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Rheumatology > Arthritides > Flashcards

Arthritides Flashcards

1
Q

Define Arthritides

A

Types of arthritis

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2
Q

Key Manifestations of Arthritis

A

Pain
Swelling
Limited motion

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3
Q

Types of Joints

A

Fibrous/Bony
Cartilaginous
Synovial

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4
Q

Fibrous/Bony Joint Motion

A

Minimal to no motion

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5
Q

Cartilaginous Joint Motion

A

Limited motion

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6
Q

Synovial Joint Motion

A

Freely mobile
Comprised of 2+ bones
May have meniscus

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7
Q

Define Osteoarthritis

A

Degenerative arthritis or joint disease

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8
Q

Pathophysiology of Osteoarthritis

A

Damage to normal articular cartilage
Chondrocytes react by releasing degradative enzymes
Bone reacts with subchondral sclerosis & osteophytes
Degredation of cartilage & bony reaction
Complete loss of cartilage
Joint space narrowing & possible deformity
Hypertrophy/hyperplasia of osteocytes -> subchondral sclerosis -> osteophyte formation

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9
Q

Predisposing Factors of Osteoarthritis

A 
Age
Female sex
Previous injury
Obesity
Heavy physical labor
Positive family history
Sports activities
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10
Q

Features of Osteoarthritis

A 
Joint pain
Swelling
Crepitation
Tenderness
Effusions
Hands, hips, knees, spine
Tenderness on palpation & on passive motion (late signs)
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11
Q

Osteoarthritis in the Hands

A

Middle-aged & elderly women
Strong family history
DIP & PIP joints

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12
Q

Location of Heberden’s Nodes

A

DIP

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13
Q

Location of Bouchard’s Nodes

A

PIP

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14
Q

Osteoarthritis in the Shoulder

A

Progressive anterior shoulder pain, worse with motion
Difficulty with overhead activities, sleeping, axillary hygiene
Seen frequently with rotator cuff disease/tears, AC joint arthritis

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15
Q

Osteoarthritis of the Hip

A

Pain deep in the groin- can radiate to anterior thigh, knee, & buttock
Starts with prolonged standing/walking becoming intolerable
Then difficulty putting on socks/shoes
Pain with abduction

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16
Q

Osteoarthritis of the Knee

A

Difficulty doing stairs, getting out of low chairs, off of toilets
Pain with kneeling/squatting

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17
Q

Osteoarthritis of the Cervical Spine

A

Pain & stiffness

Aching pain down the arm

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18
Q

Osteoarthritis of the Lumbar Spine

A

Pain across low back/buttocks with LOM flex/ext

Can develop spinal stenosis

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19
Q

Diagnosis of Osteoarthritis

A

Clinical supported by H&P, labs, & imaging
No specific labs
X-ray sufficient

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20
Q

Findings on Osteoarthritis Imaging

A 
Joint space narrowing
Surface irregularity
Osteophytes
Subchondral sclerosis
Subchondral cysts
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21
Q

Non-pharmacological Treatment of Osteoarthritis

A 
Moderate weight loss
Exercises
PT/OT
Braces
Heat/cold
Rest
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22
Q

Pharmacologic Treatment of Osteoarthritis

A 
Acetaminophen
NSAIDs
Tramadol
Opioids
Intra-articular Injections
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23
Q

Benefits of Glucocorticoid Intra-Articular Injection for Osteoarthritis

A

Slow cartilage degradation

Provide pain relief

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24
Q

Benefits of Hyaluronans Intra-Articular Injection for Osteoarthritis

A

Macromolecules absorb water & may protect cartilage

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25
Q

How to Perform a Knee Injection/Aspiration

A 
Thorough skin prep
Supero-lateral portal
Patient supine
Sit with knee at eye level
Little pain when slow
Aspiration/injection
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26
Q

Surgical Treatment for Osteoarthritis

A

Arthroscopic procedures
Total joint replacement
Chondrocyte grafting

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27
Q

Arthroscopic Procedures

A

May aggravate underlying arthritis

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28
Q

Total Join Replacement

A

Gold standard for severe knee, hip, or shoulder joint arthritis

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29
Q

Chondrocyte Grafting

A

Perhaps for small, isolated defects

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30
Q

Benefits of Total Joint Replacement

A

Relieves pain
Corrects deformity
Improves function

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31
Q

Infections & Joint Replacements

A

More susceptible due to implant

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32
Q

Replacements & Loosening

A

May be due to bone resorption or macrophage response

Follow-up x-rays

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33
Q

Replacements & Periprosthetic Fractures

A

Metal creates stress risers

Difficult to treat

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34
Q

Rheumatoid Arthritis

A

Women > men
Autoimmune disease that primarily involves joints
Breakdown of immune tolerance to synovial inflammation

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35
Q

Pathophysiology of Rheumatoid Arthritis

A

Prominent immunologic abnormalities
Plasma cells produce antibodies
Macrophages migrate to synovium
Macrophages & lymphocytes produce pro-inflammatory cytokines & chemokines in synovium
Synovium thickens over time
Hyperplastic synovial tissue releases inflammatory mediators

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36
Q

Clinical Presentation of Rheumatoid Arthritis

A

Gradual, insidious onset
Symptoms wax & wane
Usually multiple joints
Can cause significant disability

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37
Q

Systemic Symptoms of Rheumatoid Arthritis

A

Early morning stiffness
Generalized afternoon fatigue & malaise
Anorexia
Generalized weakness & fever

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38
Q

Joint Symptoms of Rheumatoid Arthritis

A

Pain
Swelling
Stiffness
Erythema

39
Q

Rheumatoid Arthritis Imaging

A

X-ray (initially)

MRI, ultrasound (shows more damage)

40
Q

Findings on X-ray for Rheumatoid Arthritis

A 
Joint space narrowing
Soft tissue swelling
Bony erosions
Osteopenia
Laxity -> deformity
Destruction/fusion (late)
41
Q

Rheumatoid Arthritis in the Hand

A 
Swollen, painful MP, PIP joints
Reduced grip strength
Tendon ruptures, triggering
Joint deformities (ulner deviation)
5% carpal tunnel
42
Q

Rheumatoid Arthritis of the Wrist

A

Loss of extension
Carpal drift
Tendon rupture

43
Q

Rheumatoid Arthritis of the Elbow

A

Loss of extension
Olecranon
bursitis
Ulnar neuritis

44
Q

Rheumatoid Arthritis of the Shoulder

A

Adhesive capsulitis
Rotator cuff disease
Joint destruction

45
Q

Rheumatoid Arthritis of the Foot

A

MP joint involvement
Toe deformities
Heel, annkle pain

46
Q

Rheumatoid Arthritis of the Knee

A

Synovitis & effusion
Backer’s cyst
Loss of flexion

47
Q

Rheumatoid Arthritis of the Hip

A

Groin pain

Loss of rotation

48
Q

Locations of Extra-Articular Rheumatoid Arthritis

A 
Skin & pulmonary nodules
Pericarditis
Splenomegaly
Neuropathy
Vasculitis
Episcleritis
Lymphadenopathy
49
Q

Laboratory Findings in Rheumatoid Arthritis

A 
Rheumatoid factor
Anti-CCP
ESR
CRP
Synovial fluid: elevated WBCs
50
Q

Diagnosis of Rheumatoid Arthritis

A

Inflammatory arthritis in 3+ joints for 6+ weeks
Positive RF & ACCP
Elevated ESR & CRP
Have excluded gout, CPDD, viral arthritis, SLE, psoriatic arthritis

51
Q

General Treatment of Rheumatoid Arthritis

A

Management of acute flares
Use DMARDs early
Surgery for soft tissues & joints
Helping the patient manage

52
Q

How to manage acute flares of rheumatoid arthritis?

A

NSAIDs

Glucocorticoids

53
Q

Types of DMARDS

A

Non-biologics

Biologics

54
Q

How to help the patient manage?

A

PT
OT
Bracing
Support groups

55
Q

Non-Pharmacological Treatment of Rheumatoid Arthritis

A

Heat/cold
Orthotics & splints
Therapeutic exercise
PT/OT

56
Q

Treat of Acute Pain in Rheumatoid Arthritis

A

NSAIDs

Glucocorticoids: systemic

57
Q

SE of Glucocorticoids

A 
Hyperglycemia
Skin fragility
Osteoporosis
Weight gain
Adrenal insufficiency
Muscle breakdown
Euphoria
Glaucoma
58
Q

SE of NSAIDs

A

GI

CV

59
Q

Non-Biologic Agents for Rheumatoid Arthritis

A 
Methotrexate
Sulfasalazine
Leflunomide
Hydroxychloroquine
Cyclosporine
Gold salts
Azathioprine
60
Q

Biologic Agents for Rheumatoid Arthritis

A

TNF inhibitors
Entanercept (Enbrel)
Infliximab (Remicade)
Adalimumab (Humira)

61
Q

MOA of Methotrexate

A

Inhibits biosynthesis

62
Q

AE of Methotrexate

A 
Ulcerative stomatitis
Leukopenia
Predisposition to infection
Nausea
Abdominal pain
Fatigue
Fever
Dizziness
Pneumonia
Pulmonary fibrosis
63
Q

Contraindications of Methotrexate

A

Renal dysfunction

Pregnancy or possible pregnancy

64
Q

Surgery for Rheumatoid Arthritis

A 
Synovectomy
Tendon repairs
Removal of nodules
Total joint replacements
Fusions
65
Q

Gout Characterized by

A

Painful joint inflammation in the first metatarsophalageal joint

66
Q

Pathophysiology of Gout

A

Precipitation of monosodium rate crystals in joint space
Joint space damaged
Top may also form in joint space

67
Q

Reasons for Gout

A

Decreased excretion
Increased production
Increased purine taste

68
Q

Risk Factors for Gout

A 
Increases with age
Estrogen increases urinary excretion of uric acid
Alcohol
Meat
Seafood
69
Q

Clinical Presentation of Gout

A 
Severe pain
Redness/warmth
Swelling/disability
Onset more at night
Overlying skin becomes tense
70
Q

Diagnosis of Gout

A

Clinical criteria
Synovial fluid analysis
Elevated serum urate level
X-rays

71
Q

Treatment of Acute Gout

A

NSAIDs
Cholchicine
Glucocorticoids

72
Q

SE of Cholchicine

A

GI upset
Neutropenia
Peripheral neuropathy

73
Q

Intra-articular Glucocorticoids

A

Often quickly resolves symptoms

74
Q

Oral Glucocorticoids

A

Multiple joints

Can’t use NSAIDs or cholchicine

75
Q

Treatment of Hyperuricemia

A 
Reduced intake of purines
Xanthine oxidase inhibitors (allopurinol)
Uricosuric drugs (probenecid)
76
Q

Preventing Recurrent Gout Attacks

A

Lifestyle changes
Diet
Lowering serum uric acid

77
Q

Lifestyle Changes in Preventing Gout Attacks

A

Weight loss

Decreased ETOH intake

78
Q

Diet & Preventing Recurrent Gout Attacks

A

Decreasing meat & fish

Increasing dairy products

79
Q

Lowering Serum Uric Acid & Preventing Recurrent Gout Attacks

A

Uricosuric agents

Xanthine oxidase inhibitors

80
Q

Define Pseudogout

A

Calcium pyrophosphate dehydrate (CPPD) crystal deposition disease (Chondrocalcinosis)

81
Q

Etiology of Pseudogout

A

Trauma
Hypomagnemia
Hyperparathyroidism

82
Q

Clinical Presentation of Pseudogout

A

Similar to gout but less severe

Large peripheral joints

83
Q

Diagnosis of Pseudogout

A

Synovial fluid

X-rays

84
Q

Treatment of Pseudogout in a Single Joint

A

Aspirate & inject with steroids
Immobilize
Apply ice or cool pack

85
Q

Treatment of Pseudogout in Multiple Joints

A

NSAIDs
Colchicine
Systemic steroids

86
Q

Prevention of Pseudogout After 3+ Attacks

A

Daily colchicine

87
Q

Major Features of OA, RA, Gout/Pseudogout

A

OA: degeneration of cartilage leads to joint damage
RA: Autoimmune disease that attacks synovium & soft tissue
Gout: deposition of crystals leads to joint inflammation & damage

88
Q

Clinical Features of OA, RA, Gout

A

OA: limited to the joint
RA: generalized disease- multiple, swollen, painful joints
Gout: red, hot swollen joint/skin sensitivity

89
Q

Imaging Findings in OA, RA, Gout

A

OA: joint space narrowing, subchondral sclerosis, osteophytes, subchondral cysts
RA: joint space narrowing, soft tissue swelling, bony erosions, osteopenia about joint
Gout: erosions & joint descruction

90
Q

Swelling, Stiffness, & Fingers in OA & RA

A

OA: hard, bony; worse after use (PM); DIP/PIP + nodes
RA: soft, warm, tender; worse after resting (AM), MP & PIP + deformity

91
Q

Lab Work in OA, RA, Gout

A

OA: normal
RA: ESR, CRP, RF, & ACCP
Gout: elevated uric acid, crystals in joint fluid

92
Q

Synovial Analysis in OA, RA, Gout

A

OA: clear fluid, negative for crystals
RA: slightly to moderate turbid
Gout: turbid

93
Q

Goals of Treatment of Arthritides

A

Prevent progression, recurrence
Relief of pain
Improvement of function

94
Q

Modalities of Arthritides

A

Lifestyle changes
Braces, OT, PT
Medications
Reconstructive surgery

Rheumatology (8 decks)

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