Rheum - Polyarticular Arthritis Flashcards Preview

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

Causes of joint pain without inflammatory changes?

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

1

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

Extra-articular soft tissue inflammation – bursitis or tendinitis

2

If polyarticular disease with acute Sx?

If acute and symmetric?

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

If causing symmetric polyarthritis and fever consider: rheumatic fever

3

Symmetric peripheral polyarthritis characteristic finding of?

Rheumatoid arthritis or lupus

4

Psoriatic arthritis – findings?

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

Reactive arthritis symptoms? Caused by what organisms?

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

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

6

Hand finding in Osteoarthritis vs RA?

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

Swan neck deformity, boutonnière deformity, ulnar deviation

7

Rheumatoid nodules found where?

Extensor surfaces of proximal ulnar, lungs

8

Rheumatoid factor?

IgM that reacts to Fc portion of IgG

9

Radiologic findings in rheumatoid arthritis?

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

10

Felty syndrome?

#Rheumatic arthritis
#splenomegaly
#neutropenia

Can also see lymphadenopathy, thrombocytopenia, leukopenia

11

Classic Disease modifying antirheumatic drugs? Drug of choice?

DoC: Methotrexate

hydroxychloroquine, sulfasalazine, gold, penicillamine

12

Biologic agents? Advantage over other DMARDS? Side effect?

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

Reactivation TB

13

Drugs for patients who have failed Biologics and DMARDS?

Immunosuppressive agents – azathioprine, cyclosporine, cyclophosphamide, leflunomide

14

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

Slow progression of bone erosions

15

Extra-articular findings in rheumatoid arthritis?

#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

Sicca syndrome?

#RA
#Dry eyes and mouth

16

Specific RA tests?

#Anti-CCP > RF

17

RA Scoring?

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

6+ points = RA

18

Caplan syndrome?

#RA
#Pneumoconiosis
#Lung nodules

19

Most common cause of death in RA?

Coronary artery Disease

20

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

Methotrexate to slow disease progression

21

RA pt undergoing surgery should get?

Cervical spine x-ray to rule out subluxation before intubation

22

Adverse effects of methotrexate?

#Liver toxicity
#bone marrow suppression
#pulmonary toxicity

23

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

PPD

24

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

Hydroxychloroquine can cause retinal toxicity

Dilated eye exam

25

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

Sulfasalazine

26

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

Gold salts

27

Features of JRA OR Adult Still disease?

#Fever spikes
#Salmon colored rash on chest

Also:
#Splenomegaly
#Pericardial diffusion
#Mild joint symptoms

28

Treatment Of JRA/stills?

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

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