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**FINAL REVIEW > *Arthritis > Flashcards

*Arthritis Flashcards

1
Q
A

osteoarthritis

in the metatarsophalangeal joint of the big toe

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2
Q
A

Psoriatic Arthritis

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3
Q
A

Osteoarthritis

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4
Q
A

Psoriatic Arthritis

(highlighting ivory phalanx); pencil-in-cup;

whittling of the distal tufts of the phalanges

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5
Q
A

Psoriatic Arthritis:

  • “pencil in cup” deformity of left 1st MTPJ
  • bilateral erosion of the head of the first metatarsal, worse on the left where the head is almost completely destroyed. Corresponding but less florid erosion is present on the distal aspect of this joint, producing a characteristic deformity.
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6
Q
A

Reactive Arthritis

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7
Q
A

Reactive Arthritis

juxta- articular osteoporosis present in the third MTP joint. Periostitis is present along the shafts of the second, third, and fourth proximal phalanges and the neck of the third metatarsal

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8
Q
A

Rheumatoid Arthritis

fibular dislocation of the toes; juxta-articular osteopenia metatarsal heads are washed out

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9
Q
A

Rheumatoid Arthritis

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10
Q
A

Septic Arthritis

poorly defined bony destruction with indistinct superficial marginal erosions may be evident along the articular surfaces. This may be accompanied by joint space narrowing, secondary to chondral destruction. Joint space ankylosis may occasionally occur in advanced cases.

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11
Q
A

Septic Arthritis

a destructive erosive process involving the first metatarsophalangeal joint with associated subluxation of the joint. This patient has septic arthritis.

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12
Q
A

Rheumatoid nodules

(assoc w/ RA)

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13
Q
A

Boutonniere finger deformity

(assoc w/ Rheumatoid Arthritis)

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14
Q
A

Swan neck deformity

(assoc w/ Rheumatoid Arthritis)

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15
Q
A

Baker’s cyst

(assoc w/ Rheumatoid Arthritis)

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16
Q
A

Felty Syndrome:

(assoc w/ Rheumatoid Arthritis)

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17
Q
A

Pannus Formation

(assoc w/ Rheumatoid Arthritis)

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18
Q
A

Heberden nodes

at DIPJs

(assoc w/ Osteoarthritis)

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19
Q
A

Bouchards nodes

at PIPJ

(assoc w/ Osteoarthritis)

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20
Q

Positive Schober Test

A

Ankylosing Spondylitis

(also poker spine, bamboo spine, kyphosis)

(+) result is a decrease in lumbar spine range of motion (flexion), most commonly as a result of ankylosing spondylitis

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21
Q
A

Keratoderma Blennorrhagica

assoc. w/ Reiter’s/ Reactive Arthritis

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22
Q
A

Ivory phalanx

assoc w/ Psoriatic arthritis

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23
Q
A

Keratoderma blennorrhagica

(assoc w/ Reactive/Reiters arthritis)

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24
Q

purpose of arthrocentesis

A

performed daily to BID

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25
Q

types of septic arthritis

A
  • Acute bacterial
    • nongonococcal
    • gonococcal
  • Viral -
    • MC by Hep B, then mono > rubella > mumps …etc
  • Tuberculosis arthritis -
    • dx w/ synovial biopsies
  • Fungal arthritis -
    • MC sporothrix schenckii
  • Lyme disease
    • MC borrelia burgdorferi
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26
Q

compare Overproducers and Underexcretors of Gout

A
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27
Q

overproducer of uric acid

treatment

A

recall: overproducer = METAbolic gout
* Allopurinol (Xanthine oxidase inhibitor) - 300 mg QD

*not as common; caused by genetic enzyme defect or tumor

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28
Q

underexcretor of uric acid

treatment

A

recall: underexcretor = RENAL gout (more common)

  • Probenecid: competes w/ uric acid for reabsorption from the kidneys
    • 250 mg BID x 1 week, then double dose, then inc. by 500 mg/d every 4 weeks (do not exceed 2 g/d)
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29
Q

how do diuretics affect gout?

A

increase osmolarity → increase risk of gout

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30
Q

pseudogout

A

chondrocalcinosis, calcium pyrophosphate dihydrate, CPPD

MC: Knee (50%) > ankle, wrist, shoulder

associated w/ high-grade fever

rhomboid crystals

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31
Q

pseudogout radiographic findings

A

calcification of the articular cartilage or meniscus

(recall: MC in knee)

rhomboid-shaped crystals, positively birefringent, blue

32
Q

drugs that can cause Drug-induced lupus

A

PCH PIG

  • Procainamide
  • Hydralazine
  • Chlorpromazine
  • Isoniazid
  • Penicillamine
  • Griseofulvin
33
Q

proximal nail fold telangiectasias,

assoc. w/ which connective tissue disease

A

Systemic lupus erythematosus

34
Q

systemic lupus erythematosus:

treatment

A

symptomatic:

  • steroids
  • antimalarials (chloroquine)
  • immunosuppressants
  • avoid sunlight
35
Q
A

Scleroderma (progressive systemic sclerosis)

36
Q

CREST syndrome

A

assoc. w/ scleroderma

  • calcinosis cutis (calcifications in the skin)
  • raynaud phenomenon
  • esophageal dysfunction
  • sclerodactyly - localized scleroderma of the digits
  • telangiectasias
37
Q

Scleroderma:

key words

A
  • mask facies
  • thick, hard leathery skin
  • nails grow claw-like over shortened distal phalanges
  • matlike telangiectasias
  • mouse-like appearance due to skin around mouth having many furrows radiating outward
  • (+) ANA
38
Q

Dermatomyositis/Polymyositis

A
39
Q

Dermatomyositis/Polymyositis:

key words

A
  • Gottron sign
  • Reddish-purplish (heliotrope) facial lesions
  • proximal muscle weakness
  • proximal nail fold telangiectasias
40
Q
A

Gottron sign: (assoc w/ Dermatomyositis)

flat-topped violaceous papules over the dorsal aspect of the knuckles

41
Q

Dermatomyositis/Polymyositis:

diagnosis & tx

A

tx: steroids

42
Q

Sjogren syndrome:

define & key words

A
  • assoc. w/ rheumatic disease
  • keratoconjuncitivitis sicca (dry eyes) - feels burning or itching
  • xerostomia (dry mouth)
  • dry vagina
  • dysphagia
  • dry skin
  • possible loss of taste/smell
  • parotid gland enlargement
43
Q

Sjogren Syndrome:

diagnosis

A
  • W > M (9:1), 40-60s
  • mild anemia, leukopenia
  • (+) RA factor
  • (+) Schirmer test (tears)
  • Bx of saliva gland
44
Q

Schirmer test:

what is it, and what condition does it test for?

A
  • measures quantity of tears
  • litmus paper is placed in the eye for 5 minutes; if less then 5mm of wetness, test is (+) positive

Tests for Sjogrens Syndrome

45
Q

Sxs of IBD-associated Arthritis

A

Crohn dz and Ulcerative colitis

  • rheumatologic manifestations in 15-20% of patients
  • asymmetric, nondestructive, transient arthritis
  • arthritis flares tend to parallel flares of the underlying bowel disease
  • commonly affects knees, ankles, elbows, wrists
46
Q

what can positive ANA be seen with,

beyond the connective tissue diseases?

A
  • aging
  • HIV
  • viral hepatitis
  • interstitial lung disease
  • Tuberculosis
  • Malignancy (especially B-cell lymphomas)
47
Q

connective tissue diseases

with positive (+) ANA

A
  • Sjogrens - dryness
  • Systemic lupus erythematosus - photosensitivity
  • Scleroderma
  • Dermatomyositis
48
Q

Scleroderma:

subtypes

A

Systemic sclerosis (scleroderma) - increased risk of intersititial lung disease; organ involvement

Limited/cutaneous scleroderma (CREST) - skin is taut, no wrinkles, NO ORGAN INVOLVEMENT

49
Q

most specific Rheum test for rheumatoid arthritis

A

CCP

Anti-CCP Ab: CCP is cyclic citrullinated peptide, a derivative of arginine

50
Q

what might falsely INCREASE ESR

A

severe anemia

51
Q

what might falsely DECREASE ESR

A
  • advanced liver disease
  • nephrotic syndrome
  • protein-losing enteropathies/malnourishment
52
Q

what distinguishes inflammatory from noninflammatory diseases

(i.e. synovial fluid aspiration)

A

inflammatory synovial fluid has increased WBCs

noninflammatory has WBCs WNL

53
Q

episcleritis / scleritis

A

;

associated w/ Rhematoid arthritis

Episcleritis is inflammation of the superficial, episcleral layer of the eye. It is relatively common, benign and self-limiting.

Scleritis is inflammation involving the sclera. It is a severe ocular inflammation, often with ocular complications, which nearly always requires systemic treatment

54
Q

HLA-DR4:

associated w/ what?

A

Rheumatoid arthritis,

esp in female gender

55
Q

HLA-B27:

associated with what?

A
  • Reactive Arthritis (Reiters)
  • Ankylosing Spondylitis
  • Psoriatic arthritis
56
Q

raynaud disease:

color changes

A

white → blue → red

changes w/ cold exposure of fingers, ears, nose

57
Q

organs that might be affected by Sjogren Syndrome

A
58
Q

polymyositis:

signs and sxs

A
59
Q

Dermatomyositis:

signs and sxs

A
60
Q

guttate psoriasis

A

a type of psoriasis that shows up on your skin as red, scaly, small, teardrop-shaped spots

gota = “drops”

61
Q

diruetics can contribute to decreased renal excretion of uric acid

A

can therefore contribute to gout

62
Q

pathophysiology of hyperuricemia (gout)

A
63
Q

synovial fluid cell count

and conditions

A
64
Q

what factors contribute to gout attacks occurring at night?

A

extrinsic factors trigger crystal-induced inflammation

  • pH - breathing at slower rate, pH is going to be more acidic
  • temperature - cooler at night, esp if toes are peeking out of sheets
  • dehydration - haven’t had fluid while sleeping
65
Q

crystal-induced inflammation:

pathophysiology

A

as urate crystals deposit in synovial tissues →

initial response w/ macrophages and monocytes →

recruitment of large # of neutrophils →

crystal-induced inflammation

66
Q

tx for OVERPRODUCERS vs. UNDEREXCRETORS

A
  • Overproducers:
    • acute: NSAIDs, Colchicine, Systemic Steroids, Intra-articular steroids
    • chronic: Allopurinol - to decrease uric acid production
  • Underexcretors:
    • probenecid or sulfinpyrazone
67
Q

best tx for a gout attack in patients w/:

renal insufficiency

A

intra-articular steroid injection

68
Q

risk factors for Pseudogout

A
  • elderly
  • hyperparathyroidism
  • too much iron
  • too little phosphate or magnesium

asscociated w/ hemochromatosis

69
Q

pseudogout (CPPD):

xray

A

chondrocalcinosis

(calcific deposits in the cartilage)

70
Q

hemochromatosis

A

causes your body to absorb too much iron from the food you eat.

Excess iron is stored in your organs, especially your liver, heart and pancreas. Too much iron can lead to life-threatening conditions, such as liver disease, heart problems and diabetes

71
Q

initial treatment algorithm for septic joint

A

gram positive cocci → vanc

gram negative rods → ceftriaxone

negative gram stain → vanc

72
Q

case:

w/ HA, fever, recent camping trip

A

Lyme Disease

(erythema chronica migrans)

73
Q

Case:

29 y/o F, migratory polyarthralgias

A

gonococcal infections

(disseminated gonococcal infections)

74
Q

Case:

25 y/o M, recent diarrheal illness

A

Reactive (Reiter’s) Arthritis

scleritis

75
Q

Case:

Obese older M, w/ CKD

A

chronic tophaceous gout

**FINAL REVIEW (13 decks)

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