Rheum - Polyarticular Arthritis Flashcards Preview

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Flashcards in Rheum - Polyarticular Arthritis Deck (30)
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0
Q

A patient with joint pain has soft tissue swelling and tenderness with normal passive range of motion?

A

Extra-articular soft tissue inflammation – bursitis or tendinitis

1
Q

Causes of joint pain without inflammatory changes?

A
  1. Osteoarthritis
  2. Fibromyalgia
  3. Hypothyroidism
  4. Neuropathic pain
2
Q

If polyarticular disease with acute Sx?

If acute and symmetric?

A

It’s less than six weeks consider: Viral infection(hepatitis B/C, Rubella, parvovirus)

If causing symmetric polyarthritis and fever consider: rheumatic fever

3
Q

Symmetric peripheral polyarthritis characteristic finding of?

A

Rheumatoid arthritis or lupus

4
Q

Psoriatic arthritis – findings?

A
  1. Usually peripheral joint involvement with 5+ joints
  2. Need skin rash/nail changes
  3. Sausage digits (caused by inflammation at periosteum, tendons, insertion points)
5
Q

Reactive arthritis symptoms? Caused by what organisms?

A

Can’t see, can’t Pee, can’t climb a tree

GI and GU: Salmonella, Shigella, Campylobacter, Yersinia, or Chlamydia

6
Q

Hand finding in Osteoarthritis vs RA?

A

Heberden’s nodes (DIP) and Bouchard’s nodes (PIP)

Swan neck deformity, boutonnière deformity, ulnar deviation

7
Q

Rheumatoid nodules found where?

A

Extensor surfaces of proximal ulnar, lungs

8
Q

Rheumatoid factor?

A

IgM that reacts to Fc portion of IgG

9
Q

Radiologic findings in rheumatoid arthritis?

A
  1. Erosion of periarticular bone and cartilage
  2. Loss of joint space
  3. Joint space narrowing
10
Q

Felty syndrome?

A
#Rheumatic arthritis
#splenomegaly
#neutropenia

Can also see lymphadenopathy, thrombocytopenia, leukopenia

11
Q

Classic Disease modifying antirheumatic drugs? Drug of choice?

A

DoC: Methotrexate

hydroxychloroquine, sulfasalazine, gold, penicillamine

12
Q

Biologic agents? Advantage over other DMARDS? Side effect?

A

TNF antagonists (etanercept, infliximab, adalimumab) reduce disease activity within weeks as opposed to months.

Reactivation TB

13
Q

Drugs for patients who have failed Biologics and DMARDS?

A

Immunosuppressive agents – azathioprine, cyclosporine, cyclophosphamide, leflunomide

14
Q

low-dose corticosteroids may have this effect on rheumatic arthritis?

A

Slow progression of bone erosions

15
Q

Extra-articular findings in rheumatoid arthritis?

A
#Eyes – episcleritis, Keratoconjunctivitis sicca (Sjogren's)
#heart - pericarditis 
#Lungs – pleural effusions and nodules
#spine - cervical subluxation, compression
#vasculitis  – skin ulcers, bowel, nerves
#Baker cyst 
#Anemia
15
Q

Sicca syndrome?

A
#RA
#Dry eyes and mouth
16
Q

Specific RA tests?

A

Anti-CCP > RF

17
Q

RA Scoring?

A
#joint involvement (Up to five points)
#Elevated ESR or CRP
#Duration longer than six weeks
#RF or anti-CCP

6+ points = RA

18
Q

Caplan syndrome?

A
#RA
#Pneumoconiosis
#Lung nodules
19
Q

Most common cause of death in RA?

A

Coronary artery Disease

20
Q

Patient with RA and erosive disease on x-ray needs at least?

A

Methotrexate to slow disease progression

21
Q

RA pt undergoing surgery should get?

A

Cervical spine x-ray to rule out subluxation before intubation

22
Q

Adverse effects of methotrexate?

A
#Liver toxicity
 #bone marrow suppression
#pulmonary toxicity
23
Q

Before you can give a patient a TNF inhibitor, need?

A

PPD

24
Q

Patient with RA recently started on medication presents with eye problems – possible cause? Test?

A

Hydroxychloroquine can cause retinal toxicity

Dilated eye exam

25
Q

Patient with RA recently started on medication presents with rash and hemolysis – drug?

A

Sulfasalazine

26
Q

Patient with RA recently started on medication presents with nephrosis - drug?

A

Gold salts

27
Q

Features of JRA OR Adult Still disease?

A
#Fever spikes
#Salmon colored rash on chest
Also:
#Splenomegaly
#Pericardial diffusion
#Mild joint symptoms
28
Q

Treatment Of JRA/stills?

A
#Aspirin/NSAIDs
#if no response, steroids
#If steroid resistant, TNF drugs

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