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367 Arthritides Flashcards

Chapter 367. Arthritis associated with Systemic Disease and other Arthritides

1
Q

Common feature of arthropathy of acromegaly

A

Osteoarthritis

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2
Q

When does arthropathy of hemochromatosis occur

A

Occurs in 20-40% of patients at age 50 and may be the first clinical feature of hemochromatosis

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3
Q

First and most prominent joints affected in arthropathy of hemochromatosis

A

Second and third metacarpophalangeal joints of both hands

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4
Q

What arthropathy are hook like osteophytes seen?

A

Arthropathy of hemochromatosis

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5
Q

Early diagnosis of arthropathy of hemochromatosis is suggested by what

A

High serum transferring saturation

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6
Q

Two ways iron damages articulate cartilage

A
  1. Iron catalyzed super oxide dependent lipid peroxidation which play a role in joint damage
  2. Ferric iron interfere with collagen formation leading to chondrocalcinosis
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7
Q

True or false. Repeated phlebotomy although a treatment of hemochromatosis, it has little effect on established arthritis and chondocalcinosis may progress still

A

True

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8
Q

Symptom based treatment for arthropathy of hemochromatosis

A

NSAIDs

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9
Q

Common problem of hemophilia and can lead to deforming arthritis

A

Spontaneous hemarthrosis

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10
Q

Most affected joints of hemarthrosis

A 
Knees
Ankles
Elbows
Shoulders
Hip
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11
Q

In hemarthrosis, joint function usually returns to normal or baseline in how many weeks

A

Joint function usually returns to normal or baseline in about two weeks

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12
Q

What distinguishes bleeding into the iliopsoas from hip synovitis and hemarthrosis

A

In bleeding of iliopsoas, rotation of hip is preserved

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13
Q

What forms when bleeding involves the periosteum or bone

A

Painful pseudotumor

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14
Q

True or false. Septic arthritis is common in hemophilia due to hemarthrosis

A

False. Septic arthritis is rare. But to distinguish clinically from hemarthrosis

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15
Q

What is the treatment of musculoskeletal bleeding in patients with hemophilia

A

Immediate infusion of factor VII or IX at first sign of joint or muscle hemorrhage

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16
Q

What may be given to those hemophilia patient who developed factor inhibitors

A

Recombinant activated factor VII or activated prothrombin complex concentrate

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17
Q

How should the joint be positioned in hemarthrosis

A

Joint should be rested in position of forced extension to avoid contracture

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18
Q

What time of algesia is given to hemarthrosis or in patients with hemophilia

A

Non selective NSAIDs

COX-2 inhibitors

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19
Q

Alternative treatment for hemarthrosis when surgical synovectomy is not practical

A

Radiosynovectomy with either yttroum 90 silicate or phosphorus 31

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20
Q

Refers for the diffuse swelling tenderness and warmth of the hands and feet lasting for 1-3 weeks in patients with sickle cells disease

A

Sickle cell dactylitis or hand-foot syndrome

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21
Q

What causes the dactylitis in sickle cell disease

A

Result from infarction of the bone marrow and cortical bone leading to periostitis and soft tissue swelling

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22
Q

True or false. Sickle cell dactylitis is seen in patient of all age groups.

A

False. Rarely seen beyond 5 years old as hematopoeisis ceases in small bones of hand and feet after age 5.

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23
Q

In sickle cell crisis, which joints are commonly affected

A

Knees and elbows

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24
Q

True or false. Patient with sickle cell disease are predisposed to osteomyelitis

A

True

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25
In osteomyelitis affected sickle cell disease, which bones are commonly affected
Long tubular bones
26
What is the common pathogen for osteomyelitis in patients with sickle cell disease
Salmonella
27
True or false. Clinical distinction between osteomyelitis and bone infarction can be difficult without imaging.
True
28
How does sickle cell disease lead to bone infarction
Resulting from vaso occlusion from sickling of the cells
29
A vascular necrosis of the head of the femur occurs in 5% of patient with sickle cell disease
True
30
True or false. Septic arthritis is occasionally encountered in sickle cell disease
True
31
Common pathogen for septic arthritis in sickle cell disease
Staph aureus Streptococcus Salmonella
32
True or false. Acute gouty arthritis is uncommon in sickle cell disease despite hyperuricemia
True
33
True or false. Bone and joint abnormalities are common in thalassemia major and intermedia group
True
34
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
35
About 50% of patients with thalassemia have this kind of arthropathy
Symmetric ankle arthropathy
36
Onset of ankle arthropathy in thalassemia
Second or third decade of life
37
Soft cutaneous masses located over the extensor surfaces of the elbows, knees, and hands as well as on the buttocks
Tuberous xanthomas
38
True or false. Patients given niacin may develop myositis more often than myalgias
True
39
True or false. Patients taking HMG-Co reductase inhibitor may experience myalgias
True
40
Progressive destructive arthritis associated with loss of pain sensation, proprioception or both
Neuropathic joint disease (Charcot joint)
41
Most frequent cause of neuropathic joint disease
Diabetes mellitus
42
In tabes dorsalis which joint are commonly affected in Neuropathic joint disease
Knees Hips Ankles
43
In syringomyelia, which joint are commonly affected by neuropathic joint disease
Glenohumeral joint Elbow Wrist
44
In diabetes mellitus, which joint are commonly affected by neuropathic joint disease
Tarsal and tarsometatarsal joints
45
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
46
Two mechanism involved in the pathogenesis of neuropathic joint disease
1. Abnormal autoimmune nervous system responsible for dysregulated blood flow to the joint with subsequent resorption of bone 2. Analgesics effect of glucocorticoids leads to overuse of an already damaged joint leads to accelerated cartilage damage
47
Second most affected joints in Neuropathic joint disease among diabetic patients
Metatarsophalangeal and talotibial joints
48
What is rocker foot
Downward collapse of the tarsal bones lead to convexity of the sole
49
Destructive changes at the tarsometatarsal joints
Lisfranc fracture-dislocation
50
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
51
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
52
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
53
Characterized by clubbing of digits and in more advanced stages by perioateal new bone formation and synovial effusions
Hypertrophic osteoarthropathy (HOA)
54
True or false. Secondary hypertrophic osteoarthropathy is associated with intra thoracic malignancies, suppurativr and some hyooxemic lung disease and congenital heart disease
True
55
Almost always a feature of HOA
Clubbing
56
Other name for primary or familial HOA
Pachydermoperiositis | Touraine - Solente- Gole syndrome
57
Prominent feature of primary HOA
Skin changes and periostitis
58
Referred to thick corrugated scalp in familiar HOA
Cutis verticis gyrata
59
True or false. Secondary HOA is more common than primary HOA
True.
60
How clubbing objective measured
Diameter at base of nail and at the distal interphalangeal joint. Sum of individual digital ratio is more than 10
61
Progression of HOA is more rapid when associated with malignancies. Notably which cancer
Bronchogenic carcinoma
62
True or false. Secondary HOA is not associated with excessive sweating and oiliness of skin or thickening of facial skin
True
63
Clubbing of the toes but not the fingers has been associated with what disorders
Infected abdominal aortic aneurysm and patent ductus arteriosus
64
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
65
Refers to clubbing and periostitis of the bones of the hands and feet in hyperthyroidism
Thyroid acropachy
66
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
67
manifested by painful swelling of one or more costochondral articulations
Tietze syndrome
68
usual joint affected by Tietze syndrome
second or third costochondral joint
69
differentiate Tietze syndrome and costochondritis
Age of onset. before 40 Tietze; after 40 costochondritis | affected joint. 3rd-5th in costochondritis; 2nd-3rd in Tietze
70
characterized by multiple areas area of localized musculoskeletal pain and tenderness associated with tenderness on the muscle belly
myofascial pain syndrome
71
characterized by the slowly progressive exuberant benign proliferation of synovial tissue, usually involving a single joint
pigmented villonodular synovitis (PVNS)
72
Most commonly affected joint in PVNS
knee
73
How is PVNS diagnosed
gradient echo MRI reveals a synovial mass lesion of low signal intensity typical of tissue containing hemosiderin
74
What is the treatment of PVNS
complete synovectomy
75
Disorder characterized by multiple focal metaplastic growths of normal appearing cartilage in the synovium or tendon sheath
synovial chondromatosis
76
malignant neoplasm often found near a large joint of both upper and lower extremities being more common in the lower extremity
synovial sarcoma
77
most common site of visceral metastatis of synovial sarcoma
lung

Rheumatology (15 decks)

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