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MSK clin Med > Reactive and rheumatoid arthritis > Flashcards

Reactive and rheumatoid arthritis Flashcards

(72 cards)

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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
When the DIP is involved with psoriatic arthritis, what deformity is seen
Pencil cup deformity
26
If someone presents with opera glass hands or telescoping, what do they have
Arthritis mutilans
27
What are the supporting diagnostics for psoriatic arthritis
Inflammatory synovial fluid Elevated CRP / ESR RF negative
28
What is the first line treatment for psoriatic arthritis
Biologic DMARD -TNF inhibitor (etanercept, inflixamab, adulimumab) -Abatacept
29
If you give a patient with psoriatic arthritis a corticosteroid, what will the outcome be
Precipitation of pustular psoriasis
30
What is a second line agent for psoriatic arthritis
Non-biologics
31
How is RA described
Inflammatory symmetric polyarthritis
32
Which gender is RA more common in
females
33
What does RA have a strong genetic association with
HLA-DR
34
What becomes inflamed with RA
The synovial membrane
35
What are the articular symptoms associated with RA
Insidious AM prodromal pain, swelling, morning stiffness Pain / stiffness after rest periods Symptoms improve with activity
36
What joints are effected first with RA
small joints
37
What joints are NOT effected by RA
DIP T & L spine
38
What are the articular symptoms associated with RA
Hands and wrists Gross deformities with late stage RA
39
What deformities are seen with late stage RA
Swan neck deformities (hyperextension of PIP) Boutonniere deformities (flexion of PIP joint)
40
What are common presentations with RA
Dryness in eyes, mouth, mucous membranes Scleritis, keratitis, episcleritis interstitial lung disease pericarditis vasculitis
41
What is the first line of imaging with RA
Xray
42
What is the workup for RA
Anti-CCp antibodies - ACPA (most sensitive and specific) +RF Elevated ESR / CRP
43
What differentiates OA from RA
OA typically spares wrists and MCPs OA is Relieved, not worse with rest
44
How is gout differentiated from RA
Gout has rate bite lesions on Xray and is typically monoarticular
45
How is septic arthritis differentiated from RA
Septic arthritis is usually monoarticular and has no anti-ccp
46
What is the mainstay treatment for RA
DMARDs -Corticosteroids often given at start until DMARD can take effect
47
What steroid is generally given with initial DMARD treatment for RA
Prednisone
48
People with RA are at higher risk for what other diseases
Osteoporosis Lymphoma Infections
49
If someone under the age of 16 comes in with inflammatory arthritis that has lasted longer than 6 weeks, what is their likely diagnosis
Juvenile idiopathic arthritis
50
What gene is typically involved with Juvenile idiopathic arthritis
HLA
51
What is the most common joint effected by juvenile idiopathic arthritis
Knees
52
What is the most common juvenile idiopathic arthritis subtype
Oligoarticular
53
What age group is typically affected by oligoarticular JIA
Younger kids, generally girls
54
What type of patient is seropositive polyarticular JIA most often seen in
Teenage girls of color
55
What subtype of JIA is most similar to adult RA
seropositive polyarticular JIA
56
What type of JIA is most often seen in younger children (1-3y/o)
Seronegative polyarticular JIA
57
What RF factor will be seen with seronegative polyarticular JIA
RF negative but can transition to positive
58
What is systemic JIA
Arthritis in 1 or more joints with fever at least 2 weeks
59
What is the workup for JIA
Diagnosis of exclusion
60
What is osteoarthritis
Regular degenerative arthritis
61
What is the most common joint disease
Osteoarthritis
62
Who is osteoarthritis most commonly seen in
F>M
63
What is the general presentation of osteoarthritis
Asymmetrical progressive joint pain -AM stiffness <15min -joint line tenderness
64
What is the heberden node
DIP joint deformity
65
What is the Bouchard node
PIP joint deformity
66
What is the first line for diagnosis of osteoarthritis
Primarily clinical-> xray to confirm Weight bearing bilateral knee xray
67
What are the pharmacologic options for osteoarthritis treatment
Acetaminophen is first line NSAIDs are secondary-> more effective but more side effects intra-articular injection Arthroplasty
68
How often can you administer corticosteroid injections into a joint and why
Primarily given in the knee They are toxic to chondrocytes and will spike blood glucose, therefore can only be given every three months
69
What is the biggest risk of intra-articular steroid injections
Infection
70
What kind of intra-articular injections can be given for OA
Corticosteroids Hylaronic acid
71
What are hyaluronic acid injections indicated for
knee OA
72
When is a joint replacement indicated with OA
End-stage OA treatment

MSK clin Med (12 decks)

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