, Raynauds, Esophageal dysfunction, sclerodactyly, telangiectasias
64
what lab finding are there with scleroderma
ANA is present in 90% of patients with diffuse scleroderma | Anticentromere antibody
65
what is Tx for scleroderma
there is no cure | treatment is organ specific of PPI, ACE, CCB
66
what is sjogrens syndrome
is an autoimmune disorder that destroys salivary and lacrimal glands could also be a secondary complication of RA, SLE, Scleroderma or Polymyositis
67
who is affected by sjorgrens
middle aged females
68
what are the clinical features of sjogrens
mucous membranes are most affected, dry mouth, dry eyes, parotid gland enlargement
69
what lab findings are there with sjogrens
RF present in 70% of cases, ANA in 60% of cases and Anti-RO
70
what test evaluates secretions by the lacrimal gland
schirmers tear test | wetting of less than 5mm of filter paper in the lower eyelid for
71
what is the treatment of sjogrens
artificial tears, and saliva, increased fluid intake, ocular and vaginal lubricants pilocarpine
72
what is juvenile idopathic arthritis
autoimmune mono or polyarticular arthritis
73
what types of JRA are there
Pauci-articular 4 or fewer medium or large joints systemic acute arthritis polyarticular resembles adult RA with systemic joint involvement
74
how is JRA diagnosed
RF+ in 15% it is usually a clinical diagnosis elevated ESR and CRP
75
what is the treatment for JRA
NSAIDs | methotrexate, leflunomide

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