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Rheumatology 2021 > Adult Patient with Arthritis > Flashcards

Adult Patient with Arthritis Flashcards

1
Q

What is the first line medical treatment for Rheumatoid Arthritis?

A

Methotrexate (synthetic DMARD)

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2
Q

What is the gold standard diagnostic test to differentiate Gout from Pseudo-gout, and what will you see?

A

Synovial Fluid
Gout: needle shaped monosodium urate crystals negatively birefringent
Psuedogout: Rhomboid shaped CCPD crystals, positively birefringent

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3
Q

Methotrexate is a teratogen, what is the alternative treatment for RA if your patient becomes pregnant?

A

hydroxychloroquine

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4
Q

RA articular manifestations

A

ulnar deviation
boutonniere deformity
swan neck deformity

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5
Q

What are common extra-articular manifestations of RA?

A 
Derm: Rheumatoid nodules
Mucosal: Sicca symptoms, Sjogren syndrome
Ocular: scleritis 
Pulmonary: Interstitial fibrosis
Cardiac: pericarditis, pleural effusion
Lymph: lymphedema
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6
Q

What are major differences between RA and OA?

A

RA: rapid onset, typically in 20s - 40s. symmetrical joint involvement, polyarticular. joint pain may improve with usage of joint. systemic symptoms include fatigue and malaise.

OA: slow onset, typically in older age. often begins unilaterally and limited to one set of joints. joint pain worsens with usage of joint. no systemic symptoms.

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7
Q

What are the four seronegative spondyloarthropathies?

A

P: psoriatic arthritis
A: ankylosing spondylitis
I: IBD associated arthritis
R: reactive arthritis

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8
Q

In a synovial fluid analysis you see crystals that are rhomboid shaped and positively birefringent. What is the most likely diagnosis?

A

Pseudogout

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9
Q

What joint in the hands is typically spared in RA, compared to OA?

A

DIP

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10
Q

What is the typical presentation of end stage psoriatic arthritis?

A

Arthritis Mutilans

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11
Q

What joints are commonly affected by Rheumatoid Arthritis?

A

Symmetric small joints—MCP, PIP, and MTP (spares DIP) joints

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12
Q

What is the common age of onset for RA vs OA?

A

20’s to 40’s

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13
Q

How does septic arthritis occur?

A
  1. hematogenous spread (>50%)
  2. direct inoculation
  3. spread from adjacent tissue infection
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14
Q

What are possible complications of septic arthritis?

A
  1. osteomyelitis
  2. persistent/recurrent infection
  3. decreased joint mobility
  4. ankylosis
  5. persistent pain
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15
Q

What are the early treatments for septic arthritis (caused by gram-positive cocci) in prosthetic joints?

A

Salvage prosthesis; debride + antibiotics ( IV vancomycin)

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16
Q

Are males or females more likely to develop reactive arthritis post-GU?

A

Males > females

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17
Q

Which lab test is more sensitive for RA, rheumatoid factor or anti-CCP?

A

anti-CCP

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18
Q

True or false: When performing a synovial fluid analysis, you should attempt to guide the needle into the most infected area to obtain the most accurate cell counts?

A

False

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19
Q

What is the most common cause of reactive arthritis?

A

Leukemia

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20
Q

Crepitus is most commonly noticed with which arthritis? (OA or RA)

A

OA

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21
Q

What will you see on x-ray of someone who has ankylosing spondylitis?

A

Bamboo spine

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22
Q

True or false: passive range of motion is painless in someone with septic arthritis.

A

False. PROM is extremely painful in those with septic arthritis

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23
Q

First-line treatment for ankylosing spondylosis?

A

NASIDs- for pain and stiffness
Physical exercise and PT- help delay progression and prevent spinal deformity

Then can move on to: DMARDs or Anti-TNF, surgery

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24
Q

Common presentations of psoriatic arthritis?

A

Spondyloarthropathy, dactylitis (sausage fingers/toes), enthesitis (inflammation of tendon insertions), skin plaques, onycholysis

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25
Q

For a patient with osteoarthritis, is Acetaminophen or Ibuprofen a better first line treatment and why?

A

Acetaminophen because it has a safer toxicity profile than NSAIDs

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26
Q

What is the term for when an individual has gout in the 1st MTP?

A

Podagra

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27
Q

What is the first line treatment for reactive arthritis?

A

NSAIDs (Ibuprofen 600-800 mg PO every 6-8 hours prn)

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28
Q

What are the clinical findings of fibromyalgia?

A

Pain (allodynia & hyperalgesia), fatigue, non-restorative sleep, depression & anxiety, impaired cognition, morning stiffness, others (GI upset, incontinence, pelvic pain, dysmenorrhea, neuro complaints)

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29
Q

What is the treatment for gout?

A

NSAIDs first line, corticosteroids if can’t take NSAIDs

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30
Q

What are the preventative treatments for gout?

A

Diet modifications, allopurinol, Prophylactic colchicine

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31
Q

What is septic arthritis until proven otherwise?

A

acute, monoarticular arthritis

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32
Q

What is the most common pathogen responsible for reactive arthritis?

A

Chlamydia

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33
Q

What medications can trigger a gout exacerbation?

A

diuretics (loops, thiazides)**
salicylates
contrast

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34
Q

What radiographic findings suggest OA?

A

irregular joint space narrowing**
osteophytes (bone spurs)**
subchondral sclerosis

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35
Q

What is the Schober’s test?

It is used in the physical exam evaluation of what joint condition?

A

tests lumbar spine flexion

ankylosing spondylitis (will be decreased, <5cm)

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36
Q

What are the common causes of excess urate contributing to gout?

A 
Alcohol
Anchovies
Organ meat
Asparagus
Cocoa
Mushrooms
Spinach
Trauma
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37
Q

What is the most common joint disease affecting adults worldwide?

A

Osteoarthritis

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38
Q

What are some risk factors for septic arthritis?

A

Extremes age, IV drug use, diabetes, autoimmune disease/immunocompromised, prosthetic joint

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39
Q

Thick and dystrophic nails commonly referred to as Reiter’s nail can be a clinical presentation for which type of arthritis?

A

Reactive arthritis

40
Q

What do OA and RA have in common?

A

PIP Joints Affected

Morning Stiffness

41
Q

What does HLA stand for?

A

Human Leukocyte Antigen

42
Q

What are some common extra-articular manifestations of reactive arthritis?

A

Conjunctivitis, anterior uveitis, urethritis, circinate balanitis, oral ulcers, keratoderma blennorrhagicum

43
Q

Reiter Syndrome in reactive arthritis is associated with what 3 manifestations?

A

Reiter Syndrome = peripheral arthritis + conjunctivitis +urethritis/cervicitis

44
Q

Things that reactive arthritis, enteropathic arthritis, ankylosing spondylitis, and reactive arthritis have in common (lab wise)

A

Negative RF and ANA.

Positive HLA-B27

45
Q

Anklyosing spondylitis common XR finding

A

Bamboo spine

46
Q

Main cause of reactive arthritis

A

post GI or GU infection 1-4 weeks after it.

47
Q

What are the potential complications of osteoarthritis?

A

Gout, Pseudogout, osteonecrosis, Baker’s Cyst, Buritis, Meniscal Tear

48
Q

What radiological deformity is common with Psoriatic Arthritis?

A

Pencil in a cup deformity

49
Q

Screening Images to look for in CPPD (Psuedogout)

A

AP View of Pelvis, Knees, hands

50
Q

Xray finding in CPPD (Psuedogout)

A

Chrondrocalcinosis (Linear densities in hyaline articular cartilage)

51
Q

What are some pieces of information you want to know/ test on a patient before prescribing a DMARD?

A

if they have history of TB or hepatitis because DMARDs cause immunosuppression and can increase the reactivity of these diseases.

52
Q

what is the treatment for IBD associated arthritis?

A

treat IBD and get bowel disease under control

53
Q

What must be ruled out first when you suspect IBD associated arthritis?

A

Septic arthritis

54
Q

What is a complication at end stage Psoriatic arthritis that presents with subluxation and mutilating of the joint?

A

Arthritis Mutilans

55
Q

Your pt has RA and is taking Methotrexate. What should you prescribe to reduce its side effects?

A

Folic Acid

56
Q

What are the four different types of Pseudogout (CPPD)?

A

Classic CPPD
Pseudo-OA CPPD
Mimic RA
Meningitis Mimic

57
Q

What is the epidemiology of Gout?

A

25% of the time hyperuricemia progresses to gout
Men at 45
Women at 65

58
Q

What is the leading cause of disability?

A

Osteoarthritis

59
Q

What conditions are included with the acronym, PAIR?

A

Psoriatic arthritis
Ankylosing spondylitis
Inflammatory bowel disease
Reactive arthritis

60
Q

Which diseases are associated with an increased level of HLA-B27?

A

PAIR

61
Q

True or false: Prosthetic joints in septic arthritis that have a late presentation usually develops more than four weeks after implantation

A

True

62
Q

What is the most common pathogen that causes septic arthritis?

A

Staph aureus

63
Q

Describe the boutonniere deformity sometimes seen in late RA…

A

flexion at PIP, Hyperextension at DIP

64
Q

What are some of the diseases commonly associated with a positive RF?

A

RA, Sjogren syndrome, SLE, etc.

65
Q

What is the most common mechanism of spread in septic arthritis?

A

Hematogenous

66
Q

What is the abnormal cardiac finding associated with ankylosing spondylitis?

A

1st degree AV block

67
Q

How do you tx neonates with septic arthritis?

A

3rd generation cephalosporin

68
Q

A patient comes in with psoriatic arthritis with increased pain in their knees. You want to do a glucocorticoid injection of both knees; however, there is a plaque over the right knee where you would normally inject. Is it okay to proceed with both knees?

A

No. Do not inject into a plaque.

69
Q

What are differentiating characteristics of Join stiffness in RA, OA, and AS?

A

RA - AM stiffness lasting longer than 30 min

OA - AM stiffness lasting up to 30 min (self limited)

70
Q

What are the differentiating characteristics of axial spine stiffness noted in AS?

A
  • Low back pain and stiffness > 3mo,
  • Better with exercise,
  • worse with rest
71
Q

True or False: IBD associated arthritis is correlated with flares in the bowel?

A

True

72
Q

Describe the joint pain seen in IBD-associated arthritis?

A

Migratory (moves joints), rarely erosive

73
Q

What is the most common joint affected in septic arthritis?

A

The knee

74
Q

True or False: Reiter Syndrome is the same as Reactive arthritis.

A

False; Reiter syndrome is a type of reactive arthritis

75
Q

What is the first choice of non-pharmacologic treatment for ankylosing spondylitis?

A

Physical therapy: avoid spinal deformity and loss of motion through swimming

76
Q

True or false: On physical exam, a patient with OA will have crepitus, bony enlargement, and tenderness to palpation over the joint.

A

True.

77
Q

What is Scleritis and where is it commonly seen?

A

inflammation deep in the sclera that can lead to eventual blindness.

Associated with RA

78
Q

What is the LOSS acronym of Osteoarthritis?

A

L - loss of joint space
O - osteophytes
S - subchondral scleroses
S - subchondral cysts

79
Q

What dermatologic findings may be seen in enteric arthritis?

A

Erythema nodosum, pyoderma gangrenosum

80
Q

What CBC finding is associated with ankylosing spondylitis?

A

normocytic normochromic anemia of chronic disease

81
Q

What is the treatment for reactive arthritis?

A

NSAIDS, Antibiotics, DMARDS

82
Q

What are common risk factors for nongonococcal acute bacterial (septic) arthritis?

A

Previous joint damage and IV drug use

83
Q

criteria to diagnose definite vs probable vs possible CPPD

A

definite- both positively birefringent crystals and calcification on xrays
probable - either positively birefringent crystals or calcification on xrays
possible - chronic arthritis like osteoarthritis but atypical joint involvement with “attacks”.

84
Q

name prophylactic medications for gout

A

allopurinol - inhibits uric acid production

probenecid - increases uric acid excretion in the urine

85
Q

What are the types of bacteria associated with Reactive Arthritis?

A

Chlamydia (MC), Campylobacter, Yersinia, Salmonella, HIV, and Shigella

86
Q

What are the prototypical findings associated with Ankylosing Spondylitis?

A

a young, adult male, who has chronic low back/buttocks pain which improves with exercise but DOES NOT relieve with rest.

  • Decreased ROM in Lumbar Spine (Schober Test)
  • Limitation of chest wall expansion
87
Q

Are men or women more likely to develop Ankylosing Spondylitis? And their age?

A

Men > women, Young adult.

88
Q

What are some infectious triggers of psoriatic arthritis?

A

Strep, HIV

89
Q

What will distinguish osteoarthritis vs RA on a diagnostic image?

A

Osteoarthritis will have asymmetric joint narrowing and RA will show symmetric joint narrowing

90
Q

What is the first line treatment for the rheumatologic d/o that is classic for bamboo spine

A

NSAID

91
Q

True or false you treat acute flares or gout and pseudogout the same?

A

True. Indomethacin (1st line), colchicine, glucocorticoids.

92
Q

True or false: in psoriatic arthritis the psoriatic rash always precedes the arthritis?

A

False, the arthritis can occur prior to the rash but is not as common

93
Q

Treatment for an IVDU w/ septic athritis

A

IV Vanc + Ceph

94
Q

Flares of pseudogout are most common after what?

A

Anesthesia and Surgery (Thyroidectomy)

95
Q

What medication can precipitate a gout attack?

A

Loop diuretics, Thiazide diuretics

96
Q

Risk Factors for Osteoarthritis

A

Age, Female, prior injuries to the joints, body weight

Rheumatology 2021 (3 decks)

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