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Clin Med Exam 3 > RA/OA/Polymalgia/Fibromyalgia > Flashcards

RA/OA/Polymalgia/Fibromyalgia Flashcards

(108 cards)

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1
Q

Most common inflammatory arthritis

A

RA

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2
Q

RA

A

autoimmune disease; chronic, systemic, inflammatory disorder that primarily involves SYNOVIAL JOINTS (cartilage erosion and inflammation of synovial membranes); extraarticular manifestations

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3
Q

Prevalence of RA

A

W>M

Peak age: 35-50 YO

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4
Q

Cause of RA

A

Genes (HLA) + enviorment

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5
Q

Sx of RA

A

SYMMETRICAL polyarthritis
Peripheral –> proximal
Axial skeleton usually spared (except cervical spine)
GRADUAL onset (difficult performing ADL’s)
Predominant Sx: pain, stiffness and swelling
MORNING STIFFNESS >1 HOUR
- better with movement

Constituional sx: myalgia, FATIGUE, low-grade fever, weight loss, poor sleep

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6
Q

Most common joints effected in RA

A

hands, wrists, and forefoot (others: elbows, shoulder, ankles, knee)

Joints: Wrists, MCP and PIP

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7
Q

Morning stiffness >1 hour

A

RA

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8
Q

Gets better with movement

A

RA

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9
Q

RA not found in these joints

A

DIP

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10
Q

PE for RA

A

joint inflammation; pain (TTP or movement of joint, squeeze tenderness of MCP and MTP)
Swelling: palpable synovial thickening (boggy), effusion (fluctuance)

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11
Q

Hands in RA

A

symmetrical inflammation of MCP and PIP
Flexor tendon tenosynovitis (decreased ROM, reduced grip strength, trigger finger)
Swan-neck and boutonniere deformities
Ulnar deviation

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12
Q

Ulnar deviation

A

RA

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13
Q

Swan-neck and boutonniere found in

A

RA

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14
Q

Trigger finger usually occurs with

A

RA

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15
Q

Other UE sx in RA

A

wrist: loss of extension, carpal tunnel syndrome*

Shoulder (late): frozen shoulder

Elbow: loss of extension, ulnar nerve compression, rheumatoid nodules

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16
Q

Most common site for rheumatoid nodules

A

Elbow

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17
Q

LE sx of RA

A

callus/hallus (bunion) on feet, hammer toes

Effusion & limited ROM (flexion) of knee; POPLITEAL CYST

Hips: longstanding disease
restriction of movement

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18
Q

Cervical spine in RA

A

Atlantoaxial joint instability (C1-C2); cervical subluxation

Sx: neck pain, stiffness, and radicular pain; can lead to cervical myelopathy

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19
Q

Can lead to cervical myelopathy

A

RA of cervical spine

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20
Q

Marker of disease severity of RA

A

extraarticular manifestations (increased morbidity and premature mortality; may antedate onset of polyarthritis)

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21
Q

Most likely to develop extrarticular disease from RA

A

Hx of smoking
Early onset of significant physical disability
Test (+) for RF

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22
Q

Extraarticular manifestations of RA

A 
Skin: nodules (advanced)
Eye: scleritis, uveitis, keratoconjunctivitis sicca (secondary Sjogren's syndrome)
Pulmonary: pleural effusion, pleuritis, interstitial lung disease
CV: CAD, myocarditis, pericarditis
MSK: osteopenia/osteoporosis
Heme: anemia of chronic disease
CNS: aseptic meningitis
Felty Syndrome (rare)
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23
Q

Felty syndrome

A

Triad of:
RA
Splenomegaly
Neutropenia

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24
Q

Secondary sjogren’s syndrome

A

RA extraarticular manifestation of eyes

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25
Imagine for RA
Radiography*, MRI, U/S
26
Preferred initial imagine for RA & Findings
Radiography: Findings: soft tissue swelling around joint, periarticular osteopenia, joint space narrowing, bony erosion, subluxation
27
MRI and U/S in RA
no established role in routine eval of RA; sensitive at detecting changes resulting from synovitis
28
What do you use to evaluate cervical spine in RA
MRI
29
Labs for RA
RF Anti-cyclic citrullinated peptide antibodies (anti-CCP) Antinuclear antibody (ANA) CBC- anemia, thrombocytosis, mild leukocytosis ESR/CRP- elevated synovial fluid analysis (arthrocentesis)
30
First antibody associated with RA
RF (75-80% of patients); prognostic value
31
Anti-CCP anitbody
most specific for RA (in 60-70% of patients); correlate strongly with erosive disease
32
Antibodies for RA
ANA (not specific) RF (moderate specificity) ACCP (high specificity)
33
Arthrocentesis of RA
dx or exclusion of: gout, pseudogout, infection | Synovial fluid analysis: usually reveals an inflammatory effusion
34
Who should be tested for RA
- have at least 1 joint with definite clinical synovitis | - synovitis not better explained by another disease
35
Dx of RA
meet 6/10 on ACR/EULAR chart (joint involvement, serology, acute-phase reactants, duration of symptoms)
36
Seronegative RA
lack RF and ACCP anitbodies
37
Dx of seronegative RA
based on findings otherwise characteristic of RA if appropriate exclusions have been met
38
Tx for RA
``` early recognition and dx refer to rheumatology DMARD's* target-to-treat strategy antiinflammatory agents as adjunct therapy prevention of joint injury maintain muscle strength, joint alignment, joint mobility Preserve ADL ```
39
Non parm treatment for RA
rest, exercise, PT/OT nutritional and dietary counseling SMOKING CESSATION psychosocial intervention
40
Pharm tx for RA
DMARD's + NSAID or glucocorticoid
41
DMARDs
slow/halt disease progression, preserving joint function (start early)
42
Pretreatment evaluation for DMARDs
Baseline serology: CBC, serum creatinine, LFTs, ESR/CRP, Hep B or C Opthamologic screening (for hydroxychloroquine use) TB test Vaccines
43
Risk of DMARDs
infection, malignancy
44
Nonbiologic DMARD
Methotrexate (MTX)*, hydroxychloroquine, sulfasalazine, leflunomide
45
Biologic DMARD
TNF-inhibitors*, IL-1, IL-6 antagonists T-cell inhibitor monoclonal antibody JAK inhbitor
46
TNF inhibitors
etanercept infliximab Adalimumab
47
Most common joint disorder
OA
48
Leading cause of chronic disability in OLDER ADULTS
OA
49
Prevalence of OA
W>M older than 55
50
Primary sx of OA
joint pain and functional impairement
51
Joints involved in OA
knees, hips, hands (DIP, PIP, 1st CMC), spine (cervical and lumbar), feet (1st MTP joint)
52
Difference in locations of OA and RA
RA- MCP, PIP, wrists, cervical spine OA- DIP, PIP, 1st CMC, knees, hips, cerivcal & lumbar spine, feet (1st MTP)
53
Pathogenesis of RA
cartilage erosion and synovial inflammation
54
Pathogenesis of OA
involves ALL joint tissues: cartilage, bone, ligaments and synoviium Progressive loss and destruction of cartilage, overtime joint space narrows Bone changes: bone sclerosis, subchondral cysts, osteophytes (spurs) Synovitis Soft tissue: ligaments, joint capsule, menisci (knee), muscles and nerves
55
Factors contributing to OA
``` aging joint injury (postraumatic OA) obesity genetics (FHx) Anatomic factors (joint shape, aligment) female ```
56
Sx of OA
Joint pain: worse with use, relieved by rest, worse in afternoon/early evening Stiffness: worse after effort, evening stiffness, morning stiffnes <30 min
57
Morning stiffnes >1 hr
RA
58
Morning stiffness <30 min
OA
59
Worse with exercise
OA
60
Evening stiffness
OA
61
Better with activity
RA
62
Usage related pain
OA
63
PE for OA
``` TTP reduced ROM bony enlargement/swelling joint deformity joint instability ```
64
OA hands
Heberden's and bouchard's nodes, first CMC joint (squared off)
65
Squared off CMC
OA
66
Node on PIP
Bouchard's
67
Node on DIP
Heberden's
68
OA knees
bilateral, swelling/effusion, joint line tenderness, crepitus, limitation of ROM
69
Hips OA
frequently unilateral restricted internal ROM pain around hip/groin may have referred pain to knee (distal)
70
OA radiological findings
joint space narrowing, OSTEOPHYTE, sclerosis, cysts
71
Lab findings for OA
``` No specific test: Synovial fluid analysis (r/o other diseases) CBC (no leukocytosis) Negative RF & anti-CCP antibodies Normal ESR and CRP ```
72
Biggest way to distinguish between OA and RA
look at locations and LAB WORK IS REALLY DIFFERENT (ESR/CRP, RF, ACCP, Leukocytosis)
73
Dx of OA
CLINICAL: without imagine/lab investigations Criteria: presence of s/sx, at-risk age group
74
Nonpharm tx for OA
exercise, weight loss, PT/OT, assisted devices if needed
75
Pharm therapy for OA
``` pain and inflammation: NSAIDs (Topical, PO) Topical Capsaicin Duloxetine Intraarticular glucocorticoids Tramadol/tylenol * use opiods sparingly if at all ```
76
Surgical tx for OA
reserved for those who failed less invasive modes of therapy
77
3 overarching tx for OA
1. Lose weight 2. Anti-inflammatory 3. Surgery if resistant to other tx
78
Hard and bony joints
OA
79
soft, warm and tender joints
RA
80
Extrarticular manifestations
RA only (not OA)
81
Autoimmune disease
RA
82
Degenerative disease
OA
83
Polymyalgia rheumatica (PMR)
chronic, inflammatory rheumatic condition
84
Sx of PMR
proximal aching and stiffness (shoulder, pelvic girdle, neck); worse in morning >1 hr/ gel phenomenon (stiffness with inactivity) BILATERAL recent, discrete change in sx Systemic: malaise, fatigue, low-grade fever
85
Prevalence of PMR
>50 YO peak: 70-80 YO F>M; northern european
86
PMR cause
Genetic (HLA) + environmental (virus); | Association with giant cell (temporal) arteritis (GCA) (50%)
87
Sx of PMR due to
nonerosive synovitis and tenosynovitis
88
PE for PMR
limited ROM (abduction of shoulders), normal strength (subjective weakness), synovitis
89
Labs for PMR
ESR/CRP: elevated (ESR >50) normocytic anemia negative ANA, RF, ACCP CK normal
90
RA similar to PMR in labs BUT
negative ANA, RF, ACCP
91
imaging for PMR
MRI and U/S (burisitis, synovitis)
92
Dx of PMR
no criteria: >50 YO proximal and symmetrical w/ morning stiffness (shoulder, neck, pelvic girdle) Elevated ESR/CRP Rapid resolution with low-dose glucocorticoids*
93
Improves rapidly with glucocoticoid
PMR
94
Tx for PMR
GLUCOCORTICOID (10-20mg/day) | Limited use of MTX (select patients)
95
Fibromyalgia (FM)
widespread musculoskeletal pain and tenderness; often accompanied by fatigue, psych symptoms and multiple somatic symptoms; etiology unknown
96
Prevalence of FM
W>N | Increased: age 20-50
97
FM cooccurs with
RA and SLE
98
Pathophys of FM
central pain processing (central sensitive due to altered pain processing); strong genetic predisposition
99
Sx of FM
widespread MSK pain (>3 mo) FATIGUE and POOR SLEEP Cognitive distrubance (fog) psych distrubance (depression/anxiety) Additonal: H/A, pelvic pain, IBS, IC (painful bladder), OSA, RLS (restless leg syndrome), parathesia, balance issues, sensitive to light, noice, odor, cold
100
PE of FM
``` TTP in characteristic locations : under SCM near 2nd costochondral junction lateral epicondyle greater trochanter medial fat bad of knee insertion of suboccipital muscle traps supraspinatus buttock ```
101
Dx of FM
hx and PE absence of other systemic condition accounting for pain Coexist with other disorders
102
Criteria of FM
widesprain pain >7 Sx >3 mo no other disorder
103
Tx of FM
Nonpharm: exercise, PT, CBT Pharm: tricycline antidepressants (amitriptyline OR cyclobenzaprine) Serotonin and NE reuptake inhibitors (SNRIs)- Duloxetine and Milnacipran Anticonvulsants: pregabalin, gabapentin
104
Labs for FM
unremarkable
105
Anticonvulsants for FM
Pregabalin | Gabapentin
106
SNRIs for FM
Duloxetine | Milnacipran
107
Tricyclic antidepressant
Amitryptyline | Cyclobernzoaprine
108
Duloxetine use
OA or FM

Clin Med Exam 3 (7 decks)

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