Arthritic Disorders- Symptoms and Specifics Flashcards
What are the 2 Categories of ARTHRITIS?
MonoArthritis
PolyArthritis
Types of Monoarthritis
Traumatic Infectious Crystal Induces Rheumatoid Degenerative
Types of Polyarthritis
Inflammatory Joint Disease
Degenerative Joint Disease
Metabolic Deposition Disease
Description of Inflammatory Joint Disease
Painful soft tissue swelling of joints
Rheumatoid Types of Inflammatory Joint Disease
RA
Lupus
Etc
Rheumatoid Variants
AS, Reiters, PA, EA
Description of Degenerative Joint Disease
Bony Enlargement of Joints
Types of DJD?
Primary Osteoarthritis
Secondary Osteoarthritis
Description of Metabolic Deposition Disease
Lumpy Bumpy Joint Disease
Types of Metabolic Deposition Disease
Gout
Hyperlipidemia
Etc
What does HADD stand for?
What is HADD?
HydroxyApatite Deposition Disease
-Calcifying Tendinitis and Bursitis
Who does HADD affect ?
40-70 yoa
Equal Male & Female occurrence
MC site for HADD?
Shoulder
Followed by Hip, Upper C-Spine
HADD usually affects only ____ joints such as:
Single
Shoulder, Elbow, Wrist, Fingers, Hip, Knee, Foot, Spine
Most definitive Dx for HADD?
X-ray
HADD Etiology?
Unknown
What is Tendon Calcification?
Where and what does is look like?
Local Crystal Deposition
At insertion site, not blending into the cortex of the adjacent bone
Ovoid Calcifications, Sharp Margins
What helps treat Tendon Calcification?
Ultrasound Treatment
Active Mobilization
MC site for Bursal Calcification
Subacromial
Subdeltoid
Ischial
Bursal vs Tendon Calcification
Impossible to differentiate between the two Radiografically
CPPD: What does it stand for?
What is it?
Calcium PyroPhosphate Dihydrate
Crystal Deposition Disease
What is the AKA for CPPD?
Pseudo-Gout
Because it produces gout-like symptoms
3 Types of CPPD?
1) Chondrocalcinosis
2) CPPD Arthropathy
3) Pseudo Gout Syndrome
Who does CPPD affect?
Those over 30 yoa
What 2 types of Cartilage does CPPD affect?
Hyaline Type CPPD
Fibrous Type CPPD
Where can you find Hyaline Type? Fibrous Type?
Most common joint?
Hyaline “Hugs” the bone
Fibrous is found at the edges of joints
In & Around Knee Joint, followed by Wrist Joint
Radiographic Features For:
Chondrocalcinosis - Hyaline Cartilage
Thin, Linear, Parallel to articular Cortex
MC site for Hyaline Chondrocalcinosis?
Wrist, Knee, Elbow, Hip, Shoulder
Radiographic Features For:
Chondrocalcinosis- Fibrocartilage
Thick, Irregular, Shaggy poorly defined margin
MC site for Fibrocartilage Chondrocalcinosis?
Periphery of Knee Meniscus
Triangular fibrocartilage of wrist
Symphysis Pubis
Annulus Fibrosus
What does EOA Stand for? What is it?
Erosive OsteoArthritis
An Inflammatory type of OA
EOA MC site?
DIP Joints- Episodic & Acute Inflammation
Bilateral
Symmetric
Who does EOA affect?
Middle Aged Females
What can develop with >12 of EOA?
Rheumatoid Arthritis
Symptoms of EOA
Pain Edema Redness Nodules Eventual Decrease of ROM
Ragiographic EOA
Found in DIP joints
Central Erosions - aka - Gull Wing Sign
Differential Diagnosis of EOA
Rheumatoid Arthritis
Psoriatic Arthritis
Non-Inflammatory DJD
RA vs EOA?
RA rarely involves DIP joints, and patient has positive lab results
Psoriatic Arthritis vs EOA?
Marginal Erosions with adjacent periostitis
Non-inflammatory DJD vs EOA?
No Erosions, otherwise Identical to EOA
Rheumatoid Arthritis
Connective Tissue Disorder
Etiology Unknown
Attacks Synovial Tissue
RA Affects?
20-60 yoa
Females 3:1 btw 20-40 yoa
Equal M & F in patients over 40 yoa
RA Signs & Symptoms
Pain, Tenderness, Stiffness, Swelling
Jelling Phenomenon
RA MC site?
Peripheral Joints
Bilateral and Symmetrical
Progresses Proximally
RA Physical Findings
Firm, Non-tender Rheumatoid Nodules 5mm-3cm in size
Accumulation of Inflammatory Cells
Found in 20% of patients
Found on Extensor Surfaces
Haygarth’s Nodes
Found in RA
Soft Tissue Swelling
MCP Joints affected
Lab Findings of RA
Increased ESR
Increased C-reactive Protein
Presence of Rheumatoid Factor ( RF is NOT specific for RA)
3 Must-Haves for Felty’s Syndrome
1) Rheumatoid Arthiritis
2) Leukopenia
3) Splenomegaly
Poor RA Prognosis with:
Presence of SubQ nodules High Levels of Rheumatoid Factor Exacerbation of Disease for more than 1 Year Onset before 30 yoa Extra-Articular Manifestations
RA Pathology (1/6)
Acute Synovitis with Edema
Periarticular Edema
Juxta-Articular Hypermia
RA Pathology (2/6)
Synovial Proliferation forms Pannus
Pannus: Vascular Tissue spreads over intra-articular surface of bone & cartilage
RA Pathology (3/6)
Marginal Erosions at Bare Area- where intra-articular bone in direct contact with synovium
RA Pathology (4/6)
Cyst-Like Cavities- Pannus enters marrow spaces of subchondral bone
RA Pathology (5/6)
Hyaline cartilage erodes and narrows
RA Pathology (6/6)
Joint fills with pannus-> progressive Fibrous Ankylosis
Radiographic Findings of RA
Bilateral & Symmetrical Periarticular Soft Tissue Swelling Juxta-Articular Osteoporosis Uniform Loss of Joint Space Marginal Erosions (Rat Bite Erosions) Deformity Large Pseudo-Cysts Juxta-Articular Periostitis Ankylosis
MC Sites
Hand Wrist Foot Knee Hip Cervical Spine
RA in the Hands
DIPs NOT involved!!!!
Irreversible changes within 3-6 Months
MC site for Marginal Erosions?
Radial Margins of 2 & 3 Metacarpal Heads
Radial Margins of Distal & Proximal ends of Proximal Phalanges
Types of Deformities found with RA- Hands?
Boutonniere Swan-Neck Digital Ulnar Deviation Zig-Zag Deformity Carpal Deviation