Arthrides - Inflammatory Flashcards
What makes RA seropositive or seronegative?
Rheumatoid Factor (RF)
MC inflammatory arthritis
Rheumatoid Arthritis (RA)
Rheumatoid types are seronegative or seropositive?
Seropositive
Systemic Lupus (SLE) is what type of RA? RF positive or negative?
Rheumatoid Type
Seropositive
What is the MC form of Juvenile Chronic Arthritis (JCA) and what is the RF?
Polyarticular (50%)
Seronegative
What’s another name for the classic form of JCA?
Factor? %?
Still’s disease.
Seronegative.
20%
What are the most distinctive features of JCA?
Periostitis, and growth abnormalities (ie. bone shortening and ballooned epiphysis).
Inflammatory and hyperemic process loosens the periosteum causing _________ in metacarpals, metatarsals, and proximal phalanges of teenagers.
Periostitis
Examples of growth abnormalities caused by JCA
“Ballooning” of epiphyseal plates (caused by hyperemia), and bone shortening (caused by premature fusion of growth plates).
Vertebral body and disc hypoplasia (“child’s configuration”) can be caused by _________ in the cervical spine.
What other features?
JCA
Erosions and posterior joint ankylosis (facet fusion).
What joints of the hand are MC affected in RA?
MCP’s and PIP’s
What sites in the body are MC affected in RA?
Synovial tissues of the hands, feet, wrists, hips, knees, elbows and shoulders, and the atlantoaxial subluxation of the cervical spine.
This arthride is marked by bilateral symmetric distribution, and uniform loss of joint space; What other features are found?
RA
- periarticular soft tissue inflammation (pannus)
- juxta-articular osteoporosis
- marginal erosions (bare area) - “rat bites”
- subchondral erosions, cysts (or geodes) and deformities.
In ______ the SI articulations are rarely affected.
RA
What deformities are characteristic in RA?
Swan neck, boutonnière, and hitchhiker’s thumb.
Flexion of the PIP’s and extension of the DIP’s
Boutonnière Deformity
Extension of the PIP’s and flexion of the DIP’s
Swan Neck Deformity
Elevated ESR (erythrocyte sedimentation rate) and +RA factor are two clinical features of these arthrides in young middle aged women.
RA and Lupus (SLE)
Severe joint deformity / destruction
Arthritis mutilans
Enlargement of the gastrocnemius bursa
Baker’s cyst
Leukopenia, splenomegaly and RA
Felty’s syndrome
Soft tissue swelling at the MCP joints
Haygarth’s nodes
Soft tissue swelling at the PIP’s
Bouchard nodes
Soft tissue swelling at the DIP’s
Heberden’s nodes
Haygarths nodes are first in this type of arthride
RA
Heberdens nodes are first affected in this type of arthride
DJD
1 reason for an increased ADI
RA in cervical spine
An atlanto-axial subluxation is considered when the ADI is more than _____ and the PADI less than ____.
ADI >3 mm, PADI <14
Reumatoid Types
- what’s the RF?
- examples
- Seropositive
- Reumatoid Arthritis, Sistemic Lupus Erythematosis (SLE), Scleroderma, Jaccoud’s.
Butterfly rash
SLE
SLE is MC in what sex and what ages?
Females (9:1), ages 20-40 yrs
In SLE, what percentage have articular complains?
90%
Most frequent and serious features of SLE
Kidney conditions that may lead to nephropathy and renal failure
SLE may be accompanied by this condition where the fingers, toes or other areas get discolored in response to excessive reduced blood flow.
Reynaud’s phenomenon
This non-erosive arthritis involves multiple organs, is seropositive, has an elevated ESR (erythrocyte sedimentation rate) and a positive ANA (antinuclear antibodies).
Systemic Lupus Erythematosis
SLE is commonly treated with ________ witch can lead to:
Osteoporosis, avascular necrosis (AVN), water retention, spinal fractures and gastric ulcerations
In SLE, articular changes are most commonly seen in _______ and these deformities are reversible.
- what joints are usually affected?
Hands
- MCP and PIP
What is a classic deformity in the hands of patients with SLE?
- what other deformities are possible?
Ulnar deviation (>50% of patients) - swan neck and boutonnière
SLE deformities are reversible and non-erosive? What does that mean?
Yes; it means that the deformities are not rigid, and there is no bone destruction like in RA.
What other effect can SLE can have in the spine, specifically upper cervical?
It can induce laxity of the transverse ligament increasing the ADI (by 8.5%)
Ulnar deviation can be seen in SLE and what two other seropositive reumatoid types?
RA and Jaccoud’s
This seropositve reumatoid type follows rheumatic fever, multiple connective tissue disorders and has an antecedent of streptococcal pharyngitis
Jaccoud’s arthropathy
Jaccoud’s arthropathy has no evidence of _________, only capsular fibrosis and DJD.
Synovial pathology
Jaccoud’s arthropathy causes non-erosive, reversible joint deformity, just like this other reumatoid type.
SLE
Most important factor to distinguish Jaccoud’s and SLE, besides the butterfly rash, is
History and clinical presentation
Rehumatoid Type that causes small vessel disease and fibrosis in multiple organ systems.
progressive systemic sclerosis / scleroderma
Scleroderma is MC in what gender, age population?
Females (3:1), ages 30-50
In scleroderma, the skin appearance is the most unique feature with progression of 3 stages:
Edema, induration (hardening) and atrophy.
If a patient with scleroderma is exposed to cold or emotional upset conditions it precipitates ___________ changes of pallor and painful ___________ producing pain and swelling.
What is this condition called?
vasoconstrictive ; vasodilation
Reydaud’s phenomenon
Reynaud’s phenomenon is a _________ nervous system dysfunction characterized by cyclic vascular changes usually in hands.
Sympathetic
Vascular pathological changes consisting of a low grade inflammatory reaction in the perivascular tissue with atrophy and fibrosis is characteristic of
Scleroderma
Patients with this condition can have trouble swallowing and constipation due to decreased motility and dilatation/constriction of the GI tract.
Scleroderma
Scleroderma affects the lungs in all cases, however only ___% of cases are symptomatic.
25%
What is the CREST syndrome?
-Where can you find this?
Calcinosis Raynaud's phenomenon Esophageal dysmotility Sclerodactyly Telangiectasia (dilated sub-dermal blood vessels) - in patients with Scleroderma
Define:
Acro-
Miso-
Rhico-
Acro= distal extremities Miso= forearms and lower legs Rhico= humerus and femur
What is acro-osteolysis? Where can this be found?
Osseous resorption in terminal phalangeal tufts; this happens in patients with scleroderma.
What is the main distribution of Progressive Systemic Sclerosis?
Hands, chest and GI
How does scleroderma affects the hands?
Acro-osteolysis in finger tips, and subdermal calcification.
How does scleroderma affects the chest?
Interstitial fibrosis
How does scleroderma affects the GI tract?
Smooth muscle disfunction causing esophageal aperistalsis and reduced lower sphincter pressure.
What reumatoid type has these clinical features: Females 3:1 30-50 yrs old Raynaud's phenomenon Joint pain and stiffness Dysphagia Elevated ESR ANA increased RF positive
Scleroderma / Progressive Systemic Sclerosis
