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#DOOS MSK > Arthritis > Flashcards

Arthritis Flashcards

1
Q

_______ is the most common arthropathy in adults

A

Osteoarthritis

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2
Q

Osteoarthritis results in the destruction of __________, the cardinal features of __________ loss and remodeling of ____________.

A

destruction of bone causing pain
articular cartilage loss
and remodeling of subchondral bone

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3
Q

Primary OA is ________; usually results from a combination of ________ and _______

A

idiopathic

results from suceptibility(risk factors(age,race)) and joint loading

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4
Q

Secondary OA results from _________, ________, or _________

A

joint injury, congenital inflamm, or joint instability

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5
Q

*OA presents with Decreased _______, _________, and _______ that worsens ______

A

decreased ROM
crepitus
and pain that worsens throughout the day/with use

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6
Q

OA can be seen in 5 joints

A 
DIP(herberden's nodes)
PIP (Bouchard's)
Hip
Knee
and spine
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7
Q

*with OA ______, ________, and ________ are typically spared

A

MCP(except thumbs)
elbows
ankles

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8
Q

*With OA is pain more typical in the AM or PM?

A

PM, b/c worse with use

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9
Q

______ nodes are herberden’s nodes

____ nodes are Bouchard’s

A

DIP - Herb

PIP - Bouchard

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10
Q

*With OA _______ is the best evaluation tool

A

X-Ray

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11
Q

What is seen on XR with OA? (4)

A

joint space loss/assymt narrowing
subchondral sclerosis
bone cysts
osteophytes

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12
Q

With OA, what do you expect of the synovial fluid analysis? (5)

A

yellow color, 200-300 WBCs, 25% PMNs, negative culture, negative crystals
OVERALL LOOKS PRETTY NORMAL

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13
Q

Normal age of onset of OA is after _____yo

A

40yo

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14
Q

sx of OA include ______, _______, and ________

A

pain, stiffness, and gelling

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15
Q

OA is normally seen is ______joint(s)

A

one

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16
Q

what’s the prognosis for OA

A

slowly progressive

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17
Q

*What is the first line tx for OA

A

tylenol

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18
Q

what 3 reccomendations can help with OA pain

A

wt reduction, aerobic/resistance exercise, altering joint loading with PT bracing or a cane

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19
Q

what are the 4 alternative tx to 1st line in OA

A

NSAIDs -oral and topical
viscosupplement injection
intraarticular steroids (cortisone)
joint replacement (absolute last resort)

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20
Q

Avoid treating OA with _______, unless pain is refractory to other measures, then use _________

A 
narcotics
weak opioids (tramadol 10mg)
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21
Q

name the 5 alternative tx for arthritis

A

glucosamine chondrotin
acupuncture for the knee
prolotherapy - injection of nat subs to promote healing
Platelet rich plasma

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22
Q

Articular injections (such as lidocaine and steroids) are variable in relieving pain, but could be diagnostic for ___________

A

SI joint arthritis

-if injections relieves pain this is diagnostic for SI arthritis

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23
Q

viscosupplements usually require ______; pts feel relief after _____ injections; you can repeat the tx every _____ months

A

a series of injections
pts feel relief after 2-3 injections
repeat every 6 mo

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24
Q

_______ can be injected peri-articularly, though usually not covered by insurance

A

Platelet rich plasma

PRP

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25
Q

what is prolotheraphy? and 3 examples?

A

injection of any substance to promote growth of normal cells or fix CT laxity
growth factor, growth factor stimulation, dextrose (ASK THEM NOT TO TAKE NSAIDS)

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26
Q

platelets are normally ____% of plasma…. in PRP platelets are _____%

A

6%

94%

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27
Q

________ and _________ debridement(arthroscopy) is helpful to inc ROM and function.
It’s NOT efficacious for ______ and _______

A

shoulder and elbow

NOT for: hip and Knee

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28
Q

With joint arthroplasty pts are ___________ immeadiately to ward of ________ or _________

A 
weight bearing (WBAT)
ward of ROM dysfxn or clot
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29
Q

with artificial hips you are concerned about _________ or _________

A

fracture around the replacement

dislocation

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30
Q

what is RTSA

A

reverse replacement components (making the humerus the socket and the glenoid the ball)

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31
Q

RA stiffness is worse in the AM/PM?

A

AM

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32
Q

What is RA

A

autoimmune, chronic inflamm and errosive joint dz with synovitis affecting multiple joints(polyarticular) with other systemic effects

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33
Q

_____ is the most chronic inflamm arthritis

A

RA

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34
Q

females/males are affected by RA more freq

A

Females

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35
Q

RA does/does not run in families

A

does

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36
Q

common age of onset for RA

A

25-55yo

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37
Q

less than ___yo is considered juvenile RA

A

16

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38
Q

RA typically affects the small/large joints?
symmetrical/assym?
4 most common are?

A

small joints
symmetric
hands feet wrists ankle

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39
Q

RA CAN affect cervical spine, shoulders, elbows _______, and ________ but is uncommon

A

hips and knees

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40
Q

symptoms of RA are _________ and ________

A

persistent and progressive

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41
Q

what are the 6 cardinal symptoms of RA

A 
warm
tender
swollen
morning stiffness improved with moderate activity
possible synovitis 
and eventual deformity of the joint
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42
Q

what is a pannus

A

The synovial capsule (which can be hyperplastic in RA)

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43
Q

what’s the pathophys of RA

A

self reactive T cells activate B cells and macrophages drive the chronic inflamm response

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44
Q

osteoclast activation at the site of the pannus is related to….

A

focal bone erosion

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45
Q

RA will usually have accompanying _______ symptoms (list 5)

A

constitutional

fatigue, fever, wt loss, myalgia, and anemia

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46
Q

20-30% of RA pts also suffer from

A

osteoporosis

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47
Q

RA hand deformities (3)

A

ulnar deviation
swan neck (DIP flexed)
Boutonniere (DIP extended)

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48
Q

RA can result in complication in (3)

A

Lungs - Pulm effusion
Ocular- episcleritis
Skin - gramulomatous base ulcer

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49
Q

Xray findings on RA are…

A

typically only seen in late stages

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50
Q

Previously RA used to be a DDX of exclusion, now the pt must score ____ points on ACR guidelines

A

6 or more

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51
Q

Early RA can often be Dx by ______ and _______

A 
lab findings(anti-CCP)
and early joint involvement
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52
Q

_______ is the best lab to get for RA along with evidence of soft tissue swelling/acute flare ups

A

XR

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53
Q

_____ and ______ are typically elevated in RA

A

ESR and CRP

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54
Q

CBC of an RA pt can show

A

anemia of chronic dz

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55
Q

____ is positive in ~80% of RA pts and may be low in early RA

A

Rheumatoid Factor

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56
Q

*_________ is present in early dz and can be a marker for dz progression.

A

Anti-CCP

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57
Q

*______ and _____ is 99% specific for RA dx

A

Anti-CCP

RF

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58
Q

*What color is the synovial fluid in Inflammatory Processes (RA)
WBC?
PMN?
culture and crystals?

A

yellow or opalescent
3,000-5,0000
PMNs 25-50%
culture and crystals are negative

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59
Q

*What is seen on the pannus of RA?

A

focal errosions

60
Q

Compare Xray of OA vs RA

A

Both have a narrowing of the joint space
RA: sclerosis
OA: osteophytes, uneven edges, joint instability

61
Q

OA has thinned ________ and __________ happens as a result

A

cartilage

bone rubbing against each other

62
Q

RA has ________ errosion and the synovial membrane is _________________

A

focal errosion

synovial mem is swollen and inflammed

63
Q

What is the goal of RA medication therapy

A

reduce pain, preserve fxn, and prevent deformity

64
Q

what are the 3 types of medication we use for RA?

A

glucocorticoids, DMARDs, and Biologics

65
Q

Glucocoricoids can be injected intra-articularly to relieve RA pain, but what must you rule out first??

A

rule out septic joint!

66
Q

the DMARDs ___________ and ___________ combined with NSAIDs are good for mild sx of RA

A

hydroxychlorquine and sulfasalazine

67
Q

What’s the DMARD for moderate to severe RA sx

A

methotrexate

68
Q

What is the caution for using biologics for RA (3)?

A

increases risk of infection
reactivation of latent Tb
use with caution in hepatitis

69
Q

NSAIDs are used in RA to….

A

reduce pain and swelling (no fx on underlying dz)

70
Q

*Primary joints affected in RA

A

MCP and PIP

71
Q

*Primary joints affected OA

A

DIP and carpometacarpal

72
Q

*__________ nodes are present in OA but absent in RA

A

Heberden’s

73
Q

*what are the joint characteristics of RA vs OA

A

RA: warm soft tender
OA: hard and bony

74
Q

*Stiffness in RA vs OA

A

RA: worse after rest (am stiffness)
OA: worse after effort (pm stiffness)

75
Q

*In RA, RF is _______, anti-CCP is _______, and ESR and CRP are _________

A

+ RF
+ anti-CCP
ESR and CRP are elevated

76
Q

In OA, RF is ________, anti-CCP is ________, and ESR and CRP are ________.

A
  • RF
  • anti-CCP
    ESR and CRP are normal
77
Q

name the 5 spondyloarthritides

A 
Ankylosing Spondylitis
Reiter's syndrome
psoriatic arthritis
arthritis of inflammatory bowel dz 
undiff spondyloarthropathy
78
Q

what are the two cardinal clinical features of Ankylosing spondylitis (AS)

A 
SI inflamm(sacroilitis)
spinal inflammation (spondylitis)
(may also present with uveitis or conjunctivits)
79
Q

Symptoms of AS are most common in ____m/f, who are ___–____yo

A

Male

20-30yo

80
Q

AS is associated with HLA___

A

B27

81
Q

What is a syndesmophyte (AS)?

A

fusion of bone and CT

82
Q

advancement of AS results in… (4)

A

Loss of ROM (but with reduced pain, higher risk of fx)
loss of height
loss of chest expansion (inc risk for pneumonia/respiratory stress)
IBD

83
Q

Bamboo spine on Xray means…

A

ankylosing spondylitis (AS)

84
Q

what are the 3 tx for ankylosing spondylitis (AS)

A

PT -daily exercise, stretching
NSAIDs - relieve pain and stiffness
TNF-a blockers - improve fxn, slow damage

85
Q

What are the 3 TNF-a blockers, what do they do for AS?

A

infliximab, etanercept, adalimumab

reduce pain, improve fxn, slow progression/damage, and reduces attacks of uveitis

86
Q

*What is Psoriatic Arthritis (PsA) (cardinal clinical features)?

A

Inflam arthritis with psoriatic skin usually preceeding joint dz by months or years

87
Q

______ inflammed synovioum looks like RA, but will be negative for _____

A

PsA

seronegative for RF

88
Q

*PsA has symmetric arthritis in the hands and feet like ______; it also presents with 2 nail sx

A

like RA

nails are pitting and onycholysis (nail lifting/fx)

89
Q

PsA causes _________ finger features

A

sausage (caused by arthritis and tenosynovitis of flexor tendons)

90
Q

Pencil-in-cup refers to what

A

Psoriatic arth, Dip looks like a cone holding a “pencil”

seen on xray and ossification of joint margins

91
Q

With PsA ESR and CRP are ______, CBC shows _______, RF and ANA often ________.

A

elevated
CBC show normochromic, normocytic anemia
RF and ANA freq negative

92
Q

What is seen on Xray of PsA spine

A

asymmetric sacroilitis

93
Q

what are the 5 criteria that are used to dx PsA? (pt must have 3/5 minimum)

A 
evidence of psoriasis
psoriatic nail dystrophy
negative RF
dactylitis (inflam of entire digit)
radiologic evidence of juxtarticular new bone formation (ill defined ossicifcation near joint margins)
94
Q

what are the 4 tx for PsA

A

NSAIDs for mild
Methotrexate (skin, inflam, and improves fxn)
TNF-a blockers
reconstructive surgery may be needed for end stage dz

95
Q

PsA pts should not be taking ________(med)

A

corticosteroids

96
Q

what’s the idiom for reiter’s syndrome AKA reactive arthritis? (ReA)

A

Can’t see, Can’t Pee, Can’t climb a tree

97
Q

ReA is a seronegative arthritis with a tetrad of…

A

urethritis
conjunctivitis
oligoarthritis
and mucolsal ulcers (palms and soles affected as well)

98
Q

ReA typically happens after __________ or _________

A

STDs (ureaplasma or chlamydia) - this route mainly seen in men (18-40)

gastroenteritis (shigella, salmonella, yersina, or campylobacter)

99
Q

ReA is typically (sym/asym?), affecting the large joints of the (UE/LE?)

A

asym

LE

100
Q

Mucosal ulcers of ReA typically present as ______ or _______

A

balantitis

stomatitis

101
Q

what is enthesopathy? (ReA)

A

pain and inflam around the joint

102
Q

Though ReA typically affects the LE, _____ can also occur

A

digititis

103
Q

how long does arthritis of ReA persist

A

3-5 mo

104
Q

small pus filled vesicles that turn into small red/brown lesions found on the palms (keratoderma blennorrhagica) should make you think of….

A

ReA

105
Q

With ReA, ESR and CRP are ______; Associated with what genetic predisposition?

A

elevated

HLA-B27 (30-80%)

106
Q

Would you take a synovial fluid sample in suspected ReA? Why?

A

yes, r/o sepsis and rule in specific STD

107
Q

what are the 3 tx for reiter’s syndrome?

A

indomethacin (NSAID)
intra-articular steroid injection
Abx to fight STD (does NOT alleviate the arthritis)

108
Q

**_______ arthritis and _________ arthritis both affect younger people more commonly and occur abruptly. Which affects females more? which affects males more?

A

reiters syndrome/reactive arthritis (males) -palms and soles

gonnococcal arthritis (Females)

109
Q

_______ and _______ arthritis typically affect those of middle age and occur insidiously.

A

RA

psoriatic arthritis

110
Q

Gout is a systemic dz that results from altered metabolism of ________ that results in precipitation of ________ in joints

A

purines

sodium urate crystals

111
Q

Gout affects _________ much more frequently.

A

men(9:1) (however the ratio equalizes after menopause)

112
Q

________ is the main stimulus for over production of uric acid and gout (_____ is also a culprit)

A

alcohol

red meat

113
Q

what are the 3 cardinal features of gout

A

rapid onset of severe pain
erythema
and swelling of the affected joint

114
Q

with gout the _____ joint is most common and this is called a _______

A

MTP of big toe (feet, ankles, knees, elbows also affected)

podagra

115
Q

what 2 skin changes can be seen with gout

A

tophi (seen in chronic) - chalky deposits of urate crystals

cellulitis

116
Q

45 yo man woke up in the middle of the night with an exquisetly painful joint (even the sheet on the joint hurts). He drank a 24 pack over the weekend and has a Hx of HTN, poor diet, and is overweight. dx?

A

gout

117
Q

*what is the gold standard dx test for gout?

A

synovial fluid analysis (will show monosodium urate crystals)

118
Q

Serum uric acid of ____ is suggestive of gout but not diagnostic.

A

6.8 or greater

119
Q

gout synovial fluid appear __________ in color, has a ____(+/-) culture and has _______% PMNs

A

cloudy to yellow
negative culture
25-50% PMNs

120
Q

Gout onset is typically

A

acute, abrupt (not insidious)

121
Q

____ may be a helpful scan for gout, but ____ and ______ not indicated for gout

A

XR(may show errosions or tophi(CAUTION, errosions could be d/t chronic dz))
CT/MR

122
Q

gout can present in what upper extremity joint?

A

elbow - olecrenon bursitis

123
Q

what 2 NSAIDs are used for acute gout

A

indomethacin or indocin

124
Q

________ can be used for acute gout but only within the 1st 24 hrs!

A

colchicine

125
Q

If infection is r/o with gout _____ or _______ may be used as tx; cold packs, rest, and elevation are also helpful

A

cortisone injection

oral prednisone

126
Q

what 3 agents are used for long term main’t of gout

A

colchicine
Probenecid
allopuinol (caution pt, they could have an acute flare when initiating this med)

127
Q

pseudogout is also known as___________

A

calcium pyrophosphate dehyrate dz (CPPD)

128
Q

Pseudogout affects ________ joints and is usually ______articular (mono, poly, oligo, etc)

A

peripheral (knee and wrist) (may affect the pubic symph)

polyarticular

129
Q

what is seen in XR and synovial fluid analysis of pseudogout?

A

XR: chondrocalcinosis (fine line of calcifications in cartilage)
Synovium: calcium pyrophosphate crystals

130
Q

what are the 3 treatments for pseudogout

A

NSAIDs (mainstay)
colchicone for recurrent attacks
intrarticular cortisone injection (with infxn r/o only)

131
Q

*a red hot swollen joint points to…

A

SEPSIS (SEPTIC JOINT UNTIL PROVEN OTHERWISE)

esp in pts with recurrent infxn or recent surgery

132
Q

________ most commonly involves a single joint (freq the knee) and more common in IV drug users

A

septic arthritis

133
Q

*__________ is the most common pathogen in septic arth…. if pt is sexually active consider _______

A

S. aureus

N. gonorrhorea

134
Q

with septic arthritis, ROM is _______, and the pt may have fever

A

limited

135
Q

*__________ is the gold standard dx for septic arthritis

A

synovial fluid analysis

136
Q 
synovial fluid analysis of septic joint will show:
Color?
WBCs?
PMNs?
Culture?
crystals?
A 
yellow to green
>50,000 wbc
75% PMNs
Pos culture
no crystals
137
Q

why might you want to wait to tap a septic joint? whats the preferred tx?

A

specialist may want to do somethign different

surgery is tx, arthrotomy vs arthroscopy (IV abx)

138
Q

A joint presents with all sx of septic arth EXCEPT limited ROM with overlying cellulitis… what do you do?

A

Do NOT tap, you risk spreading infection to joint space

139
Q

what is osteomyelitis?

A

microbial infection of bone (d/t blood infxn, post surgery infxn, or vascular insuff/neuropathy)

140
Q

vertebral osteomyelitis aka _________, is usually caused by what microorg?

A

septic diskitis

S. Aureus

141
Q

*what is the gold standard dx in osteomyelitis?

A

MRI (or Xray)

142
Q

*If blood culture is negative but osteomyelitis is suspect, what do you need?

A

guided bone biopsy with culture

143
Q

Tx for spetic diskitis?

A

IV Abx (surgery if d/t implant infxn)

144
Q

osteomeylitis of long bones occurs mainly in who? when?

A

children

post surgery/trauma

145
Q

who does osteomyelitis of the foot occur in? (4)

A

diabetes (60-80% pts with foot wound), PAI, neuropathy, or post surgery

146
Q

osteomyelitis of the foot requires …

A

debridement, but unfortunately amputation may be the only option

#DOOS MSK (4 decks)

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