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SMS Week 5 > Arthridides > Flashcards

Arthridides Flashcards

1
Q

What is the 1 non-inflammatory arthritis we talked about?

A

osteoarthritis

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2
Q

What are the 5 inflammatory arthritides we talked about?

A

rheumatoid arthritis

juvenile idiopathic arthritis

systemic lupus erythematosis

crystal induced arthritis (gout and pseudogout0

spondyloarthropathies

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3
Q

Whihc is the most common form of arthritis?

A

osteoarthritis

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4
Q

What joints does osteoarthritis prefer?

A

the small joints of the hands - MCPs, PIPs, and DIPs

especially the base of the thumb and the great toe

knees

hips

C-spine and L-spine

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5
Q

WHat is the basis of osteoarthritis?

A

age-related progressive loss of articular cartilage

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6
Q

Describe the clinical presentation of OA?

A

it’s a gradual onset of intermittent pain initially

it’s use-related pain in the knees, hips, and hands which is worse with overuse and relieved by rest

morning stiffness less than 30 minutes

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7
Q

What will you see on physical exam in OA?

A

localized pain to palpation of joint line

limited ROM

bony enlargement - will be hard when pressed (osteophytes)

soft tissue swelling

crepitus

instability/deformity

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8
Q

What are the bumps that develop at the joints in OA called?

A

Bouchards nodes

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9
Q

What wil you see on x-ray in OA?

A

sclerosis with new bone formation int he subchondral traveculae

osteophytes (bone spurs at the joint margins)

loss of cartilage (loss of joint space)

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10
Q

What are some non-pharmacologic treatments for OA?

A

weight reduction for knees

exercise with PT

assistive devices with cane or walker

joint replacement

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11
Q

What are some pharmacological treatments for OA?

A

acetaminophen and NSAIDS for pain relief

topical agents like capsaicin and methylsalicylate

intra-articular steroid injections

hyaluronic acid derivatives

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12
Q

Will any lab tests show OA?

A

No lab tests

ESR will be normal, there will be no positive RF, and the synovial fluid will be noninflammatory

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13
Q

What is the age of onset for rheumatoid arthritis? In what gender?

A

Age of onset from 30 to 50 years old (so younger than OA)

usually women

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14
Q

Describe rheumatoid arthritis.

A

it’s an insidious onset of inflammatory arthritis which is usually symmetric.

It’s a chronic, progressive, disabling and erosive disease

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15
Q

What joints does RA like?

A

the wrists, MCPs, PIPs NOT the DIPs!!!

shoulders

knees

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16
Q

what are the two blood markers for rheumatoid arthritis? Can they be false negative?

A

Rheumatoid factor

anti CCP antibody

they can be negative in RA

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17
Q

What are some extra-articular manifestions of RA?

A

subcutaneous nodules

pericarditis

pulmonary nodules or fibrosis

inflammatory eye disease

vasculitis

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18
Q

What will you see on an exam of an RA hand/

A

redness and swelling of the joitns

they’ll be soft, warm, and painful to touch

skin will be shiny due to swelling

relative sparing of the DIP joints

in progressing RA you get MCP joint subluxation with ulnar deviation of the fingers

also development of rheumatoid nodules

extremely severe cases will result in rheumatoid mutans

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19
Q

What will you see on x-ray in RA?

A

erosion of the bone

misalignment of the mionts

no cartilage (lack of joint space)

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20
Q

Why might someone with RA not be able to move their fingers?

A

RA causes inflammation of the tendons and this can lead to tendon rupture

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21
Q

What are some meds you can give for RA?

A

NSAIDs and steroids to reduce the inflammation and help with pain

DMARDs and Biologics to actually slow the progression

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22
Q

How young does a patient have to be to get a diagnosis of juvenile idiopathic arthritis? What gender usualy gets it?

A

less than 16 years

girls

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23
Q

What are the 3 subtypes of JIA?

A

systemic onset

polyarticular onset

pauciarticular onset

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24
Q

Describe systemic onset JIA

A

equal across gender

peak onset 1-6 years

this is a systemic disease with daily spikin gfevers and an evanescent rash. you get lymphadenopathy, hepatosplenomegaly, pericardial effusion, fatigue, weight loss, anemia

RF and ANA are generally negative in this one

about half will end up haing severe chronic athritis

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25
Q

Describe polyarticular JIA

A

it’s arthritis in 5 or more joints

more in girls

malaise, weight loss, fever, lymphadenopathy, anemia

you can have positive RF in this one, but not always

if they are RF+ they will have a poor progrnosis

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26
Q

Describe oligoarticular/pauciarticular JIA

A

this one is the most common of the JIAs

you get arthritis affecting 4 or fewer joints

early onset at 1-5 years old, more in girls

affects knees, ankles, wrists, and elbows

POSITIVE ANA - so you need to check their eyes for iridocyclitis because it can cause blindness!!!!!!

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27
Q

In general, what is systemic lupus erythematosus?

A

an autoimmune disease with producion of antibodies against components of the cell nucleus

these are the antinuclear antibodies = ANA

95% will be ANA positive

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28
Q

What is the age of onset and usual gender for SLE?

A

peak incidence between ages 15 and 40 with way more females than males.

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29
Q

What are some symptoms to look for in a PE if you’re worried about SLE?

A

buttery fly rash, discoid rash, photosensitivity, oral ulcers arthrtitis, serositis, renal dysfunction, neurologic symtoms, anemia, epiepsy

30
Q

In a patient with SLE, if they have a high titer dsDNA antibody, what should you check?

A

check their kidney unction because it’s associated with glomerulonephritis

31
Q

If a patient with SLE is pregnant and she’s positive for antibodies to Ro (SSA), what do you need to check for?

A

Neonatal lupus in the fetus with congenital heart block

32
Q

How can you differentiate a malar rash from a seborrheic dermatitis or sunburn?

A

there will be sparing of the nasal labia

33
Q

Why should you avoid the TNF biologic meds in SLE?

A

because they’ve been found to cause drug-induced lupus

34
Q

How can you differentiate drug-induced lupus from SLE?

A

drug induced will be less severe and in an older person

CNA and renal involvment are rare in drug induced

they’ll have antihistone antibodies, but not ANA

therapy is to just stop the medication

35
Q

What are the two types of crystal-induced arthritis we talked about?

A

gout and pseudogout

36
Q

Gout is depositition of ____ with high blood levels of _____

A

monosodium urate wit high levels of uric acid

37
Q

What are the symptosm of gout?

A

acute inflammatory arthritis in a joint (usually big toe but not always)

in the skin you get accumulation of crystals - look slike white bumps called tophi

in th ekidneys you get uric acid urolithiasis and nephropathy

38
Q

What are the 3 stages of gout?

A

asymptomatic hyperuricemia

acute intermittent gout

chronic tophaceous gout

39
Q

Is hyperuricemia more often caused by uric acid overproduction or uric acid underexcretion?

A

90% is underxcretion

can be from renal failure, hypertension, obesity, low dose aspirin, DIURETICS, dehydration, starvation

40
Q

At what age and in what gender does an acute first attack of gout occur?

A

in 40s - 60s

males much more common

women that do get is have a later onset - usually after menopause with diuretic use, hypertension, or renal insufficiency

41
Q

Describe an acute episode of gouty arthritis

A

it’s an abrupt onset of inflammation in a joint, often occurring at night

the pain will escalate over the following 8 hours

may subside within 3 to 10 days on its own

in severe cares you can get fever, chills, and malaise

as there can also be involvment with periarticular structures it is hard to distinguish on sight from cellulitis, bursitis or tendonitis

42
Q

Acute gout is usually in the ___ extremities, but not always.

A

lower extremities initially

podagra = first MTP

other MTPs, mid foot, ankles, heels, knees, wrists, fingers, elbows

43
Q

How do you definitively diagnose gout?

A

You have to tap the joint and view the fluid under a microscope, looking for crystals

a uric acid level may be normal even if gout is present

44
Q

How are uric acid levels used in gout?

A

Since they’re not great in diagnosis, they make better markers for management. The typical target in therapy is to keep it under 6.

45
Q

What are some triggering factors for gout?

A

alcohol ingestion

trauma - stubbing the toe

severe illness

IV hydration

thiazide diuretics, low dose aspirin, cyclosporine

high purine foods in diet

contrast dye

46
Q

Describe advanced gout

A

this is uncontrolled hyperuricemia with chonic arthritis leading to constant pain in joints

flares will be more intense and will last longer

it’s a destructive arthritis that will be polyarticular at this point, affecting both upper and lower extremities

they often develop solid uric acid deposits called tophi that can drain and become infected

47
Q

Where are common locations of tophi?

A

helix of the ear

periarticular regions fo the fingers (heberden’s nodes0, wrists and olecranon bursa

48
Q

Why shouldn’t you start a patient on allopurinol during their furst acute attack of gout?

A

It will actually prolong the attack

wait to start them on it after their flare has calmed down

49
Q

Besides allopurinol (or Febuxostat or probenecid), what can you give/do to treat gout?

A

NSAIDs, colchicine, pegloticase IV (this gets rid of the tophi), glucocorticoids, analgeics

aspirate the joint

dietary counseling - no alcohol, reduce weight, control hypertension

50
Q

Which is pseudoogout also known as?

A

calcium pyrophosphate dihydrate (CPPD) deposition

51
Q

WHen does pseudogout occur? Gender?

A

Later in life than gout

men = women

52
Q

Which joints are most commonly affected in pseudogout

A

knees ar emost common

wrists

hips

shoulders

ankles

53
Q

What will X-rays show in pseudogout?

A

75% of the time, it will show chondrocalcinosis - a thin white line through the joint space

54
Q

Most pseudogout is idiopathic related to aging, but what are some metabolic diseases that can cause it?

A

hyperparathyroidism

hemochromatosis

hypothyroidism

55
Q

How do pseudogout crystals look in comparison to gout crystals?

A

pseudogout crystals are rhomoboid and blunt at the edges, while gout crystals are long spikes

56
Q

Is there a lab marker for pseudogout?

A

nope

57
Q

What pharmacological treatments are there for pseudogout?

A

less than for gout

NSAIDs are effective, but colchicine isn’t and ther eis no preventive drug

intra-articular steroid injections will work

58
Q

What area of the body is affected by the spondyloarthropathies?

A

the spine, including sacroilliits

59
Q

In spondyloarthropathis, which will be positive?

HLA B27

RF

CPP antibody

A

HLA B27 is the gene marker that is present in about 90% of cases

it’s seronegative though, so not RF Or CCP

60
Q

What are some of the nonvertebral symptoms you can get with the spondyloarthropathies?

A

platnar fasciitis

inflammatory eye disease

mucocutaneous lesions

asymmetric peripheral arthritis

dactylitis = sausage digits

achilles tenosynovitis

61
Q

What are the 4 main types of spondyloarthropathies?

A

ankylosing spondylitis is at the top of the list

psoriatic arthritis

reactive arthritis = Reiter’s syndrome

arthritis associated with IBD/Crohn’s

62
Q

Describe a presentation of ankylosing spondylitis.

A

onset before age 40

insidious inflammatory back pain

duration of over 3 months

you get stiffness in the morning and it decreases with exercise (unlike mechanical back pain which is better in the morning and get worse with activity)

axial arthritis and sacroillitis

some peripheral arthritis possible

more often in males

inflammatory eye disease

THEY WILL HAVE A VERY STRAIGHT BACK BECAUSE ITS FUSES - WON’T BE ABLE TO CURVE DOWN TO TOUCH TOES

sometimes cardiac arrhythmias

63
Q

Why do patients with AS have “bamboo spines”?

A

because they get ossification on the sides of the spine, making it look like bamboo

won’t be able to bend it

64
Q

What are some symptoms of psoriatic arthritis?

A

Associated with psoriasis obvviously, so skin lesions

nail pitting

inflammatory eye disease

peripheral arthritis of the DIP joints

dactylitis = sausage toe

enthesopathy of the achilles tendon

sacroiliitis

arthritis mutilans in bad cases

65
Q

What will you see on x-rays of the hands in psoriatic arthritis?

A

A “pencil in a cup” deformity of the finger tips

66
Q

What does reactive arthritis develop after?

A

after an infection

usually GI - campylobacter, salmonella, shigella, Yersinia

or genital - chlamydia

those with HLA B27 gene will be predisposed. TYpically in males ages 20-50

67
Q

Is the reactive arthritis an infection in the joint?

A

No - it’s inflammation triggered by the bacteria that localizes to a joint

68
Q

Which joints are usually affected in reactive arthritis? How long after the infection?

A

usually the knees or ankles

about 1 month after infection

69
Q

What are some extra-articular manifestations of reactive arthritis?

A

conjuncitivits

urethritis or cervicitis if chlamydia

genital ulcers

rashes in palms or soles

70
Q

What is the treatment for spondyloarthrtopathies?

A

NSAIDs

biologic anti TNF blockers for the axial arthritis

physical therapy and posture education in AS

ABx for Chlamydia

71
Q
A

SMS Week 5 (15 decks)

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