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MSK/Rheum > Arthritis > Flashcards

Arthritis Flashcards

1
Q

arthritis is defined as

A

swelling and pain of a joint

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2
Q

ddx of acute monoarthritis

A

trauma
infection
crystals

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3
Q

what is the most common form of arthritis?

A

osteoarthritis

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4
Q

what is the most prominent symptom of OA

A

pain

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5
Q

definition of OA

A

progressive destruction of the cartilage in the joint, which is accompanied by new bone formation

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6
Q

3 things to consider when making the diagnosis of RA

A

clinical picture (classical joints)
radiographic
normal laboratory tests (ESR, serologies, uric acid)

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7
Q

classical joints of OA

A

knees
hip
hands
spine

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8
Q

3 radiographic features of OA

A

joint space narrowing
osteophyte formation
bone sclerosis

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9
Q

which node is associated with OA on the DIP joint?

A

Heberden’s nodes

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10
Q

which node is associated with OA on the PIP joint

A

Bouchard’s nodes

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11
Q

what happens to the first CMC joint in OA

A

squared due to the osteophytes at that joint

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12
Q

swan neck deformity is associated with

A

RA

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13
Q

is RA symmetric or asymmetric?

A

symmetric

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14
Q

sausage toes are prominent in

A

psoriatic arthritis

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15
Q

onchodystrophy is associated with

A

psoriatic arthritis

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16
Q

what’s the greatest risk factor for OA progression

A

age > 60

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17
Q

bow-legged

A

varus

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18
Q

knock-kneed

A

valgus

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19
Q

treatment for mild-to-moderate pain OA

A

simple analgesics, topical creams

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20
Q

treatment for moderate-to-severe pain OA

A

COX2 selective inhibitors

NSAIDs + gastroprotection

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21
Q

increased risk of OA conferred by

A

obesity, prior injury, family history

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22
Q

how is obesity related to OA

A

may exacerbate OA via chronic inflammatory state

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23
Q

two sources of uric acid

A

dietary

cellular nucleotides and nucleoproteins

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24
Q

how much uric acid is excreted through the gut

A

⅓- not adjustable

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25
Q

how much uric acid is excreted through the kidneys

A

⅔- adjustable

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26
Q

what food increases the risk of gout

A

meat

fructose

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27
Q

what food decreases the risk of gout

A

dairy

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28
Q

what converts ribose-5-P to purines

A

PRPP synthase, which is inhibited by excess purines (ATP, ADP, AMP)

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29
Q

what converts xanthine to uric acid

A

xanthine oxidase

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30
Q

purine salvage enzyme

A

HGPR transferase

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31
Q

what converts uric acid to allantoic acid (that humans don’t have)

A

uricase

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32
Q

mechanisms of abnormal purine metabolism

A

increased production- PRPP synthase up

decreased salvage- HGPRT down

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33
Q

increased cell (and purine) turnover conditions

A

myelo- and lymphoproliferative malignancies
hemolytic anemias
chemotherapy with tumor lysis

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34
Q

how much of urate is filtered in the glomerulus

A

100%

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35
Q

dysfunction of urate secreting transporters promotes

A

hyperuricemia

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36
Q

dysfunction of urate transporters (or inhibitors of them) promotes

A

urate excretion

37
Q

how much of urate is excreted

A

90% of filtered loads

38
Q

important urate transporters

A

URAT1

ABCG2

39
Q

2 conditions promoting uric acid retention

A

lactic acid and ketoacidosis

drugs

40
Q

drugs causing hyperuricemia

A 
alcohol
diuretics
ethambutol
pyrazinamide
nicotinic acid
salicylates
41
Q

serum urate concentration for a gouty attack

A

> 8.9 mg/dL

42
Q

how to crystals initiate inflammation

A

activation of complement and other serum factors

activation of synovial macrophages

43
Q

activation of synovial macrophages produces

A

IL1, TNF-alpha, IL8

44
Q

chemoattractants activate

A

integrins

45
Q

ICAMs upregulated and activated by

A

cytokines

46
Q

phagocytosis of crystals results in

A

degranulation, O2- generation

47
Q

what happens to ESR in gout

A

elevated

48
Q

what happens to WBC in gout

A

elevated

49
Q

what happens to uric acid levels in gout

A

may be elevated. but maybe not

50
Q

short, squat, positively birefringent crystal is likely to be

A

calcium pyrophosphate

51
Q

release of PPi from the chondrocyte

A

Ank transporter- releases PPi, binds with extracellular Ca++

52
Q

colchicine action

A

diminishes stimulated endothelial adhesiveness for leukocytes

53
Q

anakinra

A

IL1 receptor antagonist

54
Q

rilonacept

A

IL1 trap

55
Q

canakinumab

A

anti-IL1 Ig

56
Q

drugs that block urate production

A

allopurinol, febuxostat

57
Q

drugs that promote urate excretion

A

probenecid, lesinurad

58
Q

drugs that prevent gout attacks

A

colchicine, NSAIDs, low-dose steroids

59
Q

allopurinol, febuxostat block

A

xanthine oxidase

60
Q

probenecid and lesinurad inhibit

A

URAT1

**only works if renal filtration is adequate

61
Q

pegloticase is used for treating

A

chronic tophaceous gout- reducing tophi

62
Q

chondrocalcinosis results from

A

calcium pyrophosphate deposition in cartilage

63
Q

peak age of RA onset

A

40-60 years

64
Q

MCP involvement in OA or RA

A

RA

65
Q

presentation of advanced RA

A

ulnar deviation
volar subluxation
interosseous wasting

66
Q

marginal erosions of the bone present in

A

RA

67
Q

RA effects on the eyes

A

scleritis

keratoconjunctivitis

68
Q

RA effects on the lungs

A

fibrosis, nodules, pleuritis, pleural effusions

69
Q

cardiovascular manifestations of RA

A

atherosclerosis
vasculitis
increased MI risk 2-3X

70
Q

1 cause of death in RA

A

CV related

71
Q

RA increases which hematologic malignancy

A

B-cell non-hodgkin’s lymphoma increased 2-3X

increased systemic inflammation

72
Q

RA susceptibility to which MHC gene

A

MHC II DRb1

73
Q

characteristic lab abnormalities of RA

A 
RF
anti-citrullinated protein antibody (ACPA, CCP)
elevated ESR
elevated CRP
anemia of chronic disease
74
Q

which RF’s do we usually test for

A

IgM-RF

75
Q

3 Ddx for RF

A

SLE
Hepatitis B, C
malignancies: lymphoma, plasma cell dyscriasis

76
Q

what accomplishes citrullination

A

PADI’s
higher specificity for RA
associated with progression and worse prognosis

77
Q

3 cytokines promoting damage to RA joints

A

TNF-alpha
IL1
IL6

78
Q

tofacitinib

A

selective inhibitor of janus kinases- modulates cytokines important in pathogenesis of RA

79
Q

HLA_B27 contributes to susceptibility to what

A

ankylosing spondylitis

80
Q

sacroiliitis is a hallmark of

A

ankylosing spondylitis

81
Q

chief complaint of AS

A

low back pain and morning stiffness

82
Q

acute anterior uveitis is a systemic feature of

A

AS

83
Q

IBD is a feature of

A

AS

84
Q

lung involvement in AS

A

pulmonary fibrosis

costovertebral joint fusion–> restrictive lung disease

85
Q

cardiac involvement in AS

A

valvular insufficiency and variable degrees of AV block in ~5% of patients

86
Q

what is used to treat spine symptoms in AS

A

TNF antagonists (etanercept)

87
Q

nail changes seen in

A

psoriatic arthritis

88
Q

achilles tendonitis seen in

A

psoriatic arthritis

MSK/Rheum (5 decks)

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