Arthritis Flashcards
what is the most common arthropathy among adults? the progressive loss of articular cartilage with reactive changes in the bone
Osteoarthritis
over the age of 55, who is more likely to have OA
females
can you have OA and RA?
Yes
what are clinical features of OA?
Decreased ROM
Crepitus
pain gradually worsening throughout the day
What is OA at the DIP called?
Heberden’s Nodes
What is OA at the PIP called?
Bouchard’s Nodes
What joints are typically spared from OA?
MCP (except thumb)
ankle
elbow
what are secondary causes of OA
joint injury
congenital
inflammatory
neurologic
what is the best evaluation tool for OA?
Xray
What are xray findigns consistent w/ OA?
joint space loss/ asymmetric narrowing
subchondral sclerosis
bone cysts
osteophytes
Is synovial fluid analysis helpful w/ OA?
only for overlapping disease
Tx for OA
moderate physical activity (Low- moderate) weight reduction NSAIDs (oral/topical) viscosupplementation Injections (FDA- knee only) intra-articular steroids (cortisone) Bracing PT Joint Replacement
what are articular corticosteroid injections good for?
pain/inflammation
variable period of relief
diagnostic/ therapeutic benefit
what is arthroscopy helpful for?
shoulder/ elbow debridement
what do you do for abx preoperatively before joint arthroplasty?
cefazolin (1 gm if less than 80 kigs, 2 gram if more) and repeated for 2 doses postoperatively
before subsequent procedures, what do joint arthroplasty patients need?
prophylactic abx
Chronic disease with synovitis affecting multiple joints and with other systemic extra-articular manifestations
Rheumatoid arthritis
common age of onset for RA
40-60
when is juvenile RA usually diagnosed
<16
what causes erosion of the cartilage, subchondral bone, articular capsule, tendon, and ligaments in RA?
Hyperplastic synovial tissue (pannus)
There are more _________ in RA than OA in the synovial fluid
neutrophils
is RA usually polyarticular or monoarticular?
polyarticular
the _____ of the hand are typically spared in RA, but not in OA.
DIP
what is a notable pulmonary complication of RA
pleural effusions
what is a notable ocular finding of RA?
episcleritis (patch of intense injection w/o scleral edema)
What is a notable skin complication of RA?
skin ulcerations
RA can’t be diagnosed until symptoms are present for at least ____ consecutive weeks.
6
____ with RA are positive early but _____ findings are typically late.
Lab
x-ray
what are the diagnostic criteria for RA
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
lab findings for RA
anemia of chronic disease
eosinophilia
ESR and CRP (elevated)
rheumatoid factor (RF) and anti-CCP antibodies
is synovial fluid analysis more helpful in OA or RA
RA
what is the best imaging for RA
Xray
soft tissue swelling, w/ acute flare-ups
tx fro RA
refer to rheumatology
consider PT/OT
may require ortho referral for joint reconstruction
pharm tx is long term
what is the frequently prescribed Rx for RA?
methotrexate
what is usually used for RA tx
combination w/ DMARD’s, biologics, and NSAIDs
Inflammatory arthritis with skin involvement usually preceding joint disease by months to years. Symmetric arthritis resembling RA that may involve the hands and feet
psoriatic arthritis
significant findings in psoriatic arthritis
pitting of nails and oncholysis
sausage-finger appearance
Labs with psoriatric arthritis
ESR elevated
CBC_ normocytic normochromic anemia
RF is normal
when you se “pencil in cup” what should you think?
Psoriatric arthritis (see in middle to distal phalanyx)
Tx for psoriatric arthritis
NSIADs (mild cases)
methotrexate
what should be avoided w/ psoriatric arthritis
corticosteroids (already getting a lot for skin)
antimalarials
Seronegative arthritis with a tetrad of: Urethritis Conjunctivitis Oligoarthrits Mucosal Ulcers
Reiter’s Syndrome (reactive arthritis)
when does reiter’s syndrome usually manifest?
after an STD
where does reiter’s usually affect
asymmetric, large joints mucocutaneous lesions (balanitis, stomatitis)
what is the leading cause of non-traumatic monoarthritis?
reiter’s syndrome
lab tests for reiter’s syndrome?
HLA B27
synovial culture is negative
Tx for Reiter’s
NSAIDs + PT
abx if they have an infection
Systemic Disease of altered purine metabolism leading to sodium urate crystal precipitation into synovial fluid
Gout
what is the initial gout attack of the 1st MTP joint?
podagra
what should you think you have if a joint is painful, swelling, redness, and exquisite.
septic joint and gout
chalky deposits of urate crystals adjacent to the joint
tophi
do you get a crystal analysis when you just send fluid to the lab?
no, must order it separately
Gout will also have what elevated?
ESR and CRP
Tx for gout
indomentacin
cochicine
what are prevention drugs for gout
allopurinol
probenicid
sulfapyrazone
febuxostat
if infection is ruled out with gout what tx can you consider
cortisone injections
calcium pyrophosphate dehydrate disease (CPPD)
affects peripheral joints, recurrent and abrupt onset of attacks
pseudogout
what crystals will you see on pseudogout aspiration?
calcium pyrophosphate crystals
On Xray what will you see w/ pseudogout?
chondrocalcinosis- fine linear calcifications in cartilage
tx for pseudogout
NSAIDs, consider adding colchicine
intra-articular cortisone if infeciton ruled out
w/ extensive chondrocalcinosis can do arthroscopy
what can Hydroxychloroquine cause?
visual loss risk
what can sulfasalazine cause?
myelosuppression, rash
what can corticosteroid cause?
DM, osteoporosis, infection
what can MTX cause?
BM suppression, liver fibrosis, teratogenic
what can gold cause?
myelosuppression, diarrhea, rash
what can cyclosporin cause?
edema, renal, THN
what can azathiprine, cyclophosphamide, chlorambucil and D-penicillamine cause?
myelosupression
IF a joint is swollen, red, hot, painful joint what should it be considered?
septic arthritis
Spread of bacteremia, periarticular osteomyelitis, and infection
septic arthritis
most common site of septic arthritis
knee
most common pathogen for septic arthritis
Staph aureus
gold standard for septic arthritis
synovial fluid analysis
tx for septic arthritis
surgery, can be done arthroscopically IV abx (wait for ortho to start these)
should you start abx on a patient w/ a septic joint?
No, need a culture first
how long do patients need IV abx for after a septic arthritis?
6 weeks then oral abx for 7-10 days following iV
follow CRP and ESR rate
what are other things that cause arthritis?
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
what are the 2 main symptoms of disseminated gonococcal infection
migratory polyarthralgia
tenosynovitis
