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**Old DOOS > Arthritis > Flashcards

Arthritis Flashcards

1
Q

what is the most common arthropathy among adults? the progressive loss of articular cartilage with reactive changes in the bone

A

Osteoarthritis

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2
Q

over the age of 55, who is more likely to have OA

A

females

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3
Q

can you have OA and RA?

A

Yes

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4
Q

what are clinical features of OA?

A

Decreased ROM
Crepitus
pain gradually worsening throughout the day

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5
Q

What is OA at the DIP called?

A

Heberden’s Nodes

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6
Q

What is OA at the PIP called?

A

Bouchard’s Nodes

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7
Q

What joints are typically spared from OA?

A

MCP (except thumb)
ankle
elbow

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8
Q

what are secondary causes of OA

A

joint injury
congenital
inflammatory
neurologic

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9
Q

what is the best evaluation tool for OA?

A

Xray

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10
Q

What are xray findigns consistent w/ OA?

A

joint space loss/ asymmetric narrowing
subchondral sclerosis
bone cysts
osteophytes

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11
Q

Is synovial fluid analysis helpful w/ OA?

A

only for overlapping disease

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12
Q

Tx for OA

A 
moderate physical activity (Low- moderate) 
weight reduction
NSAIDs (oral/topical)
viscosupplementation Injections (FDA- knee only)
intra-articular steroids (cortisone) 
Bracing
PT
Joint Replacement
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13
Q

what are articular corticosteroid injections good for?

A

pain/inflammation
variable period of relief
diagnostic/ therapeutic benefit

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14
Q

what is arthroscopy helpful for?

A

shoulder/ elbow debridement

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15
Q

what do you do for abx preoperatively before joint arthroplasty?

A

cefazolin (1 gm if less than 80 kigs, 2 gram if more) and repeated for 2 doses postoperatively

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16
Q

before subsequent procedures, what do joint arthroplasty patients need?

A

prophylactic abx

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17
Q

Chronic disease with synovitis affecting multiple joints and with other systemic extra-articular manifestations

A

Rheumatoid arthritis

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18
Q

common age of onset for RA

A

40-60

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19
Q

when is juvenile RA usually diagnosed

A

<16

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20
Q

what causes erosion of the cartilage, subchondral bone, articular capsule, tendon, and ligaments in RA?

A

Hyperplastic synovial tissue (pannus)

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21
Q

There are more _________ in RA than OA in the synovial fluid

A

neutrophils

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22
Q

is RA usually polyarticular or monoarticular?

A

polyarticular

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23
Q

the _____ of the hand are typically spared in RA, but not in OA.

A

DIP

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24
Q

what is a notable pulmonary complication of RA

A

pleural effusions

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25
Q

what is a notable ocular finding of RA?

A

episcleritis (patch of intense injection w/o scleral edema)

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26
Q

What is a notable skin complication of RA?

A

skin ulcerations

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27
Q

RA can’t be diagnosed until symptoms are present for at least ____ consecutive weeks.

A

6

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28
Q

____ with RA are positive early but _____ findings are typically late.

A

Lab

x-ray

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29
Q

what are the diagnostic criteria for RA

A

Morning Stiffness > 1 hr. x 6 wks. (minimum)

Arthritis and soft tissue swelling of > 3 joints, present for at least 6 weeks

Symmetric arthritis present for at least 6 wks.
Arthritis of hand joints x 6 weeks

Subcutaneous nodules over bony prominences, extensor surfaces or juxta-articular regions

Rheumatoid factor at a level above the 95th percentile

radiologic changes suggestive of joint erosion or bone decalcification

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30
Q

lab findings for RA

A

anemia of chronic disease
eosinophilia
ESR and CRP (elevated)
rheumatoid factor (RF) and anti-CCP antibodies

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31
Q

is synovial fluid analysis more helpful in OA or RA

A

RA

32
Q

what is the best imaging for RA

A

Xray

soft tissue swelling, w/ acute flare-ups

33
Q

tx fro RA

A

refer to rheumatology
consider PT/OT
may require ortho referral for joint reconstruction
pharm tx is long term

34
Q

what is the frequently prescribed Rx for RA?

A

methotrexate

35
Q

what is usually used for RA tx

A

combination w/ DMARD’s, biologics, and NSAIDs

36
Q

Inflammatory arthritis with skin involvement usually preceding joint disease by months to years. Symmetric arthritis resembling RA that may involve the hands and feet

A

psoriatic arthritis

37
Q

significant findings in psoriatic arthritis

A

pitting of nails and oncholysis

sausage-finger appearance

38
Q

Labs with psoriatric arthritis

A

ESR elevated
CBC_ normocytic normochromic anemia
RF is normal

39
Q

when you se “pencil in cup” what should you think?

A

Psoriatric arthritis (see in middle to distal phalanyx)

40
Q

Tx for psoriatric arthritis

A

NSIADs (mild cases)

methotrexate

41
Q

what should be avoided w/ psoriatric arthritis

A

corticosteroids (already getting a lot for skin)

antimalarials

42
Q 
Seronegative arthritis with a tetrad of:
Urethritis
Conjunctivitis
Oligoarthrits
Mucosal Ulcers
A

Reiter’s Syndrome (reactive arthritis)

43
Q

when does reiter’s syndrome usually manifest?

A

after an STD

44
Q

where does reiter’s usually affect

A 
asymmetric, large joints
mucocutaneous lesions (balanitis, stomatitis)
45
Q

what is the leading cause of non-traumatic monoarthritis?

A

reiter’s syndrome

46
Q

lab tests for reiter’s syndrome?

A

HLA B27

synovial culture is negative

47
Q

Tx for Reiter’s

A

NSAIDs + PT

abx if they have an infection

48
Q

Systemic Disease of altered purine metabolism leading to sodium urate crystal precipitation into synovial fluid

A

Gout

49
Q

what is the initial gout attack of the 1st MTP joint?

A

podagra

50
Q

what should you think you have if a joint is painful, swelling, redness, and exquisite.

A

septic joint and gout

51
Q

chalky deposits of urate crystals adjacent to the joint

A

tophi

52
Q

do you get a crystal analysis when you just send fluid to the lab?

A

no, must order it separately

53
Q

Gout will also have what elevated?

A

ESR and CRP

54
Q

Tx for gout

A

indomentacin

cochicine

55
Q

what are prevention drugs for gout

A

allopurinol
probenicid
sulfapyrazone
febuxostat

56
Q

if infection is ruled out with gout what tx can you consider

A

cortisone injections

57
Q

calcium pyrophosphate dehydrate disease (CPPD)

affects peripheral joints, recurrent and abrupt onset of attacks

A

pseudogout

58
Q

what crystals will you see on pseudogout aspiration?

A

calcium pyrophosphate crystals

59
Q

On Xray what will you see w/ pseudogout?

A

chondrocalcinosis- fine linear calcifications in cartilage

60
Q

tx for pseudogout

A

NSAIDs, consider adding colchicine
intra-articular cortisone if infeciton ruled out
w/ extensive chondrocalcinosis can do arthroscopy

61
Q

what can Hydroxychloroquine cause?

A

visual loss risk

62
Q

what can sulfasalazine cause?

A

myelosuppression, rash

63
Q

what can corticosteroid cause?

A

DM, osteoporosis, infection

64
Q

what can MTX cause?

A

BM suppression, liver fibrosis, teratogenic

65
Q

what can gold cause?

A

myelosuppression, diarrhea, rash

66
Q

what can cyclosporin cause?

A

edema, renal, THN

67
Q

what can azathiprine, cyclophosphamide, chlorambucil and D-penicillamine cause?

A

myelosupression

68
Q

IF a joint is swollen, red, hot, painful joint what should it be considered?

A

septic arthritis

69
Q

Spread of bacteremia, periarticular osteomyelitis, and infection

A

septic arthritis

70
Q

most common site of septic arthritis

A

knee

71
Q

most common pathogen for septic arthritis

A

Staph aureus

72
Q

gold standard for septic arthritis

A

synovial fluid analysis

73
Q

tx for septic arthritis

A 
surgery, can be done arthroscopically
IV abx (wait for ortho to start these)
74
Q

should you start abx on a patient w/ a septic joint?

A

No, need a culture first

75
Q

how long do patients need IV abx for after a septic arthritis?

A

6 weeks then oral abx for 7-10 days following iV

follow CRP and ESR rate

76
Q

what are other things that cause arthritis?

A 
acute rheumatic fever (group A strep)
viral- hep B, mumps, rubella
overlap w/ serum sickness, polyarticular gout, sarcoidosis, RA
disseminated gonoccocemia, rash
chronic- myobacteria, fungi
77
Q

what are the 2 main symptoms of disseminated gonococcal infection

A

migratory polyarthralgia

tenosynovitis

**Old DOOS (11 decks)

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