Arthritis 1 Flashcards
2 cats of rheumatic disease
- iflamm
2. non inflamm
2 cats of inflamm
- autoimmune
2. non-autoimmune
4 examples of auto immune
- RA
- lupus and other collagen
- vasculitis
- spondyloarthritis
3 examples of non-autoimmune
- crystal induced
- infection induced
- hemoarthritis
3 possible localizations
- mono arth
- oligo 1-4 joints
- poly arth - >4 joints
2 reasons for early intervention
- improve function
2. prevent damage
4 parts of makinga diagnosis
- Hx
- Px
- imaging
- labs
5 features of inflammatory
- painful joint
- warmth
- swelling
- marked stiffness esp, in morning
- typical patterns
5 features of non-inflammatory
- painful joint
- little warmth
- swelling sometimes
- minimal stiffness - after gelling
- typical patterns
4 things to consider to decide type
- Number of joints involved
- Pattern of joints involved
- time course and evolution
- age of indiv
4 parts of pattern to look at
- symetry
- upper vs. lower
- axial?
- characteristic joints
** 3 possible causes of acute, inflamatory monoarthritis
- infection
- crystals
- blood
features of hemarthrosis
- bleed in a joint
- most often with clotting abnormality
- if trauma, consider a fracture
features of septic arthritris
- life threatening
- mort 10-50%
where does septic come from
- mostly hematogenous
- major abct are Gr+ cocci (staph A most common)
- some Gr- bacc
risk factors for septic artgh
- recent infection
- portal of entry
- prosthetic joint
- damaged joint
- immunocompromised
- elderly
2 types of gonorrhea arth
- typical mono in young healthy indiv
2. disseminated infection - migratory, tenosynovitis
def. crystal arth
inflammation created by crystals depostied in joint tissues
3 types of crystals
- urate - gout
- calcium pyrophosphate - pseudo gout
- cal. hydroxyapatate
3 features of crystal arth
- dep. in the synovial fluid
- attacks are an acute and dramatic monoarth
- usually self limited
age of onset of gout
men - 40-60
women older
pathway of uric acid
purine>hypoxanthine>xanthine> (via xantine oxydase)>uric acid
3 mech. of uric acid buidup
- dietary intake (red meat, fish, beer)
- synteheis (error of metabolism, ethanol, illness)
- underexcretion (renal fail, metabolic syn, diuretics)
4 major gout risk factors
- illness
- surgery
- meds
- alc
inital gout episode (typical)
1st MTP
- acute and intermittent
- may become chronic
what are tophi
tissue deposits of of urate outside the joint (lumps)
def. CPPD
from Ca pyrophosphate
- pseudo gout - gout-like attacks
typical presentaion of CPPD
> 60yo
- typically wrist and knee
typical presentation of hydroxyapatate
- younger indivs
- acute arth.
- shoulder, hip, first toe
3 universal features of acute monoarth
- swelling, pain, redness
- fever
- malaise
4 features to look for on physical
- portal of entry
- tophi
- bruising suggestive of coag. defect
- skin lesions typical of GC arth
2 tests to do for monoarthririts
- synovial fluid anal
2. imaging
3 Cs of synovial fluid anal
Culture
Cell count
Crystals
**what is cutoff for inflammatory
WBC>2000
what is typical but not always infections
WBC>50000
2 features of gout crystals
- long and needle
2. neg, birefringence
2 feature of CPPD crystals
- rhomboid
2. pos. birefringence
use of x-rays
- as a baseline
- lask spec. in acute setting
mgmt of acute crystal arth.
treat inflammation - NSAIDS - prednisone - injections rest, ice, elevation
mgmt of spetic arth
- start empiric ABs as soon as fluid drawn
- change AB when get cultures back
- daily drain of joint space
mgmt of hemoarth
- drain the blood
- inject glucocorticoids
