Arthritides Flashcards
0
Q
List 5 common types of arthritides (degenerative/inflammatory/deposition) that are M/C in males?
A
- DISH
- AS
- Synoviochondrometaplasia
- Gout
- Reiter’s syndrome
1
Q
What are the 3 motion characteristics of joints?
A
1) Synarthroses – fibrous (mostly immobile)
2) Amphiarthroses – cartilaginous (slightly movable)
3) Diarthroses – synovial (freely movable)
2
Q
What is an eponym for osteoarthritis?
A
Kellgren’s arthritis
3
Q
At what level is the M/C cervical degenerative spondylolisthesis?
A
C7
4
Q
What is Maigne’s syndrome?
A
Apophyseal pain from lower T/S that refers to lower lumber segments.
5
Q
What is Robert’s syndrome?
A
Costal joint involvement in lower T/S that can simulate GI disease.
6
Q
Which portion of the sacroiliac joint is synovial?
A
Lower 2/3rds
7
Q
What is the relationship between hip arthrosis and osteoporosis?
A
Hip arthrosis correlation with DECREASED risk for osteoporosis.
8
Q
A person may be at risk for which degenerative condition when their “Q” angle is >20 degrees?
A
Chondromalacia patella
9
Q
Patella alta may be a contributing factor for which condition?
A
Chondromalacia patella
10
Q
Where are Herberden’s nodes? Where are Bouchard’s nodes?
A
Herberden = DIP Bouchard = PIP
11
Q
True or false: vacuum clefts denote degeneration in any joint of the body.
A
False. Only the spine but not other joints.
12
Q
What % of erosive osteoarthritis go on to develop RA?
A
15%
13
Q
What is an eponym for DISH?
A
Forestier’s disease
14
Q
What % of DISH patients have diabetes myelitis?
A
20-50%
15
Q
What is the M/C initial site for DISH?
A
Thoracolumbar
16
Q
What are some clinical concerns associated with DISH?
A
- dysphagia from esophageal obstruction
- “carrot stick” fracture
- spinal stenosis (rare)
17
Q
What is the diagnostic criteria for DISH?
A
- flowing hyperostosis of at least 4 contiguous segments
- preservation of IVD height
- no ankylosis of facets
- no inflammation of SI joints
18
Q
What are two named radiograph signs for the flowing ossification in DISH?
A
- dripping candle wax
- flame-shaped osteophytes (hyperostosis tapers either upwards or downwards)
19
Q
Ossification of the SI joints in DISH typically involves what part of the joint?
A
Superior 1/3rd (ossify pelvic ligaments; the non-synovial part)
20
Q
What % of DISH patients show extraspinal involvement?
A
30%
21
Q
What % of OPLL cases have concurrent DISH?
A
85%
22
Q
Tabes dorsalis is associated with which condition and usually affects with anatomical locations?
A
Tertiary syphilis; affects ankle, subtalar and feet joints
23
Q
What % of diabetic patients develop peripheral neuropathy?
A
5%
24
What % of syphilis patients show arthropathic changes?
20%
25
What % of syringomyelia patients have upper extremity arthropathy?
25%
26
What is the French (Charcot) theory for neurotrophic joint?
Lack of nutrition from CNS trophic centers.
27
What is the German (Volkmann & Virchow) theory for neurotrophic joint?
Unprotected mechanical microtraumas
28
Atrophic neuropathic arthropathy usually affects which joints and with what classic radiographic sign?
Seen usually in non-weight bearing joints; but also hip and foot.
Licked candy stick (amputated bone) appearance.
29
What are the named radiographic signs of hypertrophic arthropathy in the spine?
- Jigsaw vertebra
| - Tumbling building-block spine
30
What are some causes for neurotrophic arthropathy?
- Diabetes
- Syphilis
- Syringomyelia
- Spinal cord injury
- Leprosy
- Steroid use
31
Which form of neurotrophic arthropathy occurs M/C?
Atrophic
32
What is the M/C/C for neuropathic arthorpathy of the spine?
Syphilis
33
What is the M/C to be affected by synoviochondrometaplasia?
Knee (70%)
34
What % of RA cases presents with rheumatoid nodules?
20% (overestimation!)
35
What is Felty's syndrome?
Leukopenia, splenomegaly & RA
36
What is the name of the phenomenon in RA where symptoms are worse in the morning?
Jelling phenomenon
37
What % of cases eventually involve the C/S?
80%
38
What are rheumatoid soft tissue nodules at the MCP called?
Haygarth's nodes
39
What is a button hole rupture in RA?
Rupture of the extensor digitorum tendon at PIP with the joint protruding through the rupture. Seen in boutonniere deformity.
40
Joints in a limb are spared in RA when...
that limb is paralyzed.
41
What is a hitchhiker's thumb?
1st IP flexed w/ MCP extended
42
What is a Lanois deformity?
MTP dorsal subluxation w/ fibular deviation.
43
What is another name for ball catcher's view?
Norgaard view
44
What are the differentials for carpal erosions?
"GS RAT"
- Gout
- Sudek Atrophy
- RA
- Trauma
45
Which MTP is the first to be involved in RA?
5th
46
What % of RA cases have sacroiliac joint findings?
Less than 35%
47
What are the 3 forms of Still's disease and what are their frequencies?
a) Classic systemic (20%)
b) Polyarticular form (50%)
c) Pauciarticular/monoarticular form (30%)
48
What % of JCA patients have positive RF?
<10% (poor prognosis when present)
49
What are the radiographic signs of JCA?
- metaphyseal linear periostitis; esp. hands & feet
- radiolucent submetaphyseal bands
- ectopic calcifications
- tibiotalar slant
50
What is an epynom for AS?
Marie-Strumpell's disease
51
What % of AS patients develop chronic prostatitis?
80%
52
What % of AS patients have peripheral skeletal findings in large joints? In small joints?
50% large joints
| 30% small joints
53
What are some extraskeletal manifestations of AS?
- unilateral iritis (25%)
- aortic aneurysms
- upper lung cavitating fibrosis
- prostatitis
- GI findings
54
What % of AS patients have a positive HLA-B27 lab finding?
90%
55
What is the earliest sign seen involving the SI joint in AS?
widening of the joint
56
What are Forestier's 3 stages in AS?
Stage 1: Pseudowidening of joint space (loss of cortical bone margin d/t subchondral osteoporosis)
Stage 2: Erosive & Sclerotic
Stage 3: Ankylosis
57
What is an Andersson lesion?
Pseudoarthrosis at an old carrot stick fx through a previously ankylosed motion segment.
58
In what condition is a shiny odontoid sign seen?
AS
59
True or false: AS patients get posterior body scalloping?
True -- from dural ectasia & arachnoid diverticula
60
What is a Romanus lesion?
Anterior VB marginal erosion (caused by enthesopathy at annular fibers' insertion site).
61
What % of enteropathic arthritis cases have a positive HLA-B27 lab result?
10-12%
62
Isolated SI involvement is more common than SI + spine involvement in what ratio?
4:1
63
80% of psoriasis patients with which specific lesions get psoriatic arthritis?
nail lesions (eg. pitting, discoloration, subungual hyperkeratosis)
64
Which spondyloarthropathy has no synovial hyperemia and therefore, no periarticular osteoporosis?
Psoriatic arthritis
65
What % of psoriatic patients with just peripheral joint involvement have a positive HLA-B27 lab result? What % have it with SI involvement?
Just peripheral = 30% HLA-B27
| SI involvement = 75% HLA-B27
66
Endosteal periostitis results in sclerotic bone which is M/C seen in which bone and presents with what radiographic sign?
Terminal phalanx --> ivory phalanx
67
Ankylosis of the interphalangeal joints is M/C seen in RA or psoriatic arthritis?
Psoriatic arthritis
68
What % of psoriatic patients have cervical spine involvement?
75%
69
What % of psoriatic patients have SI involvement?
up to 50%
70
What % of psoriatic patients have atlantoaxial instablity?
up to 45%
71
What are the 4 variations of syndesmophytes seen with psoriatic/reactive arthritis?
i) complete
ii) incomplete
iii) bagpipe --> bulkier base attached to mid-body
iv) floating/Bywater's Dixon --> unattached ossification
72
What is the clinical triad seen with reactive arthritis?
i) urethritis
ii) conjunctivitis
iii) polyarthritis
73
Reactive arthritis M/C affects which gender?
Male (50:1)
74
What are some organisms that involved in reactive arthritis?
- Shigella
- Yersinia
- Salmonella
75
What are some clinical features seen with reactive arthritis?
- keratoderma blenorrhagica (pustular psoriasis)
| - balanitis circinata (mucocutaneous lesions on penis)
76
What is the prognosis of Reactive arthritis?
self-limiting (2-3 months)
77
What % of reactive arthritis has positive HLA-B27 lab findings?
75%
78
The sacroiliac joint is involved in what % of reactive arthritis patients?
70%
79
What are some clinical features of SLE?
- butterfly rash
- alopecia
- Raynaud's phenomenon
- renal failure
- spontaneous tendon rupture
- joint involvement (90%)
80
What are the 2 unique lab findings seen with SLE?
i) ANF (antinuclear factor antibodies)
| ii) LE cells (mature neutrophil
81
What are the x-ray findings of chest seen with SLE?
- small, bilateral pleural effusions
- pleural thickening
- cardiomegaly
- pericardial effusion
82
Which arthropathy occurs as a consequence of rheumatic fever?
Jaccoud's arthritis
83
What x-ray features differ Jaccoud's arthritis from RA?
- no erosions
- usually normal joint space
- ulnar deviation esp @ 4th & 5th digit
84
An adolescent girl with narrowed hip joint space (or even protrusio acetabuli), no osteophytes but periarticular osteopenia should be considered for what condition?
Idiopathic chondrolysis of the hip
85
What is the prognosis of idiopathic chondrolysis of the hip?
- 30% spontaneous resolution
- 20% total ankylosis
- AVN & hip deformities
86
What does CREST stand for?
```
C = calcinosis
R = Raynaud's phenomenon
E = esophageal
S = scleroderma
T = telangiectasia
```
87
What is another name from CREST?
Thibierge-Weissenbach syndrome
88
What facial feature is seen in patients with scleroderma?
Mouselike facies
89
What % of scleroderma patients have Raynaud's phenomenon?
>90%
90
What skin features are seen in scleroderma?
- skin thickening
- hidebound (adherence to underlying structures)
- nodular subcutaneous calcific masses
- prominent muscle weakness and atrophy
91
The vertical thickness of the soft tissue should not be less than what % when compared to width at base of distal phalanx?
<20%
92
What is calcinosis cutis?
Calcification of the subcutaneous tissue.
93
What are the osseous findings seen with scleroderma?
- acro-osteolysis (phalanx & clavicle)
| - bilateral resorption of 1st metacarpal base & trapezium
94
What are the GI findings associated with scleroderma?
- pulmonary interstitial fibrosis (lung bases)
- bowel dilation (from decreased peristalsis)
- pseudodiverticula (on antimesenteric surface)
95
What is osteitis pubis commonly a sequel to?
Prostate or bladder surgery
96
What is the classic clinical triad associated with heterotrophic osteoarthropathy?
i) digital clubbing
ii) periostitis
iii) symmetric arthritis
97
Which bone is the M/C bone to develop periostitis in HOA?
Tibia > fibula > radius > ulna
98
What is primary gout?
Hyperuricemia d/t overproduction (or undersecretion) of uric acid; inborn enzymatic defect (of xanthine oxidase) causing increased deposits of sodium monourate.
99
Chronic tophaceous gout has a predilection for which tissues?
Avascular tissues (eg. tendons)
100
What is Lesch-Nyhan syndrome?
Hyperuricemia causing mental retardation, abnormal self-destructive/aggressive behavior.
101
What % of gout patients develop chondrocalcinosis?
5%
102
What is the diagnostic hallmark of gout?
Soft tissue mass (w/ calcification) and erosion at superolateral patella.
103
What is the "pseudotumor of gout"?
Prepatellar tophi
104
What are causes of secondary hemochromatosis?
Alcoholism (cirrhosis)
Multiple transfusions
Anemia
Over-ingestion of iron
105
What is the diagnostic triad associated with hemochromatosis?
Cirrhosis
Diabetes
Bronze colored skin
106
Golden or greenish-golden corneal rings/crescents deposited in Wilson's disease is called?
Kayser-Fleischer rings
107
What % of shoulder calcification cases are bilateral in HADD?
50%
108
What is the underlying problem in ochronosis?
Absence of homogentisic acid oxidase --> homogentisic acid build up
109
Clinically, ochronosis presents as which other condition?
Mild AS (95% cases = spine)
110
Homogentisic acid excreted in urine is:
alkaptonuria
111
Tumoral calcinosis typically affects which age pop'n and demographics?
children/adolescents --> blacks
112
What are the radiographic features of tumoral calcinosis?
- dense, calcified mass near a joint
| - may have a fluid level
113
Sarcoidosis has a predilection for which pop'n?
black & Scandinavian
114
Where is the M/C location for an erythema nodosum in sarcoidosis and what does it signify for its prognosis?
Anterior tibia --> good prognostic sign
115
What is Lofgren's syndrome?
Acute sarcoidosis, high fever, arthralgia, lymphadenopathy & erythema nodosum.
116
What is the hallmark lesion associated with sarcoidosis?
Non-caseating granuloma
117
What are lab tests associated with sarcoidosis?
- reversed A:G ratio
- Kviem test positive
- elevated ACE
118
What is the M/C location in the lower extremity for PVNS?
Knee
119
What is the enhancement pattern of PVNS?
Does not enhance
120
What is the angiogram appearance of PVNS?
- hypervascularity --> "puddling"
| - tumor "blush"
