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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
What are the acute phase reactants? (6)
``` ESR CRP Serum amyloid A Ferritin Fibrinogen Haptoglobin ```
26
What is the general use of measuring acute phase reactants?
Reflect the intensity of inflammation (regardless of etiology)
27
What is the role of measuring acute phase reactants in rheumatic disease?
Sensitive, but very non-specific
28
What is the role of CRP in anemia?
Will be higher
29
What, generally, is an ESR? How is it performed?
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.
30
Which produces a much faster change with inflammation: CRP or ESR
CRP
31
True or false: you should never order both an ESR and CRP
False--should do together
32
What happens to ESR with age?
Elevates
33
Which gender usually has a higher sde rate?
Women
34
Which has a wider range of variance: CRP or ESR?
CRP
35
What is anti-CCP?
Relatively specific (but not sensitive) factor for RA, but not as sensitive as RF
36
What is rheumatoid factor?
IgM Antibody to the Fc portion of IgG molecule, that is present in 80% of RA pts
37
What is the problem with testing for rheumatoid factor?
Many false positives
38
True or false: rheumatoid factor levels correlate with disease activity
False
39
True or false: rheumatoid factor alone can diagnose RA
False
40
What is the infectious disease that often causes high levels of rheumatoid factor?
Hep C
41
What are some of the autoimmune diseases where RF will be falsely elevated?
Sjogren's syndrome | SLE
42
What is the autoantibody in MG? (pg 210 of FA)
Anti-ACh receptor
43
What is the autoantibody in: Goodpasture syndrome?
Anti-BM
44
What is the autoantibody in: antiphospholipid syndrome?
Anti-cardiolipin
45
What is the autoantibody in: CREST syndrome?
Anticentromere
46
What is the autoantibody in: pemphigus vulgaris?
Anti-desmoglein
47
What are the 3 autoantibodies in: SLE
Anti dsDNA Anti-smith ANA
48
What is the autoantibody in: DM 1
Anti glutamate hydroxylase
49
What is the autoantibody in: Bullous pemphigoid?
Anti-hemidesmosomes
50
What is the autoantibody in: Drug induced lupus?
Antihistone
51
What is the autoantibody in: Polymyositis and dermatomyositis?
Anti-Jo1 Anti-SRP Anti Mi-2
52
What is the autoantibody in: hashimoto's thyroiditis
Antimicrosomal | Antithyroglobulin
53
What is the autoantibody in: primary biliary cirrhosis
Antimitochondrial
54
What is the autoantibody in: Scleroderma?
Anti-SCl-70 (anti topoisomerase I)
55
What is the autoantibody in: autoimmune hepatitis
Anti-smooth muscle
56
What is the autoantibody in: Sjogren's syndrome?
Anti-SSA (Ro) | Anti-SSB (La)
57
What is the autoantibody in: Grave's disease
Anti-TSH
58
What is the autoantibody in: mixed connective tissue disease?
Anti-U1 RNP
59
What is the autoantibody in: Wegener's granulomatosis
c-ANCA
60
What are the 2 autoantibodies in: Celiac disease?
IgA antiendomysial | IgA anti tissue transglutaminase
61
What is the autoantibody in: microscopic polyangiitis and Churg-Strauss disease
pANCA
62
What is the one antibody that can actually track the course of an autoimmune disease?
Anti-dsDNA in SLE flares
63
What is the problem with Anti ss-A and ss-B in pregnancy?
Can cross the placenta and cause complete heart block in the fetus
64
What is the sensitivity of ANA in SLE?
95%
65
What is the role of ANA antibodies?
Is sensitive for autoimmune disease, but is not at all specific
66
What is the general PPV of ANA for SLE?
Not good
67
Centromere pattern of ANA suggests what syndrome?
CREST
68
nucleolar pattern of ANA suggests what?
Systemic scleroderma
69
What are the three major components of complement that are measured in autoimmune diseases?
C3 C4 CH50
70
Which complement is depleted by the alternative pathway?
C3 only
71
Which complements are depleted by the classic pathway?
C3 C4 CH50
72
What drug class makes uric acid levels go up?
Diuretics
73
Are uric acid levels sensitive or specific for gout?
Neither
74
True or false: high uric acid levels + joint pain = gout
False--many times this is not true
75
What is the only way to confirm a diagnosis of gout?
Synovial fluid analysis
76
What is the difference in crystals appearance between uric acid crystals in gout, and Calcium phosphate crystals in pseudogout?
CaPO4 are shorter, and blue
77
What is the treatment for septic joint 2/2 staph?
- Hospitalization - IV abx - Drainage - Ortho and infx dz consult
78
Are there long term residual symptoms with 5th's disease arthralgias?
No
79
What is the treatment for arthralgias with 5th's disease?
Symptomatic only--is self limited
80
What is the treatment for OA?
- Analgesics (NSAIDs) | - Total knee replacement (maybe)
81
The treatment for SLE is largely dependent on what?
Internal organ involvement
82
What are the drugs that are commonly used in treating SLE?
- Hydroxychloroquine - Prednisone - Immunosuppressants

Specialty Medicine (36 decks)

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