Arthridities

Question 1

RA

Answer 1

inflammatory arthropathy
women >35 yo
+RA, +ESR, +CRP, normocytic normochromic anemia
tx: rest, anti-inflammatory drugs, exercise, PT, comanage with rheumatologist

Question 2

RA s/s and xray

Answer 2

symmetrical
immune related
begins in small joints (PIP, MCP)
swan neck deformity
ulnar deviation
swelling of carpals, feet and elbows
morning stiffness
intra-articular rat bit erosions
pannus formation
localized peri-articular osteoporosis
symmetrical

Question 3

OA

Answer 3

non-inflammatory
no labs
tx: mobilization, patient education, exercise, anti-inflammatory drugs

Question 4

OA s/s and xray

Answer 4

asymmetrical
stress related
peri-articular
pain with exercise
morning stiffness
improved with activity
joint enlargement
spurs
subchondral sclerosis
decreased joint space
asymmetrical
large weight bearing joints most commonly affected
osteophytes

Question 5

gout

Answer 5

metabolic
UA, joint aspiration for uric acid crystals
blood tests: uric acid, leukocytosis
tx: decrease purines (red meat, cheese, beer, red wine), increase cherries
refer to rheumatologist
acute: cochicines
chronic: allopurinol

Question 6

gout s/s and xray

Answer 6

appears without warning by stress/fatigue or food/alcohol
assymetrical
poor purine metabolism
pain is progressive
podagra
fever
tachycardia
malaise
tophi on auricle of ear
toe, instep, knee, wrist elbow xray findings
late stage bone involvement
overhanging edge sign on xray

Question 7

CPPD/chondrocalcinosis

Answer 7

females and males >50 yo

UA, joint aspriation for calcium crystals

Question 8

CPPD/chondrocalcinosis s/s and xray

Answer 8

appears without warning by stress/fatigue or food/alcohol
asymmetrical
poor purine metabolism
pain is progressive
podagra
fever
tachycardia
malaise
tophi on auricle of ear
thin linear calcification in knee

Question 9

neurogenic arthropathy (charcot’s joint)

Answer 9

caused by: diabetes mellitus, tabes dorsalis, syringomyelia, leprosy, drugs

Question 10

neurogenic arthropathy (charcot’s joint) s/s and xray

Answer 10

early appears like OA
not much pain
deformity
Xray: swollen joint space
deformity
sclerosis
loose bodies
spurs

Question 11

SLE

Answer 11

inflammatory or non-inflammatory
women
+LE, +FANA, +RA, +Coombs, +ESR
non-steroidal anti-inflammatory drugs

Question 12

SLE s/s and xray

Answer 12

acute episodes
polyarthritis
malar rash
raynaud's phenomenon
oral ulcers, alopecia
renal involvement
xray: deformity but not xray erosion (jaccoud's arthritis)

Question 13

scleroderma s/s and xray

Answer 13

\+FANA, +RA latex
calcinosis
raynaud's
esophageal dysfunction
sclerodactyly
telangiectasia
xray: erosion of terminal phalanges
tx: cortisone, PT

Question 14

sjogren’s s/s and xray

Answer 14

women 20-40
+HLA B27, +ESR, +LE prep
dry eyes, dry mouth, associated with RA
no xray features

Question 15

Marie Strumpell

Answer 15

AS
males 15-35yo
\+HLA B27, +ESR, -RA latex
anemia
tx: non-steroidal anti-inflammatory drugs

Question 16

Marie Strumpell s/s and xray

Answer 16

AS
begins in SI joints
morning stiffness
\+orthopedic tests
Xray: blurring of SI joints, syndesmophytes on AP&lateral, daggar sign, shiny corner sign

Question 17

psoriatic arthritis s/s and xray

Answer 17

young male 20s
-RA latex, +/- HLA B27
asymmetrical
skin rash (silver scales)
DIPS often affected
pitted nails
xray: distal phalanges involvement
resorption of distal tufts

Question 18

bacterial/septic

Answer 18

adults: N. gonorrhea
children: H. influenza
tissue biopsy, gram stain, increased WBCs
tx: aspirate and culture joint daily, drugs, splinting

Question 19

bacterial/septic s/s and xray

Answer 19

usually acute
affects synovial tissue
warm, tender, swollen
fever and chills
no xray findings

Question 20

reactive arthritis s/s and xray

Answer 20

males, adults
-RA, +/- HLA B27, +CRP, +ESR
arthritis, urethritis, conjunctivitis