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Ortho > Arthritis > Flashcards

Arthritis Flashcards

1
Q

Definition

A

Inflammation of > 1 joints

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2
Q

Types

A
  1. Osteoarthritis (OA)- most common also known as degenerative jt dz
  2. Rheumatoid arthritis (RA)- autoimmune disease
  3. Psoriatic arthritis- autoimmune disease
  4. Septic arthritis- infectious process
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3
Q

Pathophysiology of OA

A

Joint cartilage deteriorates w/ aging (loss of articular cartilage)

Progressive loss of cartilage and bony overgrowth (osteophytes)

Bone cysts may form

Inflammation around articular surface of joint (decrease amount of hyaluronic acid in joint)

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4
Q

Risk factors for OA

A

Age - #1 risk factor

F>M
increase BMI
Joint injury/trauma
Contact sports 
Certain occupations
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5
Q

2 common Signs and Sxs of OA

A
  1. Joint Pain
    Worsens with activity or weight bearing (WB)
    Relieved with rest
  2. Joint Stiffness
    Morning joint stiffness < 30 minutes, becomes less stiff w/ movement
    (RA stiffness greater than 30 mins)
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6
Q

other signs of OA

A

Joint crepitus
↓ ROM
Usually onset is insidious
Commonly affects wrist, hand, hip, knee, back

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7
Q

Herberden’s Nodes

A

OA

DIP joint swelling

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8
Q

Bouchard’s nodes

A

OA
PIP joint swelling

Bouchard is a PImP

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9
Q

OA diagnostics

A

WEIGHT BEARING X-ray while standing (AP/Lateral/Merchant)

  1. Asymmetrical joint space narrowing
  2. Subchondral sclerosis (Shows up as white)
    increase bone formation (density) of articular bone
  3. Bone cysts
  4. Bone spurs (osteophytes)
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10
Q

Lab findings for OA

A

Synovial fluid is NON-inflammatory

Color: clear to straw-colored
Clarity: transparent
<25%
Culture of fluid- negative

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11
Q

OA treatment

A
  1. Weight loss
  2. Low impact physical activity
  3. Pain control
    Acetaminophen - first line
    NSAIDs (Aleve, naproxen BID), intra-articular cortisone (steroid) injection into joint
  4. Physical Therapy
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12
Q

RA

A

Chronic symmetric, inflammatory, peripheral polyarthritis of unknown etiology (autoimmune dz that 1st targets synovium)

Major manifestation- synovitis of multiple joints

Systemic extra-articular involvement (late in disease)- skin, eyes, vascular systems

Juvenile form (JRA) <16 yrs age

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13
Q

Signs and Sxs of RA

A
  1. Morning stiffness >30 minutes (greater than 30 mins)
    Very stiff and lasts > 1 hr after waking
    Pain and stiffness gets better w/ mobility and as day progresses (gets better w/ movement)
  2. Symmetrical polyarthritis, most commonly affecting small joints hands & feet
    Wrists and MCP jts commonly involved
    DIP is spared
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14
Q

systemic manifestations of RA

A
  1. subcutaneous nodules over bony prominences
  2. ocular sxs - dry eyes, scleritis (inflammation of whites of eyes)
  3. vasculitis, pulmonary fibrosis
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15
Q

deformities common w/ progression of RA

A
  1. Boutonniere deformity – flexion of PIP and extension of DIP
  2. Swan neck deformity – flexion of DIP and extension of PIP
  3. ulnar deviated fingers
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16
Q

RA diagnostics Labs general

A
  1. CBC w/diff
  2. Erythrocyte sedimentation rate (ESR)
    Most of time will be elevated
  3. C-reactive protein (CRP)
    Most of time will be elevated
  4. Antinuclear antibody (ANA)
    Auto antibodies body produces
    can be elevated in up to 1/3 of RA pts
    Not diagnostic , also elevated in Lupus, normal healthy people can have elevated ANA 5% of time and it wont mean anything
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17
Q

what 2 labs are specific for RA

A
  1. Rheumatoid factor (RF )
  2. Anti-cyclic citrullinated peptide antibodies (anti-CCP)
    Positive in 70-80% pts w/ RA
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18
Q

X-ray for RA would show what

A

STS
joint space narrowing
MCP, MTP and or PIP involvement

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19
Q

how would you describe the synovial fluid in RA

A

Inflammatory

Color: straw to milky

> 2000-7500 WBC/mcl

PMNs 50% or more

negative string test

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20
Q

Objectives of RA tx

A

decrease inflammation and pain
prevent disease progression
preserve function/ROM
prevent deformities

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21
Q

First line for RA to prevent disease progression

A

Methotrexate (Rheumatrex)

1st synthetic DMARD
First Line for RA to retard or halt disease process

Folate analog
Inhibits dihydrofolate reductase, therefore inhibits DNA synthesis

In RA, principle moa is inhibiting neutrophils

Tetratogenic

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22
Q

second line synthetic DMARD for RA

A

Sulfasalazine (Azulfidine)- second line for RA

Suppress T-cell or B-cell activation (etiology unknown)

Side effects (n/v/ha/ skin rashes/leukopenia) 
causes about 30% pts to d/c drug

Other DMARDS- azathioprine, cyclosporine, hydroxychloroquine (Plaquenil)

Give if child bearing age, or for IBD

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23
Q

2 common synthetic DMARDS for RA

A

MTX - first line to prevent progression

Sulfasalazine- second line for RA

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24
Q

Biologic DMARDS for RA treatment

A

usually prescribed w/ MTX

Etanercept (Enbrel)- SQ

Adalimumab (Humira)- SQ
Human monoclonal antibody-TNF inhibitor

Infliximab (Remicade)- IV
Monoclonal antibody
Potential SE - development of TB

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25
Q

NSAIDS for RA tx

A

provides symptomatic relief, but does not alter disease progression
used in conjunction w/ DMARDS

Indomethacin (inhibits prostaglandin production, COX 1 and COX 2)

Celecoxib (selective COX2 inhibitor)

26
Q

Corticosteroids for RA tx

A

Oral prednisone 5-10 mg daily

inhibit prostaglandin synthesis

Prolonged use can lead to:
Hyperglycemia, osteoporosis, poor wound healing

Can be used short-term while other DMARDs take effect

27
Q

Definition of psoriatic arthritis

A

Inflammatory arthritis w/ skin involvement

Psoriasis precedes onset of arthritis 80% of cases (up to 2 yrs)

28
Q

Signs and sxs of psoriatic arthritis

A

Symmetric polyarthritis (resembles RA)

  • “Sausage”digits (dactylitis) of fingers & toes (DIPs)*

Sacroliitis and spinal involvement common

Pitting of nails and onycholysis are common

29
Q

psoriatic arthritis labs

A

ESR and CRP

RF negative

HLA-B27 (gene marker associated with rheumatologic diseases, positive is PA, reactive arthritis and alkylosing spondylitis)

30
Q

psoriatic arthritis x-ray

A

SHARPENED PENCIL

irregular destruction of joint and bone

31
Q

Are DIP joints affected in PA? RA?

A

RA- DIP are spared

DIP are affected in PA and OA

32
Q

TX for psoriatic arthritis

A
  1. NSAIDS - mild case
  2. MTX
    drug of choice in pts who do not respond to NSAIDS
    improves cutaneous and arthritic manifestations
  3. TNF inhibitors (biologic DMARD)
    added if MTX not effective
33
Q

Septic Arthritis; General

A

usually single joint involved

bacteria spread by blood to joint

Most commonly knee, followed by hip, shoulder, ankle, wrist
Children less than 3 - hip MC

34
Q

what is the most common pathogen to spread septic arthritis

A

Staph aureus

35
Q

risk factors for septic arthritis

A

Previous joint damage
IV drug use
Immunocompromised pts

36
Q

signs and sxs for septic arthritis

A

acute swelling of joint (30mins-1hour)

fever

joint warmth

erythema

Tenderness (pain w. ROM)

37
Q

fluid analysis for septic arthritis

A

yellow- green

50,000-100,000 WBC!!!!

38
Q

septic arthritis diagnostic studies

A
  1. X-ray for STS
  2. Joint aspiration
    diagnostic
    Differentiates between inflammation & infection
    send for C&S
39
Q

TX for septic arthritis

A
  1. drain and start empiric abc
    *start broad spectrum ABX8
    cover staph, step, gram negative
  2. Hospitalization always necessary
  3. Ortho consult immediately
40
Q

2 types of arthritis that are inflammatory

A

RA

Psoriatic arthritis

41
Q

population of gonococcal arthritis

A

Usually occurs in otherwise healthy sexually active young adults, M or F

Most common in young women onset of menses

42
Q

signs and sxs of GC Arthritis

A
  1. Prodromal migratory polyarthralgias involving wrist, knee, ankle or elbow
  2. Joint pain occurs over 1-4 days (septic is more acute)

Fever
Abdominal pain
Dysuria

43
Q

two forms of GC arthritis

A
  1. Tenosynovitis (commonly wrists, fingers, ankles, or toes), skin rashes, polyarthralgia syndrome, fever, chills, generalized malaise
    Skin lesions
  2. Purulent monoarthritis w/o skin lesions (frequently knee, wrist, ankle or elbow)
    Affects one joints, no skin lesions
44
Q

Lab studies for GC arthritis

A
  1. Joint fluid aspirate
    Cultures
    Urethral, rectal, throat cultures & BC should be done on all pts suspected of GC arthritis
  2. Urinary NAAT for N. gonorrhea
  3. x-ray- sts if in joint
45
Q

GC Arthritis treatment

A
  1. Admission to hospital to confirm dx
  2. Joint aspiration to drain infected fluid
  3. IV Abx x 48-72 hrs, then change to IM Abx x 7-14 day course

3rd generation cephalosporin - Ceftriaxone IV, Cefixime PO

46
Q

Reactive Arthritis

A

Formerly Reiter’s Syndrome
infection in body, body is reacting and get arthritis

TRIAD - urethritis (usually first), conjunctivitis, oligoarthritis (last)

mouth ulcers

GU pathogens- chlamydia
GI - shigella

47
Q

signs and sxs for reactive arthritis

A
  1. Asymmetric sterile oligoarthritis (1-4 joints)
    Large WB joints
    Knee & ankle
  2. Dactylitis

Painful oral ulcers

Penile lesions

Ulcers on extremities, palms and soles
Plantar heel pain
Fever & weight loss common

48
Q

Reactive arthritis diagnostics

A

increase ESR, CRP, HLA- B27

clinical based on hx, sxs nand triad (back pain, few weeks ago have dysuria and GU sxs, ask about eyes)

49
Q

TX for reactive arthritis

A

Usually self-limited process (3-12 mos) but symptomatic tx needed

NSAIDs- Mainstay of treatment

If one joint, cortisone injection

if not responding to NSAIDS - sulfasalazine

50
Q

2 forms of crystal induced arthritis

A
  1. gout

2. pseudogout

51
Q

general info on gout

A

Metabolic disease marked by uric acid deposits causing painful arthritic joints

podagra - gout of big toe

Hyperuricemia results from:
1. Under-excretion problem
Most common

  1. Overproduction problem
52
Q

risk factors for gout

A
  1. M>F
  2. Family hx of gout
  3. Alcohol
    Beer

4.Medications
Diuretics (loop or thiazide)
Chemotherapy – release of uric acid
Niacin

  1. Diet – high protein, salmon, liver, red meat,
  2. Chronic kidney disease – not excreting as much uric acid as they should be
  3. Hypothyroidism
53
Q

signs and sxs of gout

A
  1. Sudden onset joint PAIN
    Frequently nocturnal
  2. 1st MTP jt (Podagra)
    Can affect knee, ankles & other toes also
  3. Localized erythema, swelling, warmth
    Dusky red, tense, warm skin over joint

+/- fever

Tophi may be found in chronic disease

*red, hot, swollen, painful big toe)

54
Q

lab diagnostics for gout

A
  1. serum uric acid > 6

* 2. monosodium urate crystals, needle-like negatively birefringent crystals*

55
Q

X-ray for gout later in disease will show:

A

“rat bite”
may be seen late in disease
Punched out erosions with an overhanging rim of cortical bone

56
Q

acute tx for gout

A
  1. NSAIDS
    indomethacin, celebrex
    contraindications: renal disease, allergy to NSAIDS, active PUD
  2. colchicine, second line after NSAIDS or if pts can’t take NSAIDS
57
Q

pseudogout general

A

Calcium pyrophosphate dihydrate (CPPD) deposition disease in fibro- and hyaline cartilage

Chondrocalcinosis of affected joints

Most common: knees and wrists

58
Q

risk factors for pseudogout

A

age > 60

OA

59
Q

signs and sxs for pseudogout

A

painful inflammation of a joint

+/- redness

60
Q

Dx studies for pseudogout

A

Calcium pyrophosphate crystals
Rhomboid-shaped positively birefringent

calcium pyrophosphate dihydrate (CPPD)

joint fluid

61
Q

x-ray of pseudogout

A

Fine linear calcifications in cartilage -chondrocalcinosis

incidental finding on xrays: does not always cause symptoms

calcified meniscus

62
Q

treatment of pseudo gout

A
  1. Treat underlying disease, (OA) if present
  2. NSAIDs – acute pain
    Indomethacin / Indocin
    Naproxen / Naprosyn
    Celebrex
  3. Intra-articular steroid injection
    when NSAIDs contraindicated

Ortho (5 decks)

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