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Bone Path II > 7. Inflammatory Arthritis > Flashcards

7. Inflammatory Arthritis Flashcards

1
Q

What is synovial chondromatosis aka osteochondromatosis, synoviochondrometaplasia?

A

Metaplastic changes in synovium produce cartilaginous bodies.

1 - These cartilaginous bodies may (or may not) calcify or ossify.
2 - they may (or may not) be free within joint capsule

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2
Q

What is seen on radiograph with synovial chondromatosis?

A

Multiple round / oval and well-defined osseous or cartilaginous densities within joint capsule

It will not be visualized on plain film if it isn’t calcified or ossified

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3
Q

Who gets synovial chondromatosis?

A

20-50 yo

M>F 3:1

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4
Q

Where is the MC location for synovial chondromatosis?

A

Knee 70%
Elbow, hip 20%

It can form at any site with synovium

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5
Q

What are symptoms of synovial chondromatosis?

A

Mild

Chronic, slow, progressive

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6
Q

If there is just one osteochondritis body plus a defect in the host bone, what is DDX instead of synovial chondromatosis?

A

Osteochondritis dissecans

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7
Q

What is the prognosis for synovial chondromatosis?

A

Risk of 2˚ DJD

Malignant transformation reported, but extremely rare

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8
Q

Tax for synovial chondromatosis?

A

Surgical removal

Though recurrence is not uncommon

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9
Q

What are the 3 inflammatory arthropathies?

A

RA
Juvenile Idiopathic Arthritis
Seronegative spondyloarthropathies

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10
Q

What is the MC inflammatory arthritis?

A

Rheumatoid Arthritis (RA)

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11
Q

What is RA?

A

Multisystem AI that targets synovial tissues and joints. Progressive, bilateral symmetry.

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12
Q

Locations of RA?

A

Wrist and hands
Feet
Shoulder, hip, knee
Cervical spine

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13
Q

What is the pathologic process of RA?

A

Antigen-antibody complex deposited in synovium with resulting inflammatory cascade

A synovial proliferation = pan USA

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14
Q

What does pannus do and what is it associated with?

A

Erodes bone and articular cartilage

RA

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15
Q

How do you diagnose RA?

A

Lab tests

Radiographic changes

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16
Q

What do you expect to see for RA lab test?

A

RF (+)ve in 70% (2-3% are (+)ve w/o RA)

Anti-CCP in addition to RF increases sen + spec

In acute cases:

  • increased ESR
  • increased CRP

Anemia (normocytic normochromic)

Synovial fluid eval + biopsy

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17
Q

Know the ACR - EULAR classification criteria?

A

[see notepacket slide 17)

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18
Q

Age of onset of RA?

A

20-60 yo

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19
Q

Sex of RA?

A

F:M 3:1 until age 60
1:1 after 60 yo

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20
Q

What joints are MC for RA to start?

A

MCP
PIP
Wrist
Larger joints and spine later

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21
Q

What systemic sx show up in RA?

A

Fatigue
Malaise
Generalized weakness
Fever

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22
Q

PE for RA?

A

Morning stiffness >1 hour
Pain with motion or tenderness
Soft tissue swelling or joint effusion but NO REDNESS
Bilateral symmetrical joint swelling (except DIP)
Sometimes nodules

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23
Q

Where are boutonnière deformities located?

A

DIP extension

PIP flexion

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24
Q

Where are swan neck deformities located?

A

DIP flexion

PIP extension

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25
Q

Where are hitchhiker thumb deformities located?

A

MCP flexion

IP extension

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26
Q

In RA, what is the earliest change and where is it located?

What are other changes in the same area?

A

Tendinopathy around the wrist

Ulnar and radial styloid erosion

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27
Q

What sign is visible in RA wrist?

A

“Spotty carpal” sign

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28
Q

Cervical spine involvement happens in ___% of RA patients

A

50-80%

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29
Q

Foot is the initial site of involvement in ___% of RA patients

A

15%

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30
Q

Canal stenosis possible due to “______” kyphotic changes in RA spine

A

Stepladder

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31
Q

What is visualized in RA chest?

A 
Pericarditis
Pulmonary nodules
Diffuse interstitial fibrosis
Pleural effusions
Rib erosions
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32
Q

TX for RA?

A 
Refer to rheumatologist
DMARDS to slow/stop inflamm
Protect from deformity and disability
Lifestyle mods
Psychological support
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33
Q

DMARDs stands for?

A

Disease Modifying Antirheumatic Drugs

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34
Q

Prognosis of RA?

A

Variable: periods of exacerbation/remission and gradual progression

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35
Q

What findings suggests poorer prognosis for RA patient?

A 
Earlier onset
Nodules
High levels RF
Sustained activity
Extraarticular manifestations
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36
Q

What is JIA?

A

Juvenile Idiopathic Arthritis

  • One of several forms of juvenile chronic polyarthritis
  • Similar to adult onset RA
  • Onset before 16 yo
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37
Q

What is the worst kind of JIA? And what are the %

  1. Systemic arthritis
  2. Oligoarthritis
  3. Polyarthritis, RF neg
  4. Polyarthritis, RF pos
A

Systemic arthritis is the worst kind, destructive

  1. Systemic arthritis - 5%
  2. Oligoarthritis - 30%
  3. Polyarthritis, RF neg - 20%
  4. Polyarthritis, RF pos - 5%
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38
Q

Systemic Arthritis is a type of JIA also called __?

A

Still Disease

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39
Q

MC age group for Systemic presentation JIA AKA Still Disease?

A

<5 yo

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40
Q

What JIA is typically found in teenage girls?

A. Systemic arthritis AKA Still Disease
B. Oligoarthritis
C. Polyarthritis, RF neg
D. Polyarthritis, RF pos

A

D. Polyarthritis, RF pos

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41
Q

Which JIA has fever, rash, hepatosplenomegaly?

A. Systemic arthritis AKA Still Disease
B. Oligoarthritis
C. Polyarthritis, RF neg
D. Polyarthritis, RF pos

A

A. Systemic arthritis AKA Still Disease

42
Q

Which JIA is the most common and does not carry into adulthood?

A. Systemic arthritis AKA Still Disease
B. Oligoarthritis
C. Polyarthritis, RF neg
D. Polyarthritis, RF pos

A

B. Oligoarthritis

43
Q

What are the 4 seronegative spondyloarthropathies?

And which one is MC?

A

Ankylosis spondylitis - MC
Reactive arthritis (Reiter)
Psoriatic arthritis
Enteropathic arthropathy

44
Q

Who gets AS?

A

Young males

It’s a chronic inflamm process of unknown etiology. Axial skeleton predominance.

Bony ankylosis, ligament ossification, enthesopathy.

Ankylosis Spondylitis AKA Marie-Strumpell or Becchterew disease

45
Q

What are the clinical features of AS?

  • age
  • gender
  • symptoms
  • systems involved
  • lab results
A 
Onset 15-35 yo
M:F
Low back aching, stiffness esp early AM
Pain, tenderness at enthesopathies
Involves eyes, heart, great vessels, lungs, GI, GU
Increased ESR, positive HLA-B27
46
Q

Is AS bilateral/unilateral?

Symmetric/asymmetric?

A

Bilateral

Symmetric

47
Q

Classic finding in AS?

A

SI joints

Bilateral, symmetric involvement

48
Q

Romanus lesion
Shiny corner sign
Syndesmophyte formation

Late stage NP calcification; “balloooning” of disc space.

What is it?

A

AS

49
Q

Dagger sign
Railroad track
Trolley track

What is it?

A

AS

50
Q

TX for AS?

A

Pain control
Maint mobility/prevent deformity
Anti-inflamm

51
Q

“Carrot sick” or “chalk-stick” fractures is a possible complication of ?

A

AS

52
Q

1-2% of ____ patients may get interstitial lung disease

A

AS

53
Q

What are enteropathic arthritis diseases?

A

UC and Crohn disease

Also: Whipple disease, Salmonella, Shigella, Yersinia

54
Q

15% of psoriasis patients may get ___?

A

Psoriatic arthritis

55
Q

Onset of Psoriatic arthritis

A

20-50 yo

DDX from reactive arthritis is difficult

56
Q

Sausage digit

A

Psoriatic arthritis

57
Q

Lab changes in psoriatic arthritis?

A

Increased ESR (acute)
Negative RF
Occasional hyperdrive is
75% HLA-B27

58
Q

MC locations of psoriatic arthritis?

A

DIPs
SI joints
Spine

59
Q

Hallmark combo of psoriatic arthritis?

A

Erosion + periostitis

60
Q

Involvement of all 3 joints in single digit is called what?

What condition?

A

‘ray pattern’

Psoriatic

61
Q

Pencil-in- cup deformity

A

Psoriatic

62
Q

‘Opera glass’ hand

A

Psoriatic

63
Q

Is psoriatic symmetric /asymmetric?

Non-marginal or marginal syndesmophytes?

A

Asymmetric, non-marginal syndesmophytes

Opposite of AS, which has symmetric, marginal syndesmophytes

64
Q

Treatment for psoriatic?

A

Early PT/ rehab

NSAIDs, DMARDS to reduce inflamm

65
Q

What is reactive arthritis?

  • AKA
  • body system involvement
  • onset age
  • gender
  • triad
A

AI reaction to distal infection
AKA reiter syndrome
associated with GI or GU infection

  • onset 15-35 yo
  • M>F
  • urethritis, conjunctivitis, polyarthritis
66
Q

“Lover’s heel”

A

Reactive arthritis

  • painful plantar or achilles enthesopathy
67
Q

Lab results for Reactive arthritis ?

A

Increased ESR
Anemia
Leukocytosis
75% HLA-B27, negative RF

68
Q

Which sacroilitis are symmetrical?

Asymmetrical?

A

Symmetrical

  • AS
  • enteropathic spondyloarthropathy

Asymmetrical

  • psoriatic
  • reactive
69
Q

What is an AI CT disorder with multiple system involvement? Chronic disease with periods of exacerbation and remission?

A

systemic lupus erythematosus (SLE)

70
Q

Clinical features of systemic lupus erythematosus (SLE)?

  • onset
  • gender
  • lab results
  • symptoms
A

onset 10-40 yo
Female
(+) ANA
Fever, joint pain, rash

71
Q

Is systemic lupus erythematosus (SLE) bilateral/unilateral?

Symmetric/asymmetric?

A

Bilateral

Symmetric

72
Q

What is a generalized, systemic, inflammatory CT disease associated with CREST syndrome?

A

Scleroderma AKA systemic sclerosis

73
Q

Clinical picture of scleroderma?

  • onset
  • gender
  • symptoms
  • radiographic findings
A

Onset 30-50 yo
Female
Edema, induration (hardened), atrophy of skin
Acro-osteolytic (unguarded tuft resorption) and soft tissue calcifications

74
Q

What condition is predominantly in women of childbearing age, asymptomatic (though sometimes chronic LBP and stiffness), SI motion may be altered and CMT may increase sx and then they’ll decrease

A

Osteitis Condensans Ilii (OCI)

75
Q

Bilateral, symmetric triangle shaped area of sclerosis on iliac side of lower SIJ

A

Radiographic findings of Osteitis Condensans Ilii (OCI)

76
Q

Severely painful pubic bone area

A

Osteitis Pubis

  • usually subsides over 1-2 years
  • bone inflammation and resorption w/ spontaneous re-ossification (eventually)
77
Q

What is the latent period of osteitis pubis?

A

1-3 week following onset of Sx

78
Q

Radiographic findings of osteitis pubis?

A

Bilateral, symmetric involvement of both sides of symphysis

  • irrectular joint margin
  • reactive scerosis
  • widened joint space
79
Q

This condition is 2˚to major visceral disorder, esp intrathoracic

A

Hypertrophic Osteoarthropathy

80
Q

What condition is MC 2˚ to bronchogenic carcinoma?

A

Hypertrophic Osteoarthropathy

81
Q

What is the triad of clinical and radiographic findings for Hypertrophic Osteoarthropathy?

A

Digital clubbing
Symmetric arthritis
Periosteal reaction

82
Q

What is the periosteal reaction for Hypertrophic Osteoarthropathy?

  • bi/unilateral?
  • symmetric/asymmetric?
  • single/solid layer?
A

Bilateral
Symmetric
Solid OR single layer

83
Q

What are the 4 metabolic disorders?

A

Gout
CPPD
HADD
Ochronosis

84
Q

What condition is hyperuricemia plus recurrent, acute, inflammatory, arthritis, tophus formation?

A

Gout

85
Q

What are the 5 stages of gout?

AAICG
“Ah Ah! I Conceived Gout!”

A

1 - Asymptomatic

2 - Acute: red, hot, swollen, monoarticular. Early AM, resolves in 7-10 days, recurrence common.

3 - Intercritical: time (months) between flares.

4 - Chronic tophaceous gout. Chronic, uncontrolled hyperuricemia.

5 - Gouty neuropathy

86
Q

Joint space preserved in Gout?

A

Yes, until late in the process. Then uniform loss.

87
Q

Overhanging margin sign

A

Erosion changes seen in Gout.

88
Q

Chondrocalcinosis w/ or w/o secondary DJD

A

Calcium Pyrophosphate Dihydrate (CPPD) crystal deposition disease

89
Q

Onset and peak age of Calcium Pyrophosphate Dihydrate (CPPD) crystal deposition disease

A

After 30 yo

Peak 60 yo

90
Q

How to definitively dx Calcium Pyrophosphate Dihydrate (CPPD) crystal deposition disease?

A

Aspiration synovial fluid to demonstrate crystals

91
Q

Radiographic features for hyaline cartilage in CPPD?

A

Parallel to cortex, thin, linear

92
Q

Radiographic features for fibrous cartilage in CPPD?

A

Thick, irregular, poorly defined, menisci, triangular cartilage, pubic symphysis, annulus fibrosis

93
Q

What condition is 2˚ to DJD and may mimic neuropathic?

A

Pyrophosphate Arthropathy

DDX 1˚ DJD

  • unusual joint or joint compartment involvement
  • prominent cysts
  • severe changes
  • variable osteophyte formation
94
Q

SLAC wrist

  • what does it stand for?
  • what condition?
A

SLAC - ScaphoLunate Advanced Collapse

Pyrophosphate Arthropathy

95
Q

MC site for radiographic and clinical findings for Pyrophosphate Arthropathy?

Second location?

A

Knee

Wrist

96
Q

Calcification tendinitis that is common at shoulder at hip, MC 40-70 yo. Single site of involvement.

A

Hydroxyapatite Deposition Disease (HADD)

97
Q

What is the more sensitive lab finding for catching early calcification in Hydroxyapatite Deposition Disease (HADD)?

A

US

98
Q

What is seen on radiograph in Hydroxyapatite Deposition Disease (HADD)?

A

Calcification near tendon insertion

Linear, round, oval, globular

99
Q

4 phases of HADD

  • which phase is asymptomatic
  • which phase is most symptomatic/painful
A
  1. Pre-calcific ** asymptomatic
  2. Calcification/formative
  3. Resorptive ** PAINFUL! ** crystals extravasate into adjacent tissues
  4. Post-calcific
100
Q

MC tendons involved in shoulder HADD?

A

Supraspinatus 80%
Infraspinatus 15%

MC at “critical zone” of rotator cuff

101
Q

Where can HADD be seen in spine?

- name the muscle

A

Longus colli

Anterior to C2-C3 bodies and inferior to anterior tubercle of C1

Bone Path II (9 decks)

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