Rheum #4

Question 1

how many people with radiographic OA have symptoms?

Answer 1

33%

Question 2

Common S&S of OA

Answer 2

joint pain w/ motion, relieved with rest

short duration of stiffness (<30 min) after immobility (GELLING)

Question 3

what are herberdens and bouchards nodes

Answer 3

herberden- distal nodes

bouchards- pip

Question 4

common back OA locations

Answer 4

l4/l5, l5/s1

C5 and c6

Question 5

radiographic hallmarks of OA

Answer 5

loss of joint space, osteophytes, subchondral sclerosis, subchondral cysts

Question 6

non pharm tx of OA

Answer 6

1. pt education
2. weight loss
3. Exercise + physiology
4. Acu around jt

Question 7

meds for OA?

Answer 7

acetaminophen up to 4 g/d
NSAIDs (2nd line)
3rd line (acetaminophen and codein)
4th line (cortciosteroid or hyaluronic acid)

Question 8

what is gout + who does it affect

Answer 8

defect in urate metabolism with 90% of cases in men

-forms monosodium urate crystals

Question 9

major risk factors of gout

Answer 9

Diet (alcohol, red meats and seafoods)

Diuretics

Question 10

major S&S of gout

Answer 10

1) acute gouty arthritis (pain, redness, joint swelling, usually lower extremities)
2) Tophi (urate deposites, commonly first MTP)
3) Kidney –> uric acid nephrolithiasis

Question 11

common locations of gout

Answer 11

1st mtp = podagra
ankle
knee

Question 12

2 precipitants of gout, acronyms

Answer 12

FACT (furosemide, aspirine/alcohol, cylclosporine, thiazide diuretics)

SALT (seafood, alcohol, liver/kidney, turkey (meat) )

Question 13

Best investigations for gout

Answer 13

joint aspirate (negatively birefringent, needle-shaped)
2. (normal in early disease, cortical erosion happens later)

Question 14

is elevated uric acid level alone good enough for indication for treatment for gout?

Answer 14

no, you must tap the joint

Question 15

best initial treatment for acute gout

Answer 15

NSAIDs

Question 16

treatment for chronic gout?

Answer 16

conservcative –> decrease high-purine foods (meat + seafood), alcohol and beer

avoid drugs with hyperuricemic effects (thiazide)

Question 17

what is pseudogout also known as

Answer 17

Calcium Pyrophosphate Dyhidrate Disease (CPPD)

Caused by calcium pyrophosphate crystals
slower onset than gout (pt will not wake up w severe pain)

Question 18

S&S of pseudogout (CPPD)

Answer 18

asymptomatic cyrstal deposition, with acute crystal arthritis that resembles gout

may cause psuedo-OA, but does not affect DIP and PIP

Question 19

What areas does pseudogout ignore

Answer 19

DIP and PIP

Question 20

common sites of gout/CPPD

Answer 20

knee (MC), polyarticular wrist, hand (mcp only), foot (1st mtp), hip

Question 21

most accurate test for pseudogout?

Answer 21

joint aspiration

Question 22

how to differentiate gout vs pseudogout on aspiration

Answer 22

on aspiration, crystals are positive birefringence (blue) and rhomboid shaped in pseudogout/cppd

Question 23

treatment for pseudogout

Answer 23

NSAIDs (best)

intraarticular or oral steroids for inflammation

Question 24

characteristics of polymyalgia rheumatica (PMR)

Answer 24

pain and stiffness at proximal extremities (girdle)

no muscle weakness
2:1 F/M
normally over age 50

Question 25

S&S of Polymyalgia rheumatica (PMR)

Answer 25

constitutional symptoms (fever, weight loss, malaise) pain and stiffness at proximal muscles difficult combing hair, rising from chair tender muscles but NO TRUE WEAKNESS OR ATROPHY

Question 26

Investigations for polymyalgia rheumatica (PMR)

Answer 26

``` elevated ESR and CRP U/S and MRI thyroid profile electrolytes level FBS rheumatic factor (RF) ```

Question 27

required diagnostic criteria for polymyalgia rheumatica (PMR) because it is dx of exlcuison (3)

Answer 27

age > 50 yr bilateral shoulder aching (no weakness tho) abnormal ESR/CRP (elevated)

Question 28

PMR morning stiffness?

Answer 28

lasts for hours!

Question 29

treatment for PMR

Answer 29

prednisone 10-20mg orally will help with pain, should be continued for 1-2 yrs

Question 30

the most frequent vasculitis in north america is?

Answer 30

giant cell arteritis (large vessel vasculitis)

Question 31

S&S of giant cell Arteritis

Answer 31

new onset temporal headache sudden, painless loss of vision and/or diplopia tongue and jaw claudication PMR present in 30% of cases

Question 32

Investigations for Giant Cell Arteritis

Answer 32

Increased ESR Increased CRP Temporal artery biopsy (most accurate)

Question 33

Giant Cell Arteritis diagnositic crtieria (how many do u need)

Answer 33

1.Age at onset 50 2.New headache (Often temporal) 3.Temporal artery abnormality (temporal artery tenderness or decreased pulsations, not due to arteriosclerosis) 4.Elevated ESR (ESR ≥ 50 mm/hr.) 5.Abnormal artery biopsy (Mononuclear cell infiltration or granulomatous inflammation, usually with multinucleated giant cells) ● GCA is Diagnosed if 3 or more of the above 5 criteria present

Question 34

if suspect GCA, treatment?

Answer 34

immediate high dose prednisone, may need methylprednisolone IV this is an emergency!

Question 35

prognosis related to giant cell arteritis

Answer 35

increased risk of thoracic aortic aneurysm and aortic dissection

Question 36

investigations for Fibromyalgia

Answer 36

TSH and ESR (typically normal) order laboratory sleep assessment

Question 37

Diagnostic criteria for fibro

Answer 37

widespread pain index over 7 and Symptom Severity over 5 OR WPI 3-6 and SS scale over 9

Question 38

treatmetns for fibro

Answer 38

education, exercise, stress reduction, low dose tricyclic antidepressent. NSAIDS NOT first line

Question 39

etiology of chronic fatigue syndrome

Answer 39

More sprevelent in women

Question 40

Suggested causes in chronic fatigue syndrome

Answer 40

- exposure to toxins etc - genetic abnormalities - immune response to inf - microbial inf - trauma