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MSK clin Med > Reactive and rheumatoid arthritis > Flashcards

Reactive and rheumatoid arthritis Flashcards

1
Q

What is another name for reactive arthritis

A

Reiters syndrome

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2
Q

Oligoarthritis that is precipitated by infection describes what kind of arthritis

A

Reactive arthritis

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3
Q

Where is reactive arthritis most commonly seen

A

Lower extremities

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4
Q

Which gender is more apt to get reactive arthritis

A

M 9:1

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5
Q

What gene is involved with reactive arthritis

A

HLA-B27

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6
Q

What is reactive arthritis often secondary to

A

GI or GU infections

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7
Q

Which GI bacteria can lead to reactive arthritis

A

shigella
salmonella
yersinia
campylobacter

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8
Q

What type of GU pathogens are involved with reactive arthritis

A

Chlamydia trichomatis
Ureaplasma urealyticum

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9
Q

What does asymmetric oligoarthritis mean in regards to reactive arthritis

A

Unpaired joint involvement
2-4 joints involved

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10
Q

What are common signs and symptoms of reactive arthritis

A

Joint stiffness/ decreased ROM
Joint effusion
Joint tenderness

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11
Q

What symptoms are associated with reactive arthritis

A

Enthesis
Dactylitis
Mucocutaneous lesions
ocular inflammation
cardiac manifestations

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12
Q

Where can mucocutaneous lesions occur with reactive arthritis

A

Circinate balanitis
Urethritis / cervicitis
Painless oral ulcers
Nail changes

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13
Q

What type of ocular inflammation is seen with reactive arthritis

A

Conjunctivitis
Iritis
scleritis
keratitis

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14
Q

What cardiac manifestations occur with reactive arthritis

A

Arotitis
Aortic regurge
Heart block

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15
Q

What is the reactive arthritis presentation PEARL to remember

A

Conjunctivitis (can’t see)
Urethritis (Can’t pee)
Arthritis (can’t climb a tree)
Balantitis (Can’t have sex with me)

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16
Q

What are supporting diagnostics for reactive arthritis

A

Synovial fluid
Elevated ESR and CRP
negative RF

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17
Q

What is the treatment with reactive arthritis

A

Mainstay is NSAIDs
2nd line is steroids
if persistent-> sulfasalazine or methotrexate

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18
Q

If a patient has chlamydia and is diagnosed with reactive arthritis, what additional treatment is required

A

6 months of targeted antibiotics

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19
Q

What is secondary to psoriasis

A

Inflammation arthritis

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20
Q

What gene is involved with psoriatic arthritis

A

HLA-B27

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21
Q

Who is at 5x greater risk for psoriatic arthritis

A

Those with severe skin conditions

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22
Q

What are the 5 different disease patterns seen with psoriatic arthritis

A

Systemic polyarthritis
Asymmetric mono- or oligoarthritis
Monoarthritis of DIP
Axial arthritis (spinal involvement)
Arthritis mutilans

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23
Q

Where on the body is psoriatic arthritis typically seen

A

Hands and feet

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24
Q

What is the preferred imaging for psoriatic arthritis and why

A

Xray
helps differentiate between other arthridities

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25
Q

When the DIP is involved with psoriatic arthritis, what deformity is seen

A

Pencil cup deformity

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26
Q

If someone presents with opera glass hands or telescoping, what do they have

A

Arthritis mutilans

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27
Q

What are the supporting diagnostics for psoriatic arthritis

A

Inflammatory synovial fluid
Elevated CRP / ESR
RF negative

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28
Q

What is the first line treatment for psoriatic arthritis

A

Biologic DMARD
-TNF inhibitor (etanercept, inflixamab, adulimumab)
-Abatacept

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29
Q

If you give a patient with psoriatic arthritis a corticosteroid, what will the outcome be

A

Precipitation of pustular psoriasis

30
Q

What is a second line agent for psoriatic arthritis

A

Non-biologics

31
Q

How is RA described

A

Inflammatory symmetric polyarthritis

32
Q

Which gender is RA more common in

A

females

33
Q

What does RA have a strong genetic association with

A

HLA-DR

34
Q

What becomes inflamed with RA

A

The synovial membrane

35
Q

What are the articular symptoms associated with RA

A

Insidious AM prodromal pain, swelling, morning stiffness

Pain / stiffness after rest periods

Symptoms improve with activity

36
Q

What joints are effected first with RA

A

small joints

37
Q

What joints are NOT effected by RA

A

DIP
T & L spine

38
Q

What are the articular symptoms associated with RA

A

Hands and wrists
Gross deformities with late stage RA

39
Q

What deformities are seen with late stage RA

A

Swan neck deformities (hyperextension of PIP)
Boutonniere deformities (flexion of PIP joint)

40
Q

What are common presentations with RA

A

Dryness in eyes, mouth, mucous membranes
Scleritis, keratitis, episcleritis
interstitial lung disease
pericarditis
vasculitis

41
Q

What is the first line of imaging with RA

A

Xray

42
Q

What is the workup for RA

A

Anti-CCp antibodies - ACPA (most sensitive and specific)

+RF

Elevated ESR / CRP

43
Q

What differentiates OA from RA

A

OA typically spares wrists and MCPs
OA is Relieved, not worse with rest

44
Q

How is gout differentiated from RA

A

Gout has rate bite lesions on Xray and is typically monoarticular

45
Q

How is septic arthritis differentiated from RA

A

Septic arthritis is usually monoarticular and has no anti-ccp

46
Q

What is the mainstay treatment for RA

A

DMARDs
-Corticosteroids often given at start until DMARD can take effect

47
Q

What steroid is generally given with initial DMARD treatment for RA

A

Prednisone

48
Q

People with RA are at higher risk for what other diseases

A

Osteoporosis
Lymphoma
Infections

49
Q

If someone under the age of 16 comes in with inflammatory arthritis that has lasted longer than 6 weeks, what is their likely diagnosis

A

Juvenile idiopathic arthritis

50
Q

What gene is typically involved with Juvenile idiopathic arthritis

A

HLA

51
Q

What is the most common joint effected by juvenile idiopathic arthritis

A

Knees

52
Q

What is the most common juvenile idiopathic arthritis subtype

A

Oligoarticular

53
Q

What age group is typically affected by oligoarticular JIA

A

Younger kids, generally girls

54
Q

What type of patient is seropositive polyarticular JIA most often seen in

A

Teenage girls of color

55
Q

What subtype of JIA is most similar to adult RA

A

seropositive polyarticular JIA

56
Q

What type of JIA is most often seen in younger children (1-3y/o)

A

Seronegative polyarticular JIA

57
Q

What RF factor will be seen with seronegative polyarticular JIA

A

RF negative but can transition to positive

58
Q

What is systemic JIA

A

Arthritis in 1 or more joints with fever at least 2 weeks

59
Q

What is the workup for JIA

A

Diagnosis of exclusion

60
Q

What is osteoarthritis

A

Regular degenerative arthritis

61
Q

What is the most common joint disease

A

Osteoarthritis

62
Q

Who is osteoarthritis most commonly seen in

A

F>M

63
Q

What is the general presentation of osteoarthritis

A

Asymmetrical progressive joint pain
-AM stiffness <15min
-joint line tenderness

64
Q

What is the heberden node

A

DIP joint deformity

65
Q

What is the Bouchard node

A

PIP joint deformity

66
Q

What is the first line for diagnosis of osteoarthritis

A

Primarily clinical-> xray to confirm

Weight bearing bilateral knee xray

67
Q

What are the pharmacologic options for osteoarthritis treatment

A

Acetaminophen is first line

NSAIDs are secondary-> more effective but more side effects

intra-articular injection

Arthroplasty

68
Q

How often can you administer corticosteroid injections into a joint and why

A

Primarily given in the knee

They are toxic to chondrocytes and will spike blood glucose, therefore can only be given every three months

69
Q

What is the biggest risk of intra-articular steroid injections

A

Infection

70
Q

What kind of intra-articular injections can be given for OA

A

Corticosteroids
Hylaronic acid

71
Q

What are hyaluronic acid injections indicated for

A

knee OA

72
Q

When is a joint replacement indicated with OA

A

End-stage OA treatment

MSK clin Med (12 decks)

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