367 Arthritides Flashcards
Chapter 367. Arthritis associated with Systemic Disease and other Arthritides
Common feature of arthropathy of acromegaly
Osteoarthritis
When does arthropathy of hemochromatosis occur
Occurs in 20-40% of patients at age 50 and may be the first clinical feature of hemochromatosis
First and most prominent joints affected in arthropathy of hemochromatosis
Second and third metacarpophalangeal joints of both hands
What arthropathy are hook like osteophytes seen?
Arthropathy of hemochromatosis
Early diagnosis of arthropathy of hemochromatosis is suggested by what
High serum transferring saturation
Two ways iron damages articulate cartilage
- Iron catalyzed super oxide dependent lipid peroxidation which play a role in joint damage
- Ferric iron interfere with collagen formation leading to chondrocalcinosis
True or false. Repeated phlebotomy although a treatment of hemochromatosis, it has little effect on established arthritis and chondocalcinosis may progress still
True
Symptom based treatment for arthropathy of hemochromatosis
NSAIDs
Common problem of hemophilia and can lead to deforming arthritis
Spontaneous hemarthrosis
Most affected joints of hemarthrosis
Knees Ankles Elbows Shoulders Hip
In hemarthrosis, joint function usually returns to normal or baseline in how many weeks
Joint function usually returns to normal or baseline in about two weeks
What distinguishes bleeding into the iliopsoas from hip synovitis and hemarthrosis
In bleeding of iliopsoas, rotation of hip is preserved
What forms when bleeding involves the periosteum or bone
Painful pseudotumor
True or false. Septic arthritis is common in hemophilia due to hemarthrosis
False. Septic arthritis is rare. But to distinguish clinically from hemarthrosis
What is the treatment of musculoskeletal bleeding in patients with hemophilia
Immediate infusion of factor VII or IX at first sign of joint or muscle hemorrhage
What may be given to those hemophilia patient who developed factor inhibitors
Recombinant activated factor VII or activated prothrombin complex concentrate
How should the joint be positioned in hemarthrosis
Joint should be rested in position of forced extension to avoid contracture
What time of algesia is given to hemarthrosis or in patients with hemophilia
Non selective NSAIDs
COX-2 inhibitors
Alternative treatment for hemarthrosis when surgical synovectomy is not practical
Radiosynovectomy with either yttroum 90 silicate or phosphorus 31
Refers for the diffuse swelling tenderness and warmth of the hands and feet lasting for 1-3 weeks in patients with sickle cells disease
Sickle cell dactylitis or hand-foot syndrome
What causes the dactylitis in sickle cell disease
Result from infarction of the bone marrow and cortical bone leading to periostitis and soft tissue swelling
True or false. Sickle cell dactylitis is seen in patient of all age groups.
False. Rarely seen beyond 5 years old as hematopoeisis ceases in small bones of hand and feet after age 5.
In sickle cell crisis, which joints are commonly affected
Knees and elbows
True or false. Patient with sickle cell disease are predisposed to osteomyelitis
True
In osteomyelitis affected sickle cell disease, which bones are commonly affected
Long tubular bones
What is the common pathogen for osteomyelitis in patients with sickle cell disease
Salmonella
True or false. Clinical distinction between osteomyelitis and bone infarction can be difficult without imaging.
True
How does sickle cell disease lead to bone infarction
Resulting from vaso occlusion from sickling of the cells
A vascular necrosis of the head of the femur occurs in 5% of patient with sickle cell disease
True
True or false. Septic arthritis is occasionally encountered in sickle cell disease
True
Common pathogen for septic arthritis in sickle cell disease
Staph aureus
Streptococcus
Salmonella
True or false. Acute gouty arthritis is uncommon in sickle cell disease despite hyperuricemia
True
True or false. Bone and joint abnormalities are common in thalassemia major and intermedia group
True
True or false. Avascular necrosis is common in thalassemia just like sickle cell disease.
False. No sickling of cells in thalassemia that leads to thrombosis and infraction
About 50% of patients with thalassemia have this kind of arthropathy
Symmetric ankle arthropathy
Onset of ankle arthropathy in thalassemia
Second or third decade of life
Soft cutaneous masses located over the extensor surfaces of the elbows, knees, and hands as well as on the buttocks
Tuberous xanthomas
True or false. Patients given niacin may develop myositis more often than myalgias
True
True or false. Patients taking HMG-Co reductase inhibitor may experience myalgias
True
Progressive destructive arthritis associated with loss of pain sensation, proprioception or both
Neuropathic joint disease (Charcot joint)
Most frequent cause of neuropathic joint disease
Diabetes mellitus
In tabes dorsalis which joint are commonly affected in Neuropathic joint disease
Knees
Hips
Ankles
In syringomyelia, which joint are commonly affected by neuropathic joint disease
Glenohumeral joint
Elbow
Wrist
In diabetes mellitus, which joint are commonly affected by neuropathic joint disease
Tarsal and tarsometatarsal joints
Pathologic changes in Neuropathic joint disease
Fragmentation and eventual loss of articular cartilage with eburnation of the underlying bone much like what is found in severe osteoarthritis joint
Two mechanism involved in the pathogenesis of neuropathic joint disease
- Abnormal autoimmune nervous system responsible for dysregulated blood flow to the joint with subsequent resorption of bone
- Analgesics effect of glucocorticoids leads to overuse of an already damaged joint leads to accelerated cartilage damage
Second most affected joints in Neuropathic joint disease among diabetic patients
Metatarsophalangeal and talotibial joints
What is rocker foot
Downward collapse of the tarsal bones lead to convexity of the sole
Destructive changes at the tarsometatarsal joints
Lisfranc fracture-dislocation
Differentiate neuropathic arthritis from osteomyelitis
Joint margins in Neuropathic pain tend to be distinct while osteomyelitis they are blurred. Imaging may be helpful but culture of tissues from the joint is required to rule out osteomyelitis
Further imaging that differentiate neuropathic joint disease from osteomyelitis
MRI and bone scans with indium 111-labeled white blood cells or indium 111- labeled with immunoglobulin G which will show increased uptake in osteomyelitis but not in Neuropathic joint disease
Primary focus of treatment in Neuropathic joint disease
Stabilize the joint with braces and splints
Prohibition of weight bearing by the foot for at least 8 weeks
Characterized by clubbing of digits and in more advanced stages by perioateal new bone formation and synovial effusions
Hypertrophic osteoarthropathy (HOA)
True or false. Secondary hypertrophic osteoarthropathy is associated with intra thoracic malignancies, suppurativr and some hyooxemic lung disease and congenital heart disease
True
Almost always a feature of HOA
Clubbing
Other name for primary or familial HOA
Pachydermoperiositis
Touraine - Solente- Gole syndrome
Prominent feature of primary HOA
Skin changes and periostitis
Referred to thick corrugated scalp in familiar HOA
Cutis verticis gyrata
True or false. Secondary HOA is more common than primary HOA
True.
How clubbing objective measured
Diameter at base of nail and at the distal interphalangeal joint.
Sum of individual digital ratio is more than 10
Progression of HOA is more rapid when associated with malignancies. Notably which cancer
Bronchogenic carcinoma
True or false. Secondary HOA is not associated with excessive sweating and oiliness of skin or thickening of facial skin
True
Clubbing of the toes but not the fingers has been associated with what disorders
Infected abdominal aortic aneurysm and patent ductus arteriosus
Unilateral clubbing has been found in association with what disorders
Aneurysms of major extremity arteries, infected arterial grafts and with arteriovenous fistula of brachial vessels
Refers to clubbing and periostitis of the bones of the hands and feet in hyperthyroidism
Thyroid acropachy
characterized pain and swelling of a distal extremity accompanied by vasomotor instability, trophic skin changes and rapid development of bony demineralization
complex regional pain syndrome type 1
manifested by painful swelling of one or more costochondral articulations
Tietze syndrome
usual joint affected by Tietze syndrome
second or third costochondral joint
differentiate Tietze syndrome and costochondritis
Age of onset. before 40 Tietze; after 40 costochondritis
affected joint. 3rd-5th in costochondritis; 2nd-3rd in Tietze
characterized by multiple areas area of localized musculoskeletal pain and tenderness associated with tenderness on the muscle belly
myofascial pain syndrome
characterized by the slowly progressive exuberant benign proliferation of synovial tissue, usually involving a single joint
pigmented villonodular synovitis (PVNS)
Most commonly affected joint in PVNS
knee
How is PVNS diagnosed
gradient echo MRI reveals a synovial mass lesion of low signal intensity typical of tissue containing hemosiderin
What is the treatment of PVNS
complete synovectomy
Disorder characterized by multiple focal metaplastic growths of normal appearing cartilage in the synovium or tendon sheath
synovial chondromatosis
malignant neoplasm often found near a large joint of both upper and lower extremities being more common in the lower extremity
synovial sarcoma
most common site of visceral metastatis of synovial sarcoma
lung
