Arthritides Flashcards
Inflammatory Arthritide: - Symmetrical distribution - Bilateral uniform loss of joint space - Rat Bite erosions - Pannus formation - Localized periarticular osteoporosis - DIP’s spared - Atlanto-axial instability - Haygarth’s Nodes @ MCP (knuckle) - Swan Neck / Boutonniere deformity - Ulnar/Fibular deviation (Lanois) of fingers/toes
Rheumatoid Arthritis (RA)
Rheumatoid Arthritis in children
Still’s Disease
What Labs to diagnose RA?
+ RA Latex + FANA + ESR + CRP Normocytic Normochromic Anemia
RA when presenting with dry eyes and mouth is called…
Sjogren’s
Inflammatory Arthritide: - LBP with morning stiffness - Starts in the SI joints - Males 15-35 yo - Associated with iritis - Bilateral SI joint fusion (ghost joints) - Shiny corner sign (early) in spine - B/L marginal syndesmophytes - Squaring of the VB’s - Bamboo Spine - Dagger Sign - Trolley Track sign - Poker spine
Ankylosing Spondylitis
Labs to dx Ankylosing Spondylitis (AS)
+ HLA B27 + ESR
Identical to AS in the pelvis with GI dysfunction
Enteropathic Arthropathy
Inflammatory Arthritide: - Silver Scaly lesions on extensors - Pitted Nails - Cocktail sausage digits - Males 20-50 - Increase in joint space - Mouse ear deformity - Pencil in cup deformity - Ray sign - Atlanto-axial instability - Non-marginal syndesmophytes in spine
Psoriatic Arthritis
Labs to dx Psoriatic Arthritis
+ HLA B27
Inflammatory Arthritide: - Males 20-30 yo +/- - Urethritis - Conjunctivitis - Arthritis - Caused by Chlamydia - Calcaneal spur - Fluffy periostitis - Non-marginal syndesmophytes in spine
“Can’t see, Can’t pee, Can’t dance with me”
Reiter’s aka Reactive Arthritis
Labs to dx Reiter’s
+ HLA B27
Inflammatory Arthritide: - Females - Sunlight precipitates a skin rash on face (malar/butterfly rash) - Oral ulcers - Discoid lesions - Alopecia - Raynaud’s phenomenon (white, blue, red fingers) - Can cause Ulnar Deviation of Phalanges with no joint destruction - Positive Rebound effect
Systemic Lupus Erythematosus (SLE)
What labs to dx SLE
+ LE prep + FANA + RA latex + ESR Leukopenia Thrombocytopenia
How do you manage SLE?
Co-manage with Rheumatologist
Inflammatory Arthritide: - Females 30-50 yo - Associated with erosions of the Distal Tufts of Phalanges - Associated with the CREST syndrome
Scleroderma
Scleroderma labs to dx
+ FANA + RA latex (30%)
Inflammatory Arthritide: - Multiparous females 20-40 yo - Bilateral symmetric triangular sclerotic areas on the lower half of the ilium. - Joint space is normal
Osteitis Condensans Ilia ana Osteitis Triangularis
Labs & Case management for Osteitis Condensans Ilia
Labs: None - self resolving Mgmt: Trochanteric belt for stability
Degenerative Arthritide: - Non-inflammatory - MC involves weight bearing joints - Usually stiffens with rest and improves with activity - Complications include spinal stenosis and IVF encroachment
DJD aka Osteoarthritis
MC site of DJD in the spine
C5-C6
Radiographic signs: - IVD narrowing - Osteophytes - Endplate sclerosis
DJD in spine
Radiographic signs: - Heberden’s nodes (DIP) - Decreased joint space with sclerosis - Asymmetrical distribution - Non-uniform loss of joint space
DJD in Hand
Radiographic signs in the hip of decreased superolateral joint space with sclerosis
DJD of Hip
Radiographic signs in knee of decreased MEDIAL joint space with lateral space preserved
DJD of Knee
Degenerative Arthritides: - Males > 40 yo with Neck stiffness or Pain on Swallowing - Associated with DM - Can cause ossification of PLL - Flowing hyperostosis - Candle wax drippings - 4 contiguous segments involved - Disc space preserved
DISH (Diffuse Idiopathic Hyperostosis) aka Forestier’s Disease
Degenerative Arthritides: - Secondary to impaired sensory functions in joints - Seen with diabetes, tabes dorsalis, syphilis & syringomyelia
Neurogenic Arthropathy aka Charcot’s Joint
What are the 6 D’s most common in weight bearing joints associated with Neurogenic Arthropathy (aka Charcot’s Joints)
- Distention 2. Density of subchondral sclerosis 3. Debris within the joint 4. Dislocation 5. Disorganization 6. Destruction of Bone
Degenerative Arthritides: - MC joint affected is the Knee - Results in multiple loose bodies within the joint that are round or ovoid in shape
Synoviochondrometaplasia
Metabolic Arthritide: - Males > 40 yo - Due to overproduction of uric acid - Extremely painful, red, hot and swollen joints - Usually mono-articular with the MC site at the MTP of the big toe (Podagra) - Tophi crystals may be seen - Overhanging margin & Juxta-articular erosions
Gout
Labs & Special Tests for Gout
Labs: Increased Uric Acid, + ESR Tests: Joint aspiration
Pharmacology for Gout
acute - Colchicine chronic - Allopurinol
Metabolic Arthritide: - Thin linear calcification parallel to the articular cortex within the joint space - Called chondrocalcinosis when affecting cartilage - MC seen in the knee
CPPD or Pseudogout (Calcium Pyrophosphate Dihydrate Crystal Deposition Disease)
Metabolic Arthritide: - MC found in the shoulder joint - Round or oval calcifications near the insertion of a bursa or tendon
HADD (Hydroxyapatite Deposition Disease)
Metabolic Arthritide: - PPW fever, chills, possible history of trauma/surgery and a warm, tender, swollen joint
Septic Arthritis
Lab to dx Septic Arthritis
WBC Count
