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Arthritis Flashcards

1
Q

What is the definition of arthritis?

A

Inflammation of joints

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2
Q

What is the most frequent cause of disability in the US?

A

Arthritis

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3
Q

What fraction of the US is affected by arthritis?

A

Half of all adults

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4
Q

What are the three major types of joints?

A
  • Synarthroses
  • Amphiarthroses
  • Diarthroses
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5
Q

What are synarthroses? Are they moveable?

A

Skull sutures, which are immovable

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6
Q

What are amphiarthroses? Are they moveable?

A

Pubis symphysis, sacroiliac, and spine

Limited movement

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7
Q

What are diarthroses? Are they moveable?

A

Moveable joints

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8
Q

What are the moveable joints?

A

Diarthroses

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9
Q

What is the synovium? What is the role of this?

A
  • Single cell layer that lines the joint capsule

- Secretes thick viscous fluid

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10
Q

What is cortical bone?

A

Outer, denser layer of bone

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11
Q

What is trabecular bone?

A

Inner, highly vascularized bone

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12
Q

How is cortical bone arranged?

A

Along lines of stress

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13
Q

True or false: almost none of the labs that are available in rheumatology are 100% specific

A

True

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14
Q

What are the components of the history taking that are specifically important to rheumatic diseases? (5)

A
  • Location
  • Symmetry
  • Onset
  • Chronology
  • Inflammation and weakness
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15
Q

What is the difference in the affected areas of the hand with RA vs OA?

A

RA affects MCPs

OA affects DIPs

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16
Q

Which affects the PIPs: OA or RA?

A

Both

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17
Q

What is the difference between acute, subacute, and chronic in terms of rheumatological diseases?

A 
Acute = hours
Subacute = days
Chronic = weeks (6+ weeks)
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18
Q

What is the infectious diseases that causes RA-like symptoms in adults, but is self limited?

A

5th’s disease (parvovirus B19)

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19
Q

How common are fevers with rheumatologic diseases?

A

Common

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20
Q

What are four features that should be elicited with the joint exam on every joint?

A
  • Signs of inflammation
  • ROM
  • Deformities
  • Condition of surrounding structures
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21
Q

Why is acute monoarticular arthritis a red flag?

A

If a bacterial infection of the joint, can cause necrosis of the joint in a few days

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22
Q

Why are cranial symptoms in elderly patients with muscle pain a red flag?

A

Giant cell arteritis leading to blindness

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23
Q

Why is morning stiffness lasting over an hour in patients with back pain a red flag?

A

Suspicious for ankylosing spondylitis

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24
Q

What are the three major purposes of lab testing?

A
  • Screening
  • Confirming a dx
  • Monitoring treatment
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25
Q

What are the acute phase reactants? (6)

A 
ESR
CRP
Serum amyloid A
Ferritin
Fibrinogen
Haptoglobin
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26
Q

What is the general use of measuring acute phase reactants?

A

Reflect the intensity of inflammation (regardless of etiology)

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27
Q

What is the role of measuring acute phase reactants in rheumatic disease?

A

Sensitive, but very non-specific

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28
Q

What is the role of CRP in anemia?

A

Will be higher

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29
Q

What, generally, is an ESR? How is it performed?

A

The rate at which red blood cells sediment in a period of one hour.

To perform the test, anticoagulated blood was traditionally placed in an upright tube, known as a Westergren tube, and the rate at which the red blood cells fall was measured and reported in mm/h.

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30
Q

Which produces a much faster change with inflammation: CRP or ESR

A

CRP

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31
Q

True or false: you should never order both an ESR and CRP

A

False–should do together

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32
Q

What happens to ESR with age?

A

Elevates

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33
Q

Which gender usually has a higher sde rate?

34
Q

Which has a wider range of variance: CRP or ESR?

35
Q

What is anti-CCP?

A

Relatively specific (but not sensitive) factor for RA, but not as sensitive as RF

36
Q

What is rheumatoid factor?

A

IgM Antibody to the Fc portion of IgG molecule, that is present in 80% of RA pts

37
Q

What is the problem with testing for rheumatoid factor?

A

Many false positives

38
Q

True or false: rheumatoid factor levels correlate with disease activity

39
Q

True or false: rheumatoid factor alone can diagnose RA

40
Q

What is the infectious disease that often causes high levels of rheumatoid factor?

41
Q

What are some of the autoimmune diseases where RF will be falsely elevated?

A

Sjogren’s syndrome

SLE

42
Q

What is the autoantibody in MG? (pg 210 of FA)

A

Anti-ACh receptor

43
Q

What is the autoantibody in: Goodpasture syndrome?

44
Q

What is the autoantibody in: antiphospholipid syndrome?

A

Anti-cardiolipin

45
Q

What is the autoantibody in: CREST syndrome?

A

Anticentromere

46
Q

What is the autoantibody in: pemphigus vulgaris?

A

Anti-desmoglein

47
Q

What are the 3 autoantibodies in: SLE

A

Anti dsDNA
Anti-smith
ANA

48
Q

What is the autoantibody in: DM 1

A

Anti glutamate hydroxylase

49
Q

What is the autoantibody in: Bullous pemphigoid?

A

Anti-hemidesmosomes

50
Q

What is the autoantibody in: Drug induced lupus?

A

Antihistone

51
Q

What is the autoantibody in: Polymyositis and dermatomyositis?

A

Anti-Jo1
Anti-SRP
Anti Mi-2

52
Q

What is the autoantibody in: hashimoto’s thyroiditis

A

Antimicrosomal

Antithyroglobulin

53
Q

What is the autoantibody in: primary biliary cirrhosis

A

Antimitochondrial

54
Q

What is the autoantibody in: Scleroderma?

A

Anti-SCl-70 (anti topoisomerase I)

55
Q

What is the autoantibody in: autoimmune hepatitis

A

Anti-smooth muscle

56
Q

What is the autoantibody in: Sjogren’s syndrome?

A

Anti-SSA (Ro)

Anti-SSB (La)

57
Q

What is the autoantibody in: Grave’s disease

58
Q

What is the autoantibody in: mixed connective tissue disease?

A

Anti-U1 RNP

59
Q

What is the autoantibody in: Wegener’s granulomatosis

60
Q

What are the 2 autoantibodies in: Celiac disease?

A

IgA antiendomysial

IgA anti tissue transglutaminase

61
Q

What is the autoantibody in: microscopic polyangiitis and Churg-Strauss disease

62
Q

What is the one antibody that can actually track the course of an autoimmune disease?

A

Anti-dsDNA in SLE flares

63
Q

What is the problem with Anti ss-A and ss-B in pregnancy?

A

Can cross the placenta and cause complete heart block in the fetus

64
Q

What is the sensitivity of ANA in SLE?

65
Q

What is the role of ANA antibodies?

A

Is sensitive for autoimmune disease, but is not at all specific

66
Q

What is the general PPV of ANA for SLE?

67
Q

Centromere pattern of ANA suggests what syndrome?

68
Q

nucleolar pattern of ANA suggests what?

A

Systemic scleroderma

69
Q

What are the three major components of complement that are measured in autoimmune diseases?

70
Q

Which complement is depleted by the alternative pathway?

71
Q

Which complements are depleted by the classic pathway?

72
Q

What drug class makes uric acid levels go up?

73
Q

Are uric acid levels sensitive or specific for gout?

74
Q

True or false: high uric acid levels + joint pain = gout

A

False–many times this is not true

75
Q

What is the only way to confirm a diagnosis of gout?

A

Synovial fluid analysis

76
Q

What is the difference in crystals appearance between uric acid crystals in gout, and Calcium phosphate crystals in pseudogout?

A

CaPO4 are shorter, and blue

77
Q

What is the treatment for septic joint 2/2 staph?

A
  • Hospitalization
  • IV abx
  • Drainage
  • Ortho and infx dz consult
78
Q

Are there long term residual symptoms with 5th’s disease arthralgias?

79
Q

What is the treatment for arthralgias with 5th’s disease?

A

Symptomatic only–is self limited

80
Q

What is the treatment for OA?

A
  • Analgesics (NSAIDs)

- Total knee replacement (maybe)

81
Q

The treatment for SLE is largely dependent on what?

A

Internal organ involvement

82
Q

What are the drugs that are commonly used in treating SLE?

A
  • Hydroxychloroquine
  • Prednisone
  • Immunosuppressants

Specialty Medicine (36 decks)

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