arthritis Flashcards
caused by joint wear and tear → destroys articular cartilage
osteoarthritis
joint findings:
osteophytes - bone spurs caused by bone-on-bone
eburnation - polished, ivory-like appearance caused by bone-on-bone
heberden nodes (DIP)
bouchard nodes (PIP)
osteoarthritis
heberden nodes
DIP in osteoarthritis
bouchard nodes
PIP (prOximal = bOuchard) in osteoarthritis
common locations of osteoarthritis
fingers weight bearing areas (especially in obese): knees hips spine
risk factors for osteoarthritis
age - wear to articular cartilage
obesity
trauma.joint deformity - misaligned joint
pain in weight bearing joints AFTER USE/END OF DAY
improves with rest
osteoarthritis
localized, noninflammatory joint disease with no systemic symptoms
osteoarthritis
treatment of osteoarthritis
1) acetaminophen - scheduled
2) NSAIDs
3) intraarticular glucocorticoid - temporary relief (knee)
4) hyaluronic acid - in synovial fluid
5) opioids - relieve pain only
6) knee/hip replacement if can’t walk (obese)
joint space narrowing - no cartilage on xray
osteoarthritis
systemic, autoimmune joint disease involving inflammatory destruction of the synovial joints
rheumatoid arthritis
joint disease that is a type III hypersensitivity reaction
rheumatoid arthritis
autoantibodies bind to soluble antigen in blood → form immune complexes →IC deposit in tissue
female with: pannus formation of MCP + PIP (no DIP) subq rheumatoid nodules ulnar deviation of fingers at PIP subluxation Baker cyst in popliteal fossa (synovial cyst behind knee)
rheumatoid arthritis
rheumatoid factor
IgM against IgG (anti-IgG antibody)
high FP for RA (low specificity)
if positive RF → do ACPA (anti-citrullinated peptide antibody, more specific, confirms RA)
MORNING STIFFNESS >30 min
improves with use
symmetric joints + systemic symptoms (fever, fatigue, pleuritic effusion, pericarditis)
rheumatoid arthritis
swan neck deformity
advanced rheumatoid arthritis sign (opposite of Boutonneire)
extension of PIP
flexion of DIP
Boutonniere deformity
advanced rheumatoid arthritis sign
extensor tendon on back of finger splits so PIP pokes through
flexion of PIP
extension of DIP
treatment for acute exacerbation of rheumatoid arthritis
NSAID
cox-2 inhibitor
short course of steroids
long-term treatment for rheumatoid arthritis (disease modifying anti-rheumatic drugs = DMARDs)
longer you wait - more irreversible damage
low dose MTX
hydrochloroquine
sulfasalazine
TNFα inhibitor: etanercept, infliximab, adalimumab, golimumab, certolizumab
precipitation of monosodium urate crystals
gout
precipitation of calcium pyrophosphte crystals
Pseudogout (calcium Pyrophosphate crystals)
is hyperuricemia required for the diagnosis of gout
NO
can have gout without hyperuricemia or
hyperuricemia without gout
acute inflammatory monoarthritis caused by monosodium urate crystals in joints
gout
crystals are
needle shaped
negative birefingent under polarized light (yellow under parallel light, blue under perpendicular)
gout (yeLLow = paraLLel)
conditions that cause underexcretion of uric acid → hyperuricemia → gout (most common cause)
usually idiopathic
loops or thiazide diuretics
drugs that can cause gout
loop or thiazide diuretics
conditions that can cause overproduction of uric acid → hyperuricemia → gout
purine-rich foods
Lesch Nyhan syndrome
treating leukemia, lymphoma: ↑ cell turnover (tumor lysis syndrome)
asymmetric joint distribution, monoarthritis (one joint at a time)
cyclical attacks - comes and goes
swollen, red, painful joint
PODAGRA: painful MTP joint of big toe
TOPHI formation: nonpainful, uric crystals in external ear (most common), olecranon bursa, achilles tendon
gout
arthritis that occurs after big meal or alcohol consumption
gout
alcohol metabolites compete for same excretion sites in kidney as uric acid →↓ uric acid excretion → hyperuricemia
treatment of acute gout attacks
1) NSAIDs (indomethacin) - DOC
2) colchicine
3) prednisone for 4-5 days
chronic treatment for gout (>1-2 attacks/year, control uric acid levels to prevent future attacks)
1) allopurinol - inhibit XO - DOC
2) probenecid
3) febuxostat - same MOA as allopurinol
crystals are
rhomboid
weakly positively birefringent (blue under parallel light, yellow to perpendicular light)
pseudogout
Positively birefringent + calcium Pyrophosphate crystals = Pseudogout
arthritis with chondrocalcinosis (calcification of articular cartilage - esp menisci) on xray
pseudogout
arthritis involving large joints (knee usually)
>50 yo
pseudogout
treatment of pseudogout
same as gout:
sudden, severe attack: NSAIDs
steroids: prednisone
colchicine
what are the seronegative spondyloarthropathies
PAIR Psoriatic arthritis Ankylosing spondylitis Inflammatory bowel disease spondylitis Reactive arthritis (reiter syndrome)
syndrome that causes:
conjuncitivitis (or uveitis): pink eye
urtethritis (dysuria)
arthritis
reactive arthritis (reiter syndrome) Can't see, can't pee, can't climb a tree
arthritis of spine with negative rheumatoid factor (no anti-IgG antibody) common in male with HLA-B27 (codes for HLA MHC class I)
seronegative spondyloarthropathies
asymmetric + patchy, inflammatory arthritis (sometimes symmetrical) involving DIP joints, spine, SI joint
dactylitis (“sausage fingers”, inflammed finger)
psoriatic arthritis
may have psoriasis (asymmetric, patchy skin condition) without arthritis, both (1/3 psoriatic patients), or only psoriatic arthritis
“pencil-in-cup” deformity on xray
psoriatic arthritis
chronic inflammatory disease of spine + SI joints →
ankylosis (stiff spine due to fusion of SI joints, intervertebral discss, and/or facet joints) + uveitis (vascular layer of eye) + aortic regurgitation/conduction abnormalities/PVD/CHF
ankylosing spondylitis
bamboo spine on xray
ankylosing spondylitis
calcification of bone outlining intervertebral discs
↓spine mobility (including SI joint) beginning in 20-30 yo
improves with exercise
ankylosing spondylitis
arthritis associated with IBD
IBD spondylitis
chron’s/UC
may have ankylosing spondylitis or peripheral arthritis
arthritis after infection with:
chlamydia
GI infection: shigella (most common), salmonella, yersinia, campylobacter, clostridium)
reactive arthritis (reiter syndrome)
STD that can cause a migratory arthritis with asymmetric pattern (a type of septic arthritis)
Neisseria gonorrhoeae (can cause osteomyelitis too) called gonococcal arthritis STD Synovitis (knee) Tenosynovitis (hand) dermatitis (pustules)
young sexually active patient with red, swollen, painful knee
Gonoococcal arthritis (N. gonorrhoeae)
diagnosis of septic arthritis requires
arthrocentesis: ↑WBC, bacteria
treatment of septic arthritis
IV antibiotics + surgery to clean out otherwise destructive
organisms that can cause septic arthritis
S. aureus
Streptococcus
N. gonorrhoeae
treatment of seronegative spondyloarthropathies
NSAID
steroids
DMARDs (also used in RA)
TNFα inhibitors (also used in RA)
arthritis begins
juvenile idiopathic arthritis
type of juvenile idiopathic arthritis characterized by:
severe symmetrical arthritis + dactylitis (inflammation of fingers)
polyarticular juvenile idiopathic arthritis
type of juvenile idiopathic arthritis characterized by:
large joint involvement (doesn’t start in hips)
20-25% have uveitis
pauciarticular (few joints) juvenile idiopathic arthritis
type of juvenile idiopathic arthritis characterized by:
begins with systemic sx (fever, rash, ↑WBC, anemia, heaptosplenomegaly, LAD) - looks like leukemia/lymphoma
arthritis presents later
systemic onset juvenile idiopathic arthritis (still’s disease)
