Arthritides

Question 1

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

Answer 1

Rheumatoid Arthritis (RA)

Question 2

Rheumatoid Arthritis in children

Answer 2

Still’s Disease

Question 3

What Labs to diagnose RA?

Answer 3

+ RA Latex + FANA + ESR + CRP Normocytic Normochromic Anemia

Question 4

RA when presenting with dry eyes and mouth is called…

Answer 4

Sjogren’s

Question 5

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

Answer 5

Ankylosing Spondylitis

Question 6

Labs to dx Ankylosing Spondylitis (AS)

Answer 6

+ HLA B27 + ESR

Question 7

Identical to AS in the pelvis with GI dysfunction

Answer 7

Enteropathic Arthropathy

Question 8

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

Answer 8

Psoriatic Arthritis

Question 9

Labs to dx Psoriatic Arthritis

Answer 9

+ HLA B27

Question 10

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”

Answer 10

Reiter’s aka Reactive Arthritis

Question 11

Labs to dx Reiter’s

Answer 11

+ HLA B27

Question 12

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

Answer 12

Systemic Lupus Erythematosus (SLE)

Question 13

What labs to dx SLE

Answer 13

+ LE prep + FANA + RA latex + ESR Leukopenia Thrombocytopenia

Question 14

How do you manage SLE?

Answer 14

Co-manage with Rheumatologist

Question 15

Inflammatory Arthritide: - Females 30-50 yo - Associated with erosions of the Distal Tufts of Phalanges - Associated with the CREST syndrome

Answer 15

Scleroderma

Question 16

Scleroderma labs to dx

Answer 16

+ FANA + RA latex (30%)

Question 17

Inflammatory Arthritide: - Multiparous females 20-40 yo - Bilateral symmetric triangular sclerotic areas on the lower half of the ilium. - Joint space is normal

Answer 17

Osteitis Condensans Ilia ana Osteitis Triangularis

Question 18

Labs & Case management for Osteitis Condensans Ilia

Answer 18

Labs: None - self resolving Mgmt: Trochanteric belt for stability

Question 19

Degenerative Arthritide: - Non-inflammatory - MC involves weight bearing joints - Usually stiffens with rest and improves with activity - Complications include spinal stenosis and IVF encroachment

Answer 19

DJD aka Osteoarthritis

Question 20

MC site of DJD in the spine

Answer 20

C5-C6

Question 21

Radiographic signs: - IVD narrowing - Osteophytes - Endplate sclerosis

Answer 21

DJD in spine

Question 22

Radiographic signs: - Heberden’s nodes (DIP) - Decreased joint space with sclerosis - Asymmetrical distribution - Non-uniform loss of joint space

Answer 22

DJD in Hand

Question 23

Radiographic signs in the hip of decreased superolateral joint space with sclerosis

Answer 23

DJD of Hip

Question 24

Radiographic signs in knee of decreased MEDIAL joint space with lateral space preserved

Answer 24

DJD of Knee

Question 25

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

Answer 25

DISH (Diffuse Idiopathic Hyperostosis) aka Forestier's Disease

Question 26

Degenerative Arthritides: - Secondary to impaired sensory functions in joints - Seen with diabetes, tabes dorsalis, syphilis & syringomyelia

Answer 26

Neurogenic Arthropathy aka Charcot's Joint

Question 27

What are the 6 D's most common in weight bearing joints associated with Neurogenic Arthropathy (aka Charcot's Joints)

Answer 27

1. Distention 2. Density of subchondral sclerosis 3. Debris within the joint 4. Dislocation 5. Disorganization 6. Destruction of Bone

Question 28

Degenerative Arthritides: - MC joint affected is the Knee - Results in multiple loose bodies within the joint that are round or ovoid in shape

Answer 28

Synoviochondrometaplasia

Question 29

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

Answer 29

Gout

Question 30

Labs & Special Tests for Gout

Answer 30

Labs: Increased Uric Acid, + ESR Tests: Joint aspiration

Question 31

Pharmacology for Gout

Answer 31

acute - Colchicine chronic - Allopurinol

Question 32

Metabolic Arthritide: - Thin linear calcification parallel to the articular cortex within the joint space - Called chondrocalcinosis when affecting cartilage - MC seen in the knee

Answer 32

CPPD or Pseudogout (Calcium Pyrophosphate Dihydrate Crystal Deposition Disease)

Question 33

Metabolic Arthritide: - MC found in the shoulder joint - Round or oval calcifications near the insertion of a bursa or tendon

Answer 33

HADD (Hydroxyapatite Deposition Disease)

Question 34

Metabolic Arthritide: - PPW fever, chills, possible history of trauma/surgery and a warm, tender, swollen joint

Answer 34

Septic Arthritis

Question 35

Lab to dx Septic Arthritis

Answer 35

WBC Count