OA, Soft Tissue Disorders, and Vasculitis

Question 1

What is carpal tunnel syndrome?

Answer 1

caused by entrapment of the median nerve
Symptoms in first 3 1/2 fingers
Numbness, tingling, weakness
Nocturnal awakening - shake

Question 2

how do you diagnose carpal tunnel syndrome?

Answer 2

tinels or phalens

Question 3

how do you treat carpal tunnel syndrome?

Answer 3

Treatable causes - repetitive injury, hypothyroidism, pregnancy, rheumatoid
Treatment - splint, NSAIDs, surgery

Question 4

what is fibromyalgia?

Answer 4

Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues.

Question 5

how will the PE present for fibromyalgia? what about lab?

Answer 5

normal except for trigger points–> cause extreme pain

no lab changes present

Question 6

What is the treatment for fibromyalgia?

Answer 6

Treatment – Aerobic exercise, relaxation, amitriptylline for chronic pain, pregabalin

Question 7

If a joint looks red and angry, what should you do? what will the results tell you?

Answer 7

• synovial fluid analysis

1. WBC
Normal <200
Non-inflammatory - 200-2000
Inflammatory - 2000-50,000
Septic - 50,000-100,000
2. Crystals
3. Culture & Sensitivity

Question 8

what will give you a positive rheumatoid factor?

Answer 8

RA - 65-85% positive
Connective tissue diseases
Chronic inflammation
Acute/chronic infections
Malignancies
Aging - 70 y/o (15%

Question 9

What will give you a positive ANA?

Answer 9

Against nuclear cellular antigens
Found in many rheumatic disorders
Sensitive for SLE but not specific
SLE - 95%
Drug-induced SLE - 50% 
Scleroderma - 75%+
RA - 25-50%
Sjogren’s - 50%
Dermatomyositis - 25%
Normal pop’n - 15%

Question 10

what is anti-phospholipid syndrome?

Answer 10

Antiphospholipid syndrome occurs when your immune system mistakenly attacks some of the normal proteins in your blood. Antiphospholipid syndrome can cause blood clots to form within your arteries or veins. It can also cause pregnancy complications, such as miscarriage and stillbirth.

Antiphospholipid syndrome may cause blood clots to form in your leg veins, a condition known as deep vein thrombosis (DVT). Antiphospholipid syndrome may also cause blood clots to form in organs such as your kidneys or lungs. Damage depends on the extent and location of the clot. For instance, a clot in your brain can cause stroke.

There’s no cure for antiphospholipid syndrome, but medications can be effective in reducing your risk of blood clots.

In antiphospholipid syndrome, your body mistakenly produces antibodies against proteins that bind phospholipids, a type of fat present in your blood that plays a key role in clotting (coagulation)

Question 11

how do you diagnose anti-phopholipid syndrome?

Answer 11

one clinical and one lab must be found

Clinical (either of following) :
Vascular thrombosis – one or more episodes of arterial, venous, or small vessel thrombosis
Pregnancy morbidity
Late term (>10 wk) abortion (normal fetus)
Premature birth (99%ile
-Lupus anticoagulant (prolonged PTT with failure to correct) x2 twelve weeks apart

Question 12

Describe degenerative joint disease:

Answer 12

Age > 50
Female = male
Asymmetrical
<30 min stiffness
Bony deformities
Lab normal
Osteophytes

Question 13

how can you help treat DJD?

Answer 13

Joint Protection / Weight loss
Splinting
Physical Therapy
Occupational Therapy
NSAIDs
topicals --> capsacin
Joint injection--> corticosteroids, hyaluron
Orthopedic intervention--> Synoviectomy, joint replacement

Question 14

what is first line for DJD

Answer 14

acetominophen

Question 15

what is gout?

Answer 15

Acute, intermittent, inflammatory pauciarthritis - usually lower extremity
Crystals demonstrated in joint
MTP is most common joint

Question 16

what is the treatment for gout?

Answer 16

Treatment:
Acute - oral colchicine, NSAIDs, or steroids
Chronic - uricosuric vs. xanthine oxidase inhibitor (allopurinol vs. febuxostat)

Question 17

what are the seronegative Spondyloarthropathies?

Answer 17

there are four types:

1. Ankylosing Spondylitis
2. Reactive Arthritis
3. Psoriatic Arthritis
4. Inflammatory bowel disease

associated with hla-b27 (NOT diagnostic)

Question 18

describe Ankylosing Spondylitis:

Answer 18

Bilateral sacroiliac involvement
spine begins to fuse together --> bamboo spine
Asymmetrical joint involvement
Extra-articular manifestations:
-Uveitis
-Cardiac – aortic insuff, heart block

Question 19

what are the two types of reactive arthritis?

Answer 19

Endemic form:
-Venereal transmission
-High male:female ratio
-Chlamydia
Epidemic form:
-Diarrheal illness
-Equal male:female ratio
-Yersinia enterocolitica

Question 20

what is psoriatric arthritis?

Answer 20

Asymmetrical inflammatory
May involve SI joints
7% of patients with psoriasis
- may see nail pitting and nail infection

Question 21

what are the types of arthritis associated with IBD?

Answer 21

Associated with either ulcerative colitis or Crohn’s disease
Two types – axial or peripheral
Peripheral type – fluctuates with underlying bowel disease

Question 22

describe the different types of vasculitis:

Answer 22

Leukocytoclastic vasculitis – drugs/allergy, palpable purpura
Granulomatosis with polyangiitis – Requires cyclophosphamide, cANCA
Polyarteritis nodosa (PAN) – multiple small bowel microaneurysms
Cryoglobulinemia – distal extremity – Hep B/C
Kawasaki disease – IVIG for aneurysm prevention
Behçet’s syndrome – recurrent oral ulcers
Thromboangiitis obliterans – smoking/lower extremity ulcers
Takayasu’s arteritis – large vessel obstruction
Henoch-Schönlein – Self-limited renal in children
Churg-Strauss – Asthma
Giant cell (temporal arteritis) – Age >50, ESR >50, prox aches Preventable blindness (medical emergency)